Workers' Compensation For Dental Injuries

About Workers' Comp Claims

• Dental work injuries are not commonly seen in the workplace.
• According to the U.S. Bureau of Labor Statistics, out of 900,000 work-related injuries in 2018, only 2,480 were mouth-related.
• In comparison, there were 77,660 head injuries and 142,230 back injuries reported.

Workers' Compensation Claim: New Patients Welcome!

If you have experienced a work-related injury or illness and require dental treatment due to a workplace accident, our dental office specializes in assisting patients and collaborating with workers' compensation insurance providers to aid you during this challenging period. To arrange your dental appointment promptly, please contact our office at 781-604-3999.

We are a dentist that accepts workers’ compensation cases and for patient we serve Woburn, Lexington, Wilmington, Burlington, Stoneham and Winchester and other surrounding areas.  If our doctors determine your problem is work-related, then we will fully support your workers’ compensation claim.  Our doctor provides written opinion and issues any needed work restrictions for our workers’ comp patients.

We are pleased to inform you that we are willing to operate under the workers' compensation fee schedule, which sets us apart from other practices. Our utmost priority is ensuring that you receive the necessary care promptly whenever you require it. Suffering from work-related injuries can be a hassle, or even worse. We comprehend the urgency of getting you back on track as quickly as possible. If you require dental treatment due to a work-related accident and you are looking for a workers compensation dentist near me, then please don't hesitate to contact our office today!

Are dental injuries covered by workers’ compensation?

If you sustain an injury to your mouth, jaw, or teeth while at work, it is crucial to promptly seek treatment from a dentist. A skilled dentist will assess the situation and determine whether routine dental care will suffice or if a specialist's expertise is necessary. Common types of tooth injuries include chips, fractures, dislocations, and avulsions.

The treatment required for such injuries varies depending on their nature and severity. It can range from a simple filling to a complete crown or root canal. In some cases, a knocked-out tooth can be successfully replanted, while other injuries may necessitate extractions, gum surgery, or implants. It is important to note that pre-existing dental conditions or infections can complicate the treatment of your dental injury. Depending on the specific injury, you may need to consult specialists such as periodontists, endodontists, or oral or maxillofacial surgeons.

Periodontists specialize in addressing complex issues related to the gums and the supporting bones of the teeth. Endodontists are skilled in treating injuries to the tooth's pulp and are particularly proficient in performing root canals. On the other hand, oral surgeons are better equipped to handle more extensive injuries to the mouth and jaw.

Temporomandibular Joint Disorder

TMJ, also known as temporomandibular joint disorder, is a medical condition characterized by pain and discomfort in the muscles and joints of the face, jaw, and neck. In severe cases, individuals may have trouble fully opening or closing their jaws, making simple tasks like biting and chewing excruciatingly painful and challenging.

While TMJ is not commonly associated with work-related injuries, it can occur as a result of a forceful impact or blow. Treatment options for TMJ range from basic dental procedures like the placement of bridges and crowns to more invasive measures such as arthroscopic surgery or joint replacement.

If you can provide evidence that your TMJ condition is a direct consequence of a workplace accident, it should be covered under most workers' compensation laws. However, due to the complexity of proving TMJ injuries, it may be beneficial to seek legal assistance to strengthen your case.

Understanding workers’ compensation dental claims

1. Determining the workers' compensation case - When patients come to the practice, there are various indicators to consider in order to ascertain if their issues are work-related. The initial paperwork for new patients, such as the American Dental Association (ADA) form, often includes inquiries about dental problems occurring at the workplace. In cases where dental injuries are caused by trauma, it is crucial to inquire about the circumstances leading to the teeth being knocked out or a tooth being chipped. For patients presenting with dental complaints unrelated to trauma, a clinical examination can be conducted to establish the cause and determine if it is indeed a work-related injury.

2. Seeking guidance at the beginning of the claim - There are services available to assist dentists right from the start of a workers' compensation claim. These services ensure that all necessary procedures are followed and facilitate prompt payment. If the dentist is not already part of a workers' compensation provider network, the service can help with the dentist's credentialing and initiate discussions with the workers' compensation payer to expedite the approval of the claim.
3. State-specific regulations for workers' compensation - Typically, patients will reside in the same state where the dental practice is located. However, there may be instances where a patient resides in a different state. In such cases, it is important to be aware that the prevailing guidelines and regulations will be those of the state where the patient lives and works.

4. The primary distinction between a workers' compensation claim and other treatment plans lies in the fact that workers' compensation solely covers clinical care for work-related injuries. Dentists are well aware that teeth serve three crucial functions: facilitating speech and eating, as well as supporting facial structure. In the event of a job-related injury compromising any of these capabilities, it becomes the responsibility of the employer or workers' compensation payer to restore the functionality to its pre-injury state, if feasible.

5. In the case of a workers' compensation injury resulting in a chipped tooth, a dentist would typically complete a treatment plan encompassing three cavities, periodontal disease, gingivitis, and the chipped tooth. However, for a workers' compensation injury, only the repair of the chipped tooth will be covered and considered compensable. It is worth noting that certain conditions, which may not typically be associated with workers' compensation, can actually be work-related or linked to the treatment of an on-the-job injury. When these conditions are connected to a workers' compensation injury, they become compensable and should be included in the treatment plan. For instance, TMJ disorder may arise from a workplace accident or be a result of post-traumatic stress. TMJ is one of the most intricate and costly dental-related claims, as it can impact other muscles, including those in the back, neck, and shoulders. Patients should be advised to avoid excessive jaw movements, particularly if they have experienced significant facial and dental trauma.

6. Dry mouth, also known as xerostomia, refers to a reduction or absence of saliva flow. Although not classified as a disease itself, it can serve as a symptom or side effect of various medical conditions or medications. The prolonged use of opioids or narcotics, which may be prescribed for a workers' compensation injury, is often associated with this condition.

7. When evaluating the initial injury, it is crucial to obtain a patient's complete medical history and conduct a thorough examination of the oral cavity to assess the saliva flow rate. Individuals experiencing dry mouth often encounter difficulties with eating, speaking, swallowing, and wearing dentures. Dry mouth can have a significant impact on overall health, affecting nutrition, dental health, and psychological well-being. If the initial cause of temporomandibular joint (TMJ) disorder or dry mouth is a work-related injury, then these conditions, along with any complications arising from them, are eligible for compensation.

8. Obtain approval for the clinical treatment—Once a comprehensive clinical treatment plan has been formulated and the dentist has distinguished between injury-related issues and pre existing conditions, the recommendations are submitted to the adjuster at the workers' compensation insurance company for authorization. If the dentist is part of a workers' compensation network, the clinical management team will assist the adjuster in understanding the dental services outlined in the plan.

Throughout this process, it is crucial to ensure that all necessary forms and documentation are completed and provided to adjusters and case managers promptly. This will facilitate the swift approval of the treatment plan, allowing for a smooth progression without unnecessary delays that could adversely affect the claim and the recovery of the injured worker.

While workers' compensation dental claims may initially appear challenging, adhering to these best practices will prove beneficial in effectively managing such claims. Experienced clinical partners can offer valuable insights from the outset of a claim and guide dentists on the most effective approach to handling these complex cases, ultimately yielding positive outcomes.