Guidelines for the provision of dental services in Australia to injured workers under the Victorian workers' compensation scheme (the Scheme). This includes surgery by oral and maxillofacial surgeons.
These guidelines provide WorkSafe Victoria's (WorkSafe) expectations for the delivery of dental services to injured workers.
Dental providers that are registered dentists, dental specialists, and dental prosthetists, can provide dental services to injured workers under the Scheme to support a worker's recovery from their work-related injury.
The dental services provided must be performed within the dental provider’s scope of practice under the Dental Board of Australia's standards.
Dental providers must be:
Dental Specialists include but are not limited to:
You can find information about how to register as a WorkSafe provider here:
Dental providers are to provide dental services in line with the Clinical Framework for the Delivery of Health Services (the Clinical Framework) as well as meet the provider registration requirements set out in the Application for Registration to Provide Services to Workers form, and all professional obligations.
Dental providers must also submit and follow the Dental report and treatment plan form for the injured worker's dental services and maintain clinical notes to the highest standard.
Once the dental provider has assessed the worker, they are required to complete and submit the Dental report and treatment plan form to the WorkSafe Agent (the Agent) for review.
The Agent must provide written approval before dental treatment commences (excluding emergency treatment and initial assessment).
The Dental report and treatment plan will be reviewed to ensure the treatment proposed is reasonable, clinically justified, outcome focused and in line with the Clinical Framework.
WorkSafe or the Agent may contact the dental provider if further information is required to assist in the decision-making process. The Agent will let both the worker and the dental provider know what WorkSafe can pay for.
An updated Dental report and treatment plan will need to be submitted for review if:
The Agent must provide an updated written approval before further treatment is done and before WorkSafe will pay for further treatment (excluding emergency treatment).
If any further information or reports are required, the Agent may contact the dental provider.
WorkSafe can pay the reasonable costs of dental services a worker needs because of an injury for which they are entitled to compensation under the Scheme.
WorkSafe has determined that for the costs of a dental service to be reasonable, the service must be:
WorkSafe does not consider the costs of dental services provided outside of these guidelines to be reasonable, and will not pay the costs of those services, including:
WorkSafe can pay the reasonable costs of dental services up to the maximum amount, as detailed in the Dental Services Fee Schedule.
Where WorkSafe decides that it can pay for a dental service that is not listed in the fee schedule, WorkSafe will assess and determine the reasonable fee for that service.
Payment of the reasonable cost of services does not mean payment of the full cost. Sometimes there may be a gap between what the dental provider charges and what WorkSafe will pay.
Dental providers must immediately notify WorkSafe should they cease to comply with the registration or accreditation requirements established in these guidelines.
Information on actions WorkSafe may take if a provider is suspected of non-compliance is provided in the Application for registration to provide services to workers form.
Except where a WorkSafe Agent is specifically mentioned, a reference to WorkSafe is a reference to WorkSafe and its authorised agents.
These guidelines are to be considered alongside the Accident Compensation Act 1985 and the Workplace Injury Rehabilitation and Compensation Act 2013, including: