ACC may be able to help towards your treatment costs if you have a dental injury caused by an accident, a sporting injury, or as a result of dental treatment.
What help can I get?
In most cases, the dentist will treat you and ACC will pay part of the cost. If your injury is more serious, we may be able to help in other ways, for instance, if you need time off work.
Many preventable dental injuries happen on the sports field. A well-fitted mouthguard is a sporting essential. See ACC Sportsmart protective equipment and our sports injury prevention section for more information, or ask your dentist about this.
What do I need to do?
- If you suffer a dental injury, see your dentist about the injury as soon as possible. Make sure that your treatment is carried out by a registered dentist. Treatment carried out by a dental technician is not covered by ACC.
- Your dentist will help you complete an ACC claim form, which they will send to ACC. In most cases the dentist will treat you on the first visit and charge you part of their normal fee. We will pay the rest of the cost.
- If you need further treatment, you may need to revisit your dentist or see a specialist. If you are likely to need treatment from a specialist ACC must approve this treatment as necessary and appropriate first. Your dentist will discuss your treatment with you and can show you the ACC Schedule of Dental Treatment Costs Contributions. You need to ensure you are fully informed of what your financial responsibility is before undergoing any treatment.
- If you need to take time off work because of your injury, discuss this with your doctor or nurse practitioner. They will complete a medical certificate for you, if they confirm that you do need time off work.
Note:
- It is important to claim for children with dental injuries, as they may need further treatment in later years.
- Please keep your copy of forms or any letters we send you – you may need them again later.
- Your actual entitlement depends on your individual circumstances. Please contact us to confirm if you are eligible, or to identify other ways in which we can help. See Contact ACC Claims for our contact information.
What information does ACC need from me?
ACC needs the same information for all claims in the first instance. See Injury in New Zealand.
Your dentist will need to complete another form for ACC called an ACC42 Dental Injury Claim form. This form has more specific details about your dental injury. Usually they will send this form in at the same time as your claim form.
How does ACC decide if I am covered?
See Injury in New Zealand for some of the standard questions ACC considers when assessing cover.
ACC may cover dental injuries caused:
- by an accident
- by a sporting injury
- as a result of medical or dental treatment.
ACC does not cover dental claims if the:
- damage to your teeth or dentures is due to normal wear and tear
- treatment was carried out by a dental technician
- damage occurred to your dentures when you were not wearing them.
The amount that ACC can contribute depends on the type of injury you received and the condition of your mouth, dentures and teeth before the injury happens.
See Dental treatment for more information.
How long might ACC take to decide?
The majority of claims are assessed at the registration centre within 21 days of being lodged. In many cases we will decide much sooner than this.
Normally your dentist will perform the treatment and invoice ACC directly. Apart from completing a form, being treated for your accident and then paying your part of the treatment, you usually have no direct contact with ACC.
Decisions for more complicated cases
ACC needs to establish if the treatment needed is related to the accident.
Example:
ACC will not fund treatment to teeth that were decayed prior to the accident and the need for treatment is to resolve non-accident related conditions.
If the case is not straightforward, ACC’s decision may be delayed. If that happens in your case, ACC will extend the timeframe for making a decision, up to a maximum of four months from the date the claim was lodged. You will be told about the extension as soon as possible.
ACC will contact you either by phone or in writing in the following circumstances:
- There is a delay in being able to assess the case as accident related
- ACC must reduce the amount we will contribute to your treatment because of a prior non-accident related fillings or crowns
- ACC is declining entitlement. We will explain why.
ACC may refer your case to a dental advisor to give a clinical opinion on whether the need for a particular treatment is accident related.
If your claim needs to be reviewed by a dental advisor
ACC may ask a dental advisor to review your claim before we can determine if it is covered and how much ACC may contribute, if:
- we need to determine if the treatment is accident related
- there was a dental problem before the injury
- you had crowns or restorations before the injury
- the injury occurred over a year before the claim was made
- it is a serious and complex injury claim (usually where the whole mouth is damaged)
- it is a temporo-mandibular (jaw) joint injury, requiring orthodontic treatment.
What happens next?
ACC will contact you by phone or letter to let you know if your claim is accepted for cover. If your claim is declined, we will tell you why.
In some cases, ACC may need to give you prior approval before we can help with the cost of your treatment. Your dentist can advise you if your treatment requires prior approval from ACC. See Dental treatment for more information on which treatments require prior approval.
If your dentist has asked us for prior approval, we will write to you and the dentist and advise what costs ACC will pay.
Note:
If you are unhappy with the decision on your claim, you can make a complaint or ask for a review. See What if I have problems with a claim?
Related legislation
Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003
- Regulation 10: Dentists’ costs (external link)
Last updated: 20 June 2008