How to Get Workers' Compensation Benefits for Dental Injuries

When most people think of injuries that might occur in the workplace, they probably think of slip-and-fall accidents and repetitive stress injuries like carpal tunnel syndrome. But another possible source of workplace injuries—and claims for workers' compensation benefits—are dental injuries. While work-related dental injuries are less common than other injuries, they can be just as painful and debilitating, and they often require immediate medical attention.

Workers' compensation provides injured workers with benefits to cover medical expenses and lost wages, without regard to who was at fault for the injury. That means you can collect workers' compensation benefits without having to prove your employer did anything wrong. Each state has its own workers' compensation system, and maintains its own rules for eligibility and claims.

On-the-Job Dental Injuries

Any trauma to the head can result in dental injuries. They can occur at work as the result of an accident, such as a slip-and-fall, a car accident, or a falling object; or from intentional acts like assault. Most injuries result from impact with the mouth, such as falling and hitting one's face, or being hit in the face. Dental injuries occurring at work may include:

• chipped or broken teeth
• loosened teeth, or broken roots
• permanent loss of one or more teeth
• broken jaw; or
• temporomandibular joint (TMJ) disorders or other conditions affecting the jaw.

If you suffer one of these injuries at work, you'll likely have to see a dentist (or oral surgeon) for treatment. Workers' compensation benefits usually only cover treatment for the work-related injury, even if a dentist's services go further than that. If a dentist, while repairing a chipped tooth, also finds that the worker has periodontal disease and needs a root canal, workers' compensation will only pay for the chipped tooth repair. However, there may be exceptions, as discussed below, when a work-related dental injury worsens an existing condition.

Seeking Care for a Dental Injury

Dental injuries often require immediate attention, both because they can be excruciatingly painful and because of risks of infection or further damage. Treatment might require care by multiple dental professionals. This process should begin as soon as possible.

If at all possible, you should see a dentist who has experience treating dental injuries for workers' compensation claims. If you already have a dentist, you should ask them about their experience with these types of injuries and claims.

Once you have found a dentist to treat your injury, you should inform them of how the dental injury occurred. Most dental practices will have you fill out paperwork where you can explain the circumstances of the injury. This paperwork will be important for your claim.

The dentist should prepare a treatment plan to assist the workers' compensation claim process. This plan might include specialists like an endodontist or maxillofacial surgeon, depending on the type and severity of the injury.

Proving That a Dental Injury Is Work-Related

Each state maintains a workers' compensation as a form of insurance. Employers fund these systems through payroll taxes. If an employee makes a successful claim, their employer may have to pay more towards workers' compensation, much like how a driver's car insurance premiums might go up if they have an accident or get too many speeding tickets. Employers have an opportunity to challenge workers' compensation claims by their employees.

You have the burden of proving that your injury is work-related. Documentation from your dentist is essential to this process. In some cases, it might be reasonably obvious that a dental injury is related to someone's job. Chipped or broken teeth caused by an industrial accident, such as malfunctioning equipment or a falling object at a work site, are clearly injuries sustained on the job. Dental injuries resulting from an assault in the workplace can also be work-related.

Injuries That Aggravate Existing Dental Conditions

A dental injury that worsens an existing condition can still be covered by workers' compensation, as long as the injury itself is work-related. Suppose an employee has neglected his teeth, resulting in damage to the roots of several teeth. If he's involved in an accident that damages those teeth, workers' comp benefits might pay for the treatment, even though the dentist would have to address the existing damage along with the work-related injury.

Dental injuries that occur outside of work, or that are the result of poor dental hygiene, are not covered by workers' compensation. A person who loses several teeth in a fight outside of work would not be eligible for workers' compensation. Cavities aren't covered by workers' compensation, unless a worker could somehow prove a direct connection to his or her job.

Filing a Workers' Compensation Claim for Dental Injuries

The process for filing a workers' comp claim varies from state to state. It usually begins with reporting your injury to your employer and completing a claim form, and often involves an independent medical exam with a workers' comp doctor. If your claim is denied, you always have the option to appeal. If you're successful, you should receive reimbursement for the medical (or dental) care you received, and up to two-thirds of your wages for as long as you were out of work due to your injury.

The timeframes for completing those steps, from reporting your injury to appealing a denial, can be strict. If you miss any of the deadlines, your claim can potentially be dismissed. A workers' compensation attorney with knowledge of your state's rules and procedures can help you meet the legal deadlines and present the most persuasive case possible to the workers' comp board.

Contact an Attorney

If you have suffered a dental injury at work, consider contacting an experienced workers' compensation attorney. Most workers' comp lawyers don't charge anything up-front, and only collect a fee if you win your case.