WorkCover dental treatment
In some instances, WorkCover will cover the cost of dental treatment needed by a person – provided that the dental treatment is related to a work related injury, illness or condition.
There are, however, some key things that a person wishing to claim dental treatment expenses from the WorkCover insurer should be aware of.
Table of Contents
Accepted WorkCover claim
In order to claim WorkCover dental expenses, you need to first have an accepted WorkCover claim.
The WorkCover insurer will not cover the cost of dental treatment expenses unless you have first completed and lodged the WorkCover claim form, gone through the claim processing period, and had that WorkCover claim accepted.
A doctor cannot lodge a WorkCover claim on your behalf. Nor can your employer.
You will need permission from the WorkCover insurer before obtaining treatment
Before undergoing dental treatment, you should see a dentist and ask the dentist to provide a treatment plan.
You do not need to obtain a referral from a medical practitioner to a dentist in order to obtain dental treatment.
Note: prior approval or permission is not required if you need emergency dental treatment relating to a work related injury or condition.
This treatment plan outlines the treatment the dental treatment that the dentist wants to perform.
It should also set out the costs for treatment.
As well as including relevant item codes as set out in the WorkSafe scheduled fees (more on this later).
Your dentist should then send a copy of this off to the WorkCover insurer.
Some dentists will also provide you with a copy of this treatment plan.
It is then up to the WorkCover insurer to review the treatment plan and make a determination as to whether they’ll pay for the proposed dental treatment, and if so, what they’ll pay for.
They may agree to pay for the entire proposed cost.
Or some of the cost. Or elect to not pay for any of the treatment.
Sometimes, the WorkCover insurer will ask a dentist for their opinion on the treatment plan before they make a decision.
This dentist will usually be one that is on the WorkSafe clinical panel.
The dentist will then usually provide their written opinion on the treatment plan, which will be sent to the insurer.
A copy of this is not usually provided to you, the injured worker.
The insurer will send you a letter advising as to what they’ll cover for the dental treatment.
Your dentist should also receive a copy of this letter.
At this point however, it would be a good idea to make contact with your dentist to discuss the correspondence from the insurer.
If the amount being claimed by your dentist differs from the amount the insurer is offering to pay, then you can discuss what your options are with the dentist.
In some instances, the dentist might consider altering their fees or changing the scope of work to ensure that you’re not out of pocket.
However sometimes a dentist won’t want to alter their fees and so then you’ll need to decide what to do.
Other things to keep in mind regarding dental treatment:
- The dentist that you elect to use for treatment should be registered as a dental treatment provider with WorkSafe. If they are not you can ask them to contact WorkSafe.
- If you fail to attend an appointment with a dentist, if there is a non attendance fee billed by the dentist the WorkCover insurer will not cover the cost of that fee.
- Likewise, if you cancel an appointment and there is a fee associated with the cancellation.
- WorkCover will not pay for telephone conversations or consultations to you and other parties.
WorkCover dental fee schedule
It’s important to note that when it comes to WorkCover medical like expenses, the Victorian WorkCover Authority have set fees that they will pay for different types of medical treatment.
Sometimes, there is a gap between the cost of a particular type of treatment and the amount that the WorkCover insurer will pay for that treatment.
This usually isn’t a big deal, because if you were just getting physiotherapy treatment, for example, there could be a $10 or $20 gap fee that you would need to cover.
But if you’re talking about undergoing dental treatment, depending upon what’s required by way of treatment there could be a gap of several thousands of dollars.
In some instances, WorkCover can pay more than the scheduled fee amounts for dental treatment.
Before proceeding with any dental treatment, you need to check;
a) What is your dentist proposing to bill you for the dental treatment
b) What is the WorkCover insurer agreeable to paying for that dental treatment
c) Whether there is a gap amount between (a) and (b)
Conclusion
WorkCover will in some instances cover the cost of dental treatment required by an injured worker as a result of a work related injury, illness or condition.
If you need emergency treatment, you do not need to obtain permission from the WorkCover insurer to obtain that treatment.
If your treatment is not emergency treatment, you will need to obtain permission from the WorkCover insurer before obtaining treatment.
Depending upon the dental work required, your dentist will be required to submit a treatment plan to the WorkCover insurer.
The WorkCover insurer will then decide whether to pay for the entire cost of treatment claimed, a partial cost or to reject payment of the treatment altogether.
It’s important to keep in mind that the WorkCover insurer will in most instances pay for dental treatment in accordance with set fees. However in certain instances they are able to pay above these fees.
