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The worker determines the need for dental implants after abuse



An Arkansas appellate court upheld a finding that a worker’s injury was causally connected to her tooth decay and her subsequent need for dental implants.

But the court ruled that she was not entitled to recover the cost of the surgery to extract her upper teeth, as she had not sought pre-authorisation.

Tara Rowland was working for the Evangelical Lutheran Good Samaritan Society at a nursing home when a patient punched her in the face in 2014, chipping one of her teeth, according to Evangelical Lutheran Good Samaritan Society v. Rowland.

A medical scan revealed conditions requiring surgery, which was unsuccessful. Two doctors then recommended orthodontics and more surgery after the braces were removed. Evangelical Lutheran argued that there was no causal connection between the compensable injury and the recommended treatment.

An administrative law judge disagreed. After more treatment she developed caries and her upper maxilla became infected.

A doctor determined that it was necessary to extract all of Rowland̵

7;s upper teeth and did so without seeking pre-authorization. That doctor recommended dental implants.

The doctor also believed that Ms. Rowland’s remaining lower teeth would also require extraction and dental implants, and he attributed her condition to the delays in treatment caused by Evangelical Lutherans denying the claim.

The ALJ also found that Rowland’s dental caries were causally connected to her original injury and that the implants were reasonably necessary. However, the judge found that Rowland was not entitled to recover the cost of the extraction because she failed to obtain prior authorization. The Workers’ Compensation Commission confirmed.

The Arkansas Court of Appeals said there was substantial evidence to support the conclusion that Ms. Rowland was entitled to further treatment, as her doctor described dental and jaw problems that were the direct result of delays in treatment due to Evangelical Lutherans denying the claim.

However, the court said the commission properly relied on the doctor’s testimony that Ms. Rowland’s condition was not a “life or death” situation and concluded that she was not entitled to have the cost of the extraction covered.

WorkCompCentral is a sister magazine to Business Insurance. More stories here.


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