In Ontario, the Workplace Safety and Insurance Board (WSIB) generally covers emergency dental repairs, crowns, and implants if you suffer a work-related facial trauma. You must report the injury immediately, and your dentist will submit a Health Professional Report to secure coverage, which usually results in zero out-of-pocket expenses for approved treatments.
Suffering a workplace accident that results in blunt force trauma to the face can be an incredibly stressful and painful experience. Whether you work on a construction site in Toronto or in a manufacturing facility in Mississauga, dental injuries require immediate attention. Navigating the claims process to ensure your reconstructive surgery is covered should not add to your burden.
This guide explains how the WSIB handles dental injury claims across Ontario. We will walk you through the essential steps to secure coverage for emergency repairs, crowns, and dental implants. 📝 Remember, consulting with a local lawyer or law firm from our directory can help you protect your rights throughout this complex medical and legal journey.
Step-by-Step Process for WSIB Dental Claims in Ontario
Whether you live in Ottawa, Hamilton, or London, the WSIB process for reporting and treating a workplace dental injury remains consistent across the province. Following these steps carefully is crucial to ensure that your medical bills are completely covered.
Step 1: Seek Emergency Dental Care Immediately
Your first priority after a facial impact is to seek emergency medical or dental care. You can visit a local hospital emergency room or an emergency dental clinic in your city. 🏥 Be sure to explicitly tell the treating medical professional that the injury occurred while you were working.
Step 2: Report the Injury to Your Employer and WSIB
By law, you must inform your employer about the accident as soon as possible. Your employer is then required to file a Form 7 with the WSIB. Simultaneously, you should complete and submit your own Worker’s Report of Injury or Disease (Form 6) to officially start your claim.
Step 3: Ensure Your Dentist Submits the Proper Forms
When you visit your regular dentist for follow-up care or reconstructive planning, they need to submit a Health Professional Report (Form 8 or a specific dental equivalent) directly to the WSIB. 👨⚕️ This report provides the vital medical evidence connecting your broken teeth or jaw trauma to the workplace incident.
Step 4: Obtain Pre-Approval for Major Reconstructive Surgery
While emergency repairs (like fixing a knocked-out tooth) are handled immediately, major procedures such as crowns, bridges, or dental implants usually require pre-approval. Your dental office will send a detailed treatment plan and cost estimate to the WSIB for review before scheduling the final reconstructive surgery.
Step 5: Follow-Up and Consider Legal Support
If the WSIB denies your claim or refuses to cover a specific type of implant, you have the right to appeal the decision. ⚔️ An appeal goes through the Appeals Resolution Officer (ARO) and can eventually be escalated to the Workplace Safety and Insurance Appeals Tribunal (WSIAT). At this stage, speaking with a skilled workplace injury lawyer is highly recommended.
How Much Does it Cost in Ontario?
One of the biggest concerns for injured workers is the sheer cost of dental reconstructive surgery. Fortunately, if your WSIB claim is allowed, the financial burden is generally lifted from your shoulders.
- Emergency Treatment: 100% covered by the WSIB directly to the dental provider based on their fee schedule.
- Crowns and Implants: Approved reconstructive surgeries are fully funded. You should not have to pay out-of-pocket or use your personal insurance.
- Prescription Medication: Pain relief or antibiotics prescribed for the injury are usually covered.
- Lawyer Fees: If you need to hire a law firm to appeal a denial, most Ontario injury lawyers work on a contingency fee basis, meaning they only get paid a percentage if you win your case.
| Type of Expense | Estimated Cost (CAD) | WSIB Coverage Details |
|---|---|---|
| Emergency Extraction | $150 – $350 | Fully covered immediately upon claim allowance. |
| Dental Crown | $1,000 – $1,500 | Covered with pre-approved treatment plan. |
| Dental Implant | $3,000 – $5,000+ | Covered if medically necessary and pre-approved. |
How Long Does the Dental Claim Process Take?
Emergency dental care is immediate, and you should not delay treatment waiting for paperwork. However, the administrative side of a WSIB claim operates on its own timeline.
- Initial Claim Allowance: Usually processed within 2 to 4 weeks after the WSIB receives Form 6, Form 7, and the dentist’s Form 8.
- Pre-Approval for Implants: Reviewing a complex reconstructive treatment plan can take an additional 4 to 8 weeks.
- Recovery Time: Healing from blunt force facial trauma and completing implant stages can take 6 months to a year, during which you may be eligible for loss of earnings benefits.
Frequently Asked Questions (FAQ)
Do I have to pay taxes on WSIB benefits to the CRA?
No. According to the Canada Revenue Agency (CRA), WSIB loss of earnings benefits and medical coverage payouts are non-taxable, though they must still be reported on your annual tax return.
What if my employer asks me not to report the dental injury?
It is an offence under Ontario law for an employer to suppress a WSIB claim. You must always report a workplace injury to protect your health and legal rights.
Will WSIB cover cosmetic dentistry?
The WSIB covers reconstructive dentistry necessary to restore the function and appearance of your teeth to their pre-injury state. Strictly cosmetic upgrades unrelated to the trauma are not covered.
Can I interact with Service Canada while on WSIB?
If you are unable to work and waiting for WSIB approval, you may temporarily apply for Employment Insurance (EI) sickness benefits through Service Canada. However, you must repay the EI if WSIB later covers those same lost wages.
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