Slips and falls are some of the most common causes of injuries at work. In the process, you might end with just a couple of bruises. In more severe cases, you may sustain a concussion or even break an arm or leg.
So, what happens if you, somehow, while performing your regular work duties, sustain an injury that would require an emergency appointment at the dentist’s office? Will you be able to get compensated for broken teeth, crown replacement, or other oral surgery? How do you prove this and what lies within the scope of your workers’ compensation insurance? Read on to find out more!
Can my workers’ compensation insurance cover emergency dentist procedures?
You might be posing the above question on a hypothetical or a very real level. For example, you have to cover the costs of new crowns after you were hit by a piece of equipment at a construction site.
That would be a clear-cut scenario, as you were working and as a result of an accident, you were injured, and you lost a tooth, it got chipped, or you injured your gums and roots. Keep in mind that, as per the California workers’ compensation system, you don’t have to prove the fault of your employer or anyone else in that situation. It would suffice that you show evidence that:
- you have injured your teeth or gums during your working hours or while you were performing work-related duties
- that your teeth or gums weren’t injured as a result of your misconduct, horseplay, or under the influence of alcohol or drugs
In the following cases a dental or gum procedure would be covered from your own pocket, rather than deducted from your workers’ comp benefits:
- any condition that is related to poor oral hygiene, such as cavities, plaque, or chronic gum inflammation
- any aesthetic issue, such as discoloration of enamel
- any complex dental or oral issue that has more than a single cause, such as replacing dentures or dental implant surgery
What should I do if my insurance company denies my dental injury claim?
Although your rights as an employee may be very well protected by the letter of the law, insurance companies can find creative ways to keep you away from the benefits you deserve. This is why it is crucial to file a strong case, especially when you are trying to claim benefits in a seemingly gray area, such as dental injuries.
When you file a work comp claim for a dental procedure, you should focus on showing evidence that the dental issue is directly caused by a work-related accident. If you sustained an injury during work hours and it was not a result of your own will, and you have lost a tooth or got it chipped in the process, you may qualify to receive benefits. Keep in mind that it is important to ask the people in your workplace to testify on your behalf. This way, you’ll be able to build a much stronger case.
In order to have the dental costs covered by workers comp, make sure to gather the following documents:
- A written statement from your selected dentist
- A signed witness testimony
- Medical records that will serve as evidence of a lack of prior dental issues
With the necessary evidence, you can boost your chances of receiving maximum compensation for the required dental procedures. The insurance carrier will definitely try to minimize it, but with the help of a seasoned workers’ compensation attorney, you can be on the safe side and focus on your recovery. Established firms will even refer you to a dependable dentist that will give you the necessary medical attention and document the injury with precision in care.