Provincial insurer must pay orthodontic costs

Insurance Corporation of British Columbia (ICBC) must pay “without delay” for a claimant’s orthodontic treatment following an auto accident, but not for other long-term impairment claims, a B.C. Civil Resolution Tribunal says in a May 30 decision.

Neeraj Maan, was in an auto accident on May 3, 2023 and sustained injuries to his teeth, neck and upper back. ICBC refused to pay for his orthodontic treatment, saying the complaints were not related to his accident. Maan sought $90,000 for health care and rehabilitation benefits and $40,000 for permanent impairment compensation.

Background

While driving through an intersection, Maan’s vehicle collided with a left-turning vehicle, and his driver’s side front airbag deployed. Maan didn’t go to the hospital but visited his family doctor the next day.

Maan said the airbag and seatbelt contacted his head, chin, teeth, chest, right lower back, and abdomen. He had a toothache and pain in his right lower back and abdomen, and saw blood while brushing his teeth. A doctor saw no bruising or swelling but reported tenderness in Mann’s chin, chest, right-side back, and abdomen. He said Mann could go back to work but recommended a dental assessment.

A dentist, Dr. Kwan, saw Maan on Jun. 8, 2023. Kwan’s notes indicate Maan felt his lower front teeth had shifted and were “hitting too hard” on his upper teeth since the accident. His lower teeth were also sensitive to cold. Dr. Kwan noted “the two lower front teeth were slightly mobile” and that Maan’s bite may “be heavy.” The dentist gave Mann two options: remove some enamel on the teeth to adjust the bite, or be referred to an orthodontist to “consider moving those two lower front teeth to relieve the ‘heavy occlusal contacts.’”

In an Aug. 25, 2023, report to ICBC, Dr. Kwan noted he had not previously seen Mann as a patient and could not determine whether the lower teeth contact issue was related to the accident. ICBC sought Mann’s dental records.

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On December 19, 2023, the family doctor examined Maan and completed a reassessment report. He found Maan had moderate, bilateral neck and upper back pain, and a toothache. The doctor recommended physiotherapy and massage therapy.

Maan saw an orthodontist, Dr. C. Lun Wang, on Dec. 21, 2023 who recommended braces or a clear aligner treatment for 24 months, followed by a retainer. Dr. Wang’s later report on Apr. 5, 2024 confirmed Maan was experiencing “heavy incisal contact.” The estimate for orthodontic treatment was $9,300, which ICBC did not approve.

Tribunal decisions

“Mr. Maan wants ICBC to pay for his orthodontic treatment, writes tribunal member Micah Carmody in his decision.

“He says since the accident his bite has been misaligned, causing constant toothache and changed eating habits. ICBC says the evidence does not show that Mr. Maan’s incisal contact and tooth pain and numbness were caused by the accident.”

Carmody’s decision notes ICBC reviewed files from an independent medical professional in its Clinical Advisory Group (CAG). He notes prior tribunal decisions “have found CAG opinions unreliable and given them little or no weight, typically because the authors’ names and qualifications were not provided.”

The CAG opinions, he adds, “do not support ICBC’s refusal to pay for orthodontic treatment…Both CAG opinions said that loosening and displacement of the teeth is common after traumatic events such as motor vehicle accidents.” And that one of the opinions said, “Dr. Kwan’s two treatment options presented were reasonable, conservative, and supported by evidence.

“I find the orthodontic treatment outlined by Dr. Wang is a reasonable expense to facilitate Mr. Maan’s recovery from his teeth alignment injury. So, I order ICBC to fund the orthodontic treatment.”

However, Carmody dismissed Maan’s claims of $14,000 for future dental care and $5,000 for a potential root canal. “He says he may need teeth extracted, but there is little evidence of this.”

Likewise, a claim related to massage and physiotherapy treatments was dismissed because Carmody found ICBC paid the required amount under the province’s Enhanced Accident Benefits Regulation.

Regarding Maan’s claim of $40,000 to compensate for permanent impairment, the decision notes it’s not clear whether he is claiming for his dental injuries or neck and upper back injuries, or for both.

Carmody dismissed the permanent impairment claim because reports from Maan’s doctors do not report that the claimant “sustained any permanent impairment in the accident.” Likewise, if Maan’s “bite misalignment were permanent, there would be no point in the orthodontic treatment.”

Phil Porado

Phil, an award-winning journalist with over 30 years of experience in financial topics, has been managing editor of Canadian Underwriter for more than three years.