Workplace injuries can come in many forms, and while most people think of back problems or broken bones when you hear the words workplace accident, the truth is, dental injuries can also happen on the job.
Whether you’ve chipped a tooth in a fall, suffered a jaw injury from an impact, or are dealing with ongoing pain due to repetitive strain, it’s important to know that WorkCover can help cover the cost of dental treatment.
However, it is important to know how much WorkCover will actually pay when it comes to dental injuries, and what kind of dental treatments are included in that coverage?
This is where we come in to help!
We’re breaking it down for you in our blog here so you can understand what to expect and how to get support without the extra financial pressure.
Understanding WorkCover and Dental Injuries
WorkCover is a workers’ compensation insurance system available across Australia. It is designed to support employees who suffer injuries or illnesses as a result of their work. This includes dental injuries that occur directly due to a work-related incident.
If your dental injury happened at work or while performing your job duties, you may be eligible to make a WorkCover claim.
Once approved, WorkCover may help pay for your dental treatment, which can include anything from an emergency extraction to more complex procedures like implants or jaw repairs.
Does WorkCover Pay for Dental Injuries?
Yes, it does. WorkCover covers a wide range of dental procedures, depending on the injury and the severity. But how much you can claim depends on several factors, including:
- The type of dental treatment you need
- The WorkCover rates set by your state or territory
- The nature and cause of your injury
- Whether your claim is accepted and approved in full
Each state and territory in Australia may have different WorkCover rates, so the amount reimbursed may vary. For instance, in New South Wales, dental fees may be paid based on an agreed schedule of rates between WorkCover and dental providers. These are usually lower than private dental fees.
It’s important to check what your insurer will cover before starting any dental treatment.
What Is Typically Covered in a WorkCover Dental Claim?
Not every dental treatment is covered under WorkCover. However, if your dental injury is work-related and approved, you may be entitled to claim treatment for:
Emergency Dental Care
- Temporary fillings
- Pain relief
- Tooth extractions
Restorative Dental Treatment
- Fillings
- Dental crowns
- Root canal therapy
Tooth Replacement
- Dentures
- Dental implants (in severe cases)
- Dental bridges
- Fracture management
Oral surgery
- Treatment for damaged gums, lips, or cheeks
Keep in mind that WorkCover will only fund what is deemed medically necessary, and all treatments must be supported by a formal assessment from your dentist or WorkCover-approved dentist.
How Much Will WorkCover Actually Pay?
This is where it gets a bit technical. The exact amount that WorkCover pays for dental procedures will depend on your specific situation, the treatment plan, and the WorkCover rates in your area.
For example, according to Safe Work Australia, dental procedures have pre-approved maximum rates depending on the treatment category. These are reviewed regularly and published in official WorkCover fee schedules.
In most cases:
- You must get prior approval from your insurer before treatment
- Your dentist will submit a proposed treatment plan with item numbers
- The insurer will then determine what they are willing to cover and at what rate
If the cost of your treatment exceeds the approved WorkCover dental rates, you might be asked to pay the difference unless your dentist agrees to charge the WorkCover rate.
This is why it is crucial to see a dentist who has experience in WorkCover dental claims. They understand how to prepare documentation and submit your treatment plan correctly to reduce delays or out-of-pocket costs.
Important Things to Remember About WorkCover Dental Claims
You Must Report Your Injury Quickly
You should notify your employer as soon as your injury occurs and fill out an incident report. Delayed reporting can affect your claim eligibility.
You Need to Be an Eligible Worker
WorkCover typically covers employees (full-time, part-time, or casual). Contractors and self-employed individuals may not be covered under the same policy.
You Need an Assessment
Your dentist or a WorkCover-recognised dentist must assess your condition and determine that the treatment is necessary and work-related.
You Need Prior Approval
It’s essential not to start treatment until your claim and treatment plan are approved. Otherwise, you might not be reimbursed.
How Do You Start a WorkCover Dental Claim?
To make things simpler, here is a quick step-by-step guide:
- Visit a dentist with experience in WorkCover dental claims
- Explain how the dental injury happened at work
- Wait for WorkCover insurance approval before beginning any treatment
- Attend your dental consultation and receive a proposed treatment plan
- Submit the plan for approval and wait for confirmation from your insurer
- Begin treatment after full approval has been granted
- If your claim is denied, you may need to speak to a legal expert or seek review options.
Workplace injuries can leave more than just a physical mark.
Dental trauma, if left untreated, can affect your comfort, your confidence, and your overall health. But the good news is that WorkCover can cover much of your dental treatment costs—as long as the injury is truly work-related and your claim is properly submitted.
Get the Treatment You Deserve Without the Stress
At Dentist Near Me Toongabbie, we work with patients who are going through the WorkCover process. Our team understands the system and will help make your claim as smooth as possible so that you can focus on recovery.
If you’ve suffered a dental injury at work, don’t delay getting help.
Call us at (02) 7905 0814 or book online to speak with our experienced dental team. We’re here to help you recover with the care and support you need through every step of your WorkCover dental claim.