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FINALLY – Dental Fee Schedules for Workers Injured on the Job in New York!

If you have been injured on the job and sustained damage to your teeth then New York Workers Compensation is supposed to pay for your reasonable dental care. Unfortunately, experience has shown me that injured workers who suffer dental injuries often do not get the dental care they need, pay too much for it or cannot find a competent dentist to perform the work.

WHY? Because most dentists do not take insurance, and specialists (prosteodontists, etc.) want to be paid up front for Workers Compensation Cases. This is due in part to the fact that the Workers Compensation Law never provided a specific fee schedule for dental care so that an insurance company could dispute and pay different amounts for the same service to dentists.

In the 2007 Workers Compensation Reform Law there was a mandate to provide a schedule. As noted by Special Counsel, Cheryl Woods the fee schedule:

… is applicable to dental treatment and procedures
performed on or after, March 1, 2009, for the necessary care and
treatment of an injured employee regardless of the date of accident or
date of disablement. The date of service for dental treatment or for a dental
procedure shall be the applicable date for reimbursement in accordance
with this fee schedule. Dental treatment or procedures performed prior to
March 1, 2009, shall be reimbursed at the usual and customary rate in the
location where the claimant resides.

The purpose pursuant to the NYS Register/December 24, 2008 PROPOSED RULE MAKING

is needed because the law was amended to require the Chair to adopt a dental fee schedule. In
addition to the statutory mandate for a dental fee schedule, there are other
reasons why this rule is needed. First, there currently is no fee schedule for
dental care and treatment for injured workers. Prior to the legislative
change in 2007, WCL § 13(a) limited dentists to such charges as prevail in
the claimant's community for similar treatment of injured individuals of a
like standard of living. Payers of workers' compensation benefits, such as
insurance carriers, State Insurance Fund and private and public selfinsured
employers, were required to pay such charges and object to any
portion in excess of this amount. Unfortunately it was not always clear
what the charges are that prevail in a claimant's community.