Policy
The WSIB pays for necessary dental services according to an approved fee schedule, refer to 17-03-01, Health Care Fees. Dental services are approved if they are required as a direct result of a work-related injury or disease.
Purpose
The purpose of this policy is to outline the dental services the WSIB may authorize as a result of a work-related injury/disease and the criteria for payment.
Guidelines
If possible, dental services should restore the health and chewing function of the teeth to their pre-injury condition.
All dental services, except emergency services, must be authorized by the WSIB.
Emergency care
Emergency care for a work-related dental injury must be given within 48 hours of the injury.
The dentist who provides the emergency care must inform the WSIB of the services provided. Emergency services are intended to make the worker comfortable, the condition functional and stable, and prevent deterioration of the teeth.
Non-emergency care
When the acute phase of a work-related injury has passed, and before beginning treatment, the dentist must provide the WSIB with a Dental report - Form 0278A (available on wsib.ca), an outline of the worker's pre-accident dental condition, and details regarding the proposed treatment plan for restoring the worker's teeth to their pre-injury condition.
Dental report - Form 0278A
Dentists complete this form, marking which teeth require repair as a result of the work-related injury.
WSIB decision-makers review all questionable and/or extensive treatment plans and, if necessary, all X-rays. The WSIB returns all X-rays to the treating dentist when the review is complete.
The approved temporary treatment should begin within 90 days of the injury, and the approved permanent treatment should begin within one year. If treatment does not begin within the prescribed time, and it is found that the worker's condition has deteriorated as a result, the WSIB may limit entitlement to what was originally approved.
Refusal of treatment
If a worker refuses to accept the treatment plan authorized by the WSIB, and follows some other treatment plan, payment is limited to that of the authorized treatment plan.
Restoration
The WSIB does not pay for restorative services for cosmetic reasons alone.
If the teeth, damaged at the time of accident, are reasonably sound and serviceable, the WSIB pays an allowance toward necessary restorative measures. However, if there is crown decay, indicating the teeth to be of little or no actual service, reimbursement for restoration is denied.
If all or some of the worker's teeth are injured, the WSIB pays to have the teeth restored and kept in repair for the worker's lifetime, providing there is no evidence of carelessness or misconduct on the worker's part.
If a worker has four or fewer remaining teeth prior to the accident, the WSIB pays for full restoration but may limit continuing entitlement.
If some of the worker's teeth are damaged but the number of teeth to be restored increases because of the pre-existing condition of the mouth, the worker may receive the dental service but this completes the entitlement.
When some teeth are damaged and the remainder in the same arch show evidence of pre-accident dental disease, and the recommended treatment is extraction of all teeth, the WSIB pays for the extraction of the injured teeth only. This may complete entitlement.
If the restorations supplied cause deterioration of abutting teeth to the extent that they must be restored or extracted at a later date, any necessary dental work is provided. The entire restoration will be kept in permanent repair.
If the WSIB supplies the worker with necessary restoration and, later, teeth in the same arch have to be removed, the WSIB pays 50 per cent of the cost of the new restoration, provided it includes the teeth originally restored by the WSIB. This service completes the worker's entitlement. The WSIB is not responsible for maintaining the new work.
In cases where vital teeth are traumatized and require crown restorations, it is considered accepted practice to protect the injured teeth with provisional crowns for a minimum of three months following the date of accident. If the teeth are still vital after this period, the final crown is authorized by the WSIB.
If it is necessary to extract an injured tooth and a fixed bridge replacement is contemplated, a provisional denture may be supplied for a minimum of three months to permit healing of the ridge and a better final restoration.
Dentures
If a denture is broken in a work-related accident, the WSIB limits restoration of the denture to its pre-accident condition of fit and durability. If a simple repair or reline can correct the problem, no prior authorization from the WSIB is required. If replacement of the denture is necessary, the worker must get WSIB approval. The WSIB limits entitlement to the average cost of restoration of the denture.
Diseased teeth
If teeth that are not damaged by a work-related accident show apical infection, and the removal of these teeth is considered essential because they may affect the worker's recovery from the dental injuries, the WSIB may pay for their removal.
Application date
This policy applies to all decisions made on or after December 5, 2024, for all accidents.
Document history
This document replaces 17-03-03 dated October 12, 2004.
This document was previously published as:
17-03-03 dated June 15, 1999
8.11 dated January 1, 1998
06-02-04 dated June 1989.
References
Legislative authority
Workplace Safety and Insurance Act, 1997
Sections 32, 33
Workers' Compensation Act, Revised Statutes of Ontario 1990
Section 50
Approval
Approved by the President and CEO on December 3, 2024.