Case Summary : Communication

Dental Benefits

A worker called the Fair Practices Commission with a concern about his dental benefits. The worker had suffered an injury at work some time ago that required emergency dental work as well as follow-up treatment. When he contacted his dentist to arrange for the follow-up treatment, he was advised that the WSIB would only pay for a small portion of the total cost of the treatment.

The worker spoke to his claims adjudicator who advised him that the WSIB policy only allows for payment of a portion of the treatment cost.

Following a review of the worker's file, including a report from the WSIB dental consultant, it appeared that there was some misunderstanding about the processing of this claim. The Commission facilitated communication between the adjudicator, the worker, the treating dentist and the WSIB dental consultant. As a result of this communication, the worker learned that the treatment plan submitted by his dentist included dental work that was not related to the injury. The worker then understood that the decision to pay only part of the cost was not due to WSIB policy but due to the fact that only a portion of the dental work proposed by his dentist was related to the compensable injury. The worker was satisfied he now had all the information he needed to decide whether to undergo the additional work proposed by his dentist.

(2005)