Frequently Asked Questions

1.           What is workers' compensation?

Your employer is required by law to pay for any necessary medical treatment after a work-related injury occurs. (ex. accidents, falls, repeated exposure to harmful materials etc.)

2.           When do I need to notify my employer of my injury?

Whether you’ve been hurt in a sudden workplace accident or have developed a job-related injury or illness over a period of time, you must report your injury to your employer within 30 days of becoming aware of the condition. After you report your injury, your employer will give you a DWC-1 claim form, which will ask you to provide the date, time, and location of your injury, as well as a description of your injury. You will submit this form to your employer, who is required to send it to its workers’ compensation insurance company within five days. Failure to submit your DWC-1 claim form within 30 days could reduce or hold up your benefits.

3.          When is the deadline to file a workers' compensation claim in California?

Notifying your employer of your job-related injury is not the same as filing a workers’ compensation claim. To officially file your claim, you must file an Application for Adjudication of Claim and Declaration Pursuant to Labor Code 4906(g) with the workers’ compensation appeals board (WCAB). The statute of limitations for filing a workers’ compensation claim in California is one year from the date of your job-related injury or illness. If you do not file a workers’ compensation claim within a year of becoming aware of your injury or illness, you may lose your right to file at all.

4.          Are there exceptions to these limitations?

In certain situations, the statute of limitations for workers’ compensation may be extended. For example, if the injured worker was under the age of 18 at the time of the accident, the statute of limitations does not begin until the minor becomes a legal adult. If an employee suffers from a repetitive stress injury that accumulated over time, such as carpal tunnel syndrome, the statute of limitations takes effect from the date the employee became aware of the injury and that it occurred because of work. If a worker has been receiving medical treatment or benefits for an injury, he or she may file a claim within five years after the date of the injury if the original injury has caused new and further disability.

5.          How will I know exactly what will be covered by my insurance?

After performing an extensive evaluation, our office will provide you with a summary of billable work, which will then be submitted to your insurance company for authorization.

6.          What kind of dental injuries are covered under workers' comp?

Both direct and compensable consequences are covered, as well as any aggravation of pre-existing conditions.

7.          What are Direct Consequences?

A direct injury in the context of workers’ compensation is pretty simple and straightforward. If a heavy box falls on a delivery driver and hits him in the mouth, immediately breaking his tooth – this is a “direct injury” and usually cannot be disputed.

8.          What are Compensable Consequences?

A Compensable Consequence is a new health problem that results from the original injury. The injured worker is entitled to the same medical coverage and disability benefits as for a first injury. For example:

  • Carpal tunnel in the right hand that leads to the inability to brush or floss properly will result in periodontal disease or tooth loss.
  • Chronic back pain leads to a need for medications. These medications cause dry mouth and dry mouth leads to cavities and tooth loss. The treatment of the affected teeth is a compensable consequence.
  • Taking a medication for depression with a known side effect of bruxism (clenching and grinding teeth). You have pre-existing periodontal disease. The clenching and grinding causes secondary occlusal trauma which loosens your teeth and can even cause tooth loss. These are compensable consequences and treatment of the missing teeth or loose teeth needs to be completed on an industrial basis.
  • You need knee or hip replacement because of your industrial injury and you have pre-existing dental disease that can potentially infect your new hip or knee. Consultation and treatment of your dental disease must be completed on an industrial basis prior to your knee or hip replacement surgery.

9.          How are compensable injuries determined?

Teeth perform three critical functions: they enable you to speak and eat and they support your facial structure. When someone is injured on the job and any of these capabilities are compromised, the employer or workers’ compensation payer is responsible to restore that functionality to pre-injury status. Many injured workers with chronic pain and/or severe infections result in losing teeth, which would be covered by workers’ compensation as long as prior to the injury, they had a healthy mouthful of teeth.

10.          What if my original injury was treated, my claim approved and paid, and then a compensable consequence occurs? Do I have to file a new claim?

If a compensable consequence occurs later on, you would need to reopen your original claim. Under the “compensable consequences” doctrine, “where a subsequent injury is the direct and natural consequence of an original industrial injury, the subsequent injury is considered to relate back to the original injury and it generally is not treated as a new and independent injury.” For example, a patient that develops TMJ from chronic mouth pain is a compensable consequence that makes its appearance long after the original injury was treated.

11.          How long after my original injury can I reopen a claim?

An injured worker has five years from the date of the injury to reopen the case.

12.          What are some examples of mouth and jaw-related issues?

Difficulty chewing and swallowing, clicking jaw, facial muscle pain, TMJ pain, headaches, xerostomia (dry mouth), missing teeth, clenching and grinding, broken teeth, dental decay, and aggravated periodontal disease are some of the common complications.

Difficulty chewing and swallowing, clicking jaw, facial muscle pain, TMJ pain, headaches, xerostomia (dry mouth), missing teeth, clenching and grinding, broken teeth, dental decay, and aggravated periodontal disease are some of the common complications.

13.          Do I need to hire an attorney?

Yes, as workers’ compensation is complicated and challenging to secure, we highly recommend you hire a qualified attorney to ensure optimum coverage.

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