W. Va. Code R. § 85-20-15

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 85-20-15 - Dental Services

15.1. Standard dental treatment necessary as a result of a compensable injury to the face or head is covered under the Workers' Compensation program. Repair or replacement of dentures and other dental appliances damaged in an accident will not be approved for payment unless the injured worker suffers a compensable physical injury in the accident. Except in cases of emergency, prior authorization must be obtained for any and all dental services provided.

15.2. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, will not approve payment for treatment of a preexisting dental deficiency or disease, unless it is clearly established that such preexisting condition is prohibiting treatment of or recovery from an industrial injury. In such cases the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, must be provided with a complete report of the preexisting condition and authorization granted prior to rendering treatment.

W. Va. Code R. § 85-20-15