What support can I get?

Dental treatment

We can help with the costs of treatment for most types of dental injury. We normally pay the dentist part of the treatment cost and you pay the rest.

What do I need to do to get help?

The Dental injury page tells you about the type of dental injuries we may cover.

Your dentist can provide treatment for most dental injuries straight away. We have set amounts we have agreed to pay dentists for typical dental treatments. Your dentist will claim this amount from us directly and 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 we can determine if we can cover the treatment costs.

Go to What support can I get? if you need other help because of your injury.

When treatment needs prior approval

If your claim needs prior approval, your dentist will apply to us on your behalf to request this for your treatment.

Normally you will need prior approval if you need:

A dental advisor may have to review your treatment

If we need more information before we can make a cover decision, we may ask a dental advisor to help us decide if we can pay for your treatment.

The dental advisor doesn’t 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 needs 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)
  • you require treatment for teeth that were not covered in the original claim.

How am I eligible?

We may accept your dental claim if it is a result of your covered injury.

The amount we 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…

we consider…

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, eg decayed or affected by gum disease. We 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 us, our contribution may be reduced.

dentures

  • if you were wearing the dentures at the time of the accident
  • We 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:
We don’t fund treatment performed by a dental technician.

specialist treatment, eg 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. Contact us to confirm if you qualify, or to talk about other ways in which we can help.

Please discuss your co-payment responsibility and treatment options before 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, they will invoice us directly. Apart from completing your injury claim form at the time of your accident, you may not need to contact us at all.

Prior approval

We’ll normally let you know that you have prior approval for your treatment within 10 working days. However it may take longer than this if we don’t receive all the required documentation and diagnostics from your dentist, or if we need an independent clinical opinion from a dental advisor.

Dental advisor

If your treatment is complicated or a dental advisor needs to assess it, it will normally take longer to make a cover decision.

If that happens we may extend the timeframe for making a decision but will advise you of our decision as soon as possible.

Contact us if you have not heard from us within a reasonable period of time.

What happens next?

After you have received your dental treatment we’ll pay your dentist directly for treatment costs covered by us.

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 ask for prior approval from us 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 claims if you do not have this available.

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 a review. Go to 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.

Updated: 22 March 2016

Reviewed: 22 March 2016