Only dentists, oral surgeons or dental specialists licensed in the state in which they practice are eligible to treat workers entitled to benefits under the industrial insurance law.
If only a dental injury is involved, the doctor's portion of the report of accident must be completed by the dentist to whom the worker first reports. See WAC 296-20-025
for further information.
If the accident report has been submitted by another doctor, the dentist's report should be made by letter. In addition to the information required under WAC 296-20-025
, the dentist should outline the extent of the dental injury and the treatment program necessary to repair damage due to the injury. Dental X rays should be retained by the attending dentist for a period of not less than ten years. The department or self-insurer does not require submission of the actual films except upon specific request.
The department or self-insurer is responsible only for repair or replacement of teeth injured or dentures broken as a result of an industrial accident. Any dental work needed due to underlying conditions unrelated to the industrial injury is the responsibility of the worker. It is the responsibility of the dentist to advise the worker accordingly.
In cases presenting complication, controversy, or diagnostic or therapeutic problems, consultation by another dentist may be requested to support authorization for restorative repairs.
Bills covering the cost of dentures should be submitted for the denture only and should not include the cost for subsequent relining. If relining becomes necessary, authorization for relining must be obtained in advance from the department or self-insurer.
Bills must be submitted to the department or self-insurer within one year from the date the service is rendered. Bills must itemize the service rendered, including the current HCPCS Level II codes, the materials used and the injured tooth number(s). See WAC 296-20-125
and department policy for further billing rules.
[Statutory Authority: RCW 51.04.020, 51.04.030 and 1993 c 159. 94-14-044, § 296-20-110, filed 6/29/94, effective 7/30/94; 93-16-072, § 296-20-110, filed 8/1/93, effective 9/1/93. Statutory Authority: RCW 51.04.020(4) and 51.04.030. 86-06-032 (Order 86-19), § 296-20-110, filed 2/28/86, effective 4/1/86. Statutory Authority: RCW 51.04.020(4),51.04.030 , and 51.16.120(3). 81-01-100 (Order 80-29), § 296-20-110, filed 12/23/80, effective 3/1/81; Order 70-12, § 296-20-110, filed 12/1/70, effective 1/1/71; Order 68-7, § 296-20-110, filed 11/27/68, effective 1/1/69.]