Inside Workers’ Comp Blog

Dental Denial Leaves Claimant Hungry for Help

Posted by Tom Kerr on June 4, 2020

Nothing says comfort like a home-cooked meal. Food not only provides us with sustenance, but joy in life often taken for granted until we temporarily lose the ability to eat due to an injury or medical procedure. And when that simple pleasure is taken away during a pandemic, it can be downright miserable.

This was the problem an injured employee recently faced after sustaining serious facial fractures requiring numerous specialists involved in his care. This included post-surgery appointments for consultations, imaging and dental work. With many physician offices closed or restricting care to “emergency” cases due to the pandemic, the man had limited access to the post-op care he needed. That was until Jamie, his Genex field case manager, was assigned to the case. She quickly advocated for the claimant and set up telephonic appointments so therapy was not delayed. However, the man still couldn’t eat a regular diet due to metal plates inserted to fix facial fractures, which affected his dentures. Though his oral and maxillofacial surgeon cleared him for a dental referral to complete a new fitting, many dentists in the area had stopped scheduling patients due to COVID-19 constraints.

When the provider network on the case failed to locate an appropriate dentist in the network, Jamie took matters into her own hands by contacting a provider whom the surgeon recommended. After discussing the claim and current status of the man’s condition, the dentist agreed to see the patient and do the fitting. The claimant thanked Jamie and said without her help, his case would’ve “slipped through the cracks.”


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