ACC can help with the costs of treatment for most types of dental injury. ACC normally pays the dentist part of the treatment cost and you pay the rest.
What do I need to do to get help?
Ensure that your injury is covered by ACC; see Dental injury.
Your dentist can provide treatment for most dental injuries straight away. ACC have set amounts that we have agreed to pay dentists for typical dental treatments. Your dentist will claim this amount from ACC directly and then will charge you for the remainder of the treatment costs.
Some injuries will need to have prior approval, or be reviewed by a dental advisor, before ACC can determine if the treatment costs are covered.
Your treatment may need prior approval
If your claim needs prior approval, your dentist will apply to ACC on your behalf to request this for your treatment.
Normally you will need prior approval if you need:
- surgical dental implants
- crowns
- bone grafts and additions
- connective tissue grafts
- orthodontic work
- Temporo-Mandibular Joint (TMJ) surgery.
Note:
For treatment that needs prior approval, we normally need further information from a dental advisor to help us determine if your treatment can be covered by ACC.
Your treatment may need to be reviewed by a dental advisor
If ACC needs more information before we can decide if your treatment is covered, we may ask a dental advisor to review your treatment. The dental advisor does not normally need to see you. They make their decisions based on the information we have received from your dentist.
We may ask a dental advisor to review your claim if:
- the type of treatment you need requires prior approval
- there was a dental problem before the injury, which means that you will need more comprehensive treatment
- you had crowns or restorations before the injury
- the injury occurred over a year before the claim was made
- it is for a serious and complex injury (where the whole mouth is damaged)
- treatment is required for teeth that were not covered in the original claim.
How am I eligible?
You are eligible if your dental claim has been accepted by ACC and the need for treatment is directly related to the covered injury.
The amount ACC can contribute depends on the type of injury you have and the condition of your mouth, dentures or teeth before the injury happened.
If your claim is for… |
ACC considers… |
|---|---|
general dental treatment |
the condition of your teeth before the injury. if the type of treatment requested is appropriate for the covered injury. if your teeth were in poor condition before the injury, e.g. decayed or affected by gum disease, ACC may decline to contribute towards treatment needs that are not accident related. if your injured teeth were heavily filled, crowned, bridged or had implants before the accident (and were not funded by ACC because of an earlier accident), ACC’s contribution may be reduced. |
dentures |
if you were wearing the dentures at the time of the accident. ACC can only contribute to the cost of repair or replacement of dentures if they were worn at the time of the accident and the replacement or repair was done by a dentist. Note: |
specialist treatment, such as dental implants, temporo-mandibular joint surgery or orthodontic treatment |
the prior condition of the injured teeth, eg crowns, heavy restorations. overall oral condition. if there were any contributing conditions or factors that are not accident-related |
Important:
The help you will get depends on your individual circumstances. Please contact ACC to confirm if you are eligible, or to identify other ways in which we can help. See Contact ACC Claims for our contact information.
Please discuss your co-payment responsibility and treatment options prior to starting treatment with your dentist.
How long might ACC take to determine if I am eligible?
If your treatment does not require prior approval and has been completed by the dentist, your dentist will invoice ACC directly. Apart from completing your injury claim form at the time of your accident you may not need to contact ACC at all.
Prior Approval
ACC will normally let you know that you have prior approval for your treatment within 10 working days. However it may take longer than this if ACC does not receive all the required documentation and diagnostics from your dentist, or if ACC needs an independent clinical opinion from a dental advisor.
Dental Advisor
If your treatment is complicated or needs to be assessed by a dental advisor, then it will normally take longer to determine if your treatment is covered by ACC.
If that happens ACC may extend the timeframe for making a decision but will advise you of our decision as soon as possible.
Please contact us if you have not heard from us within a reasonable period of time. See Contact ACC Claims for our contact information.
What happens next?
After you have received your dental treatment ACC will pay your dentist directly for treatment costs that were eligible for payment by ACC.
If you need further dental treatment for the same injury at a later date see your dentist again. Your dentist will establish your accident related treatment needs and will either request prior approval from ACC or provide the treatment.
You will need your accident claim number when making a claim for further treatment. Either you or your dentist can contact ACC if you do not have this available, see Contact ACC Claims.
Note:
- Please keep copies of your form and any letters we send you – you may need them again later.
- If you are unhappy with the decision, you can ask for it to be reviewed. 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 website)
Published: 20 June 2008