Overview for NSW injured workers
Start with the dispute, not just the diagnosis
May be relevant when
Benefits to check
Legal help is useful when
How this affects your claim in practice
In a dental injury claim, the diagnosis is only the starting point. The records should connect dental, maxillofacial, ophthalmology or ENT reports where relevant and x-ray, CT or specialist imaging with the worker's practical limits, including cognitive load, balance, driving, machinery, screen work, fatigue and pain tolerance and risk-sensitive duties where symptoms may affect safety. If the insurer disputes whether dental, eye or jaw treatment is related to the work incident, the response should address that reason directly.
Assessment source
- NSW Guidelines for the Evaluation of Permanent Impairment, paras 1.8-1.12: NSW Guidelines control the assessment method and AMA5 is used only where adopted and not modified.
- NSW Guidelines para 1.12: AMA5 Chapter 18 pain is excluded; chronic pain is assessed through the underlying diagnosed condition, while CRPS is assessed under the relevant NSW method.
- NSW Guidelines para 1.15: assessment should usually wait until maximum medical improvement, meaning the condition is stable and unlikely to change substantially in the next year.
- NSW Guidelines Chapter 6 and AMA5 Chapter 11: use the retained masticatory function method; NSW Table 6.1 separately controls facial disorder or disfigurement.
What injuries or conditions may be assessed?
Dental injury may involve fractured or lost teeth, damage to supporting bone, bite change, nerve injury, infection, or a jaw or temporomandibular condition affecting mastication.
- Dental treatment cost or the number of repaired teeth does not itself establish permanent WPI; a stable functional loss must fit the controlling method.
Symptoms and findings that matter
Dental and maxillofacial evidence should record permanent tooth or supporting-structure loss, occlusion, chewing function, sensation and whether restoration has stabilised the condition.
Pain on chewing without objective permanent masticatory or nerve dysfunction is not a percentage by itself.
What investigations are usually relevant
Investigations for dental injury may include ambulance, emergency and hospital records, including Glasgow Coma Scale, post-traumatic amnesia and acute neurological observations where relevant and neurologist, rehabilitation physician, neuropsychologist, speech pathologist, vestibular, urology or other specialty reports matched to the function in issue. Each result should answer a defined clinical question and be read with the examination, diagnosis and history.
- CT/MRI, neuropsychological testing, vestibular testing or EMG/NCS interpreted with the clinical examination rather than in isolation.
- Functional records showing memory, communication, community independence, self-care, seizure safety, gait, sensory or motor consequences.
How WPI is assessed for this body part
Permanent masticatory impairment is assessed under the applicable AMA5 Chapter 11 function method as retained by NSW Chapter 6; a facial deformity instead uses NSW Table 6.1.
A distinct trigeminal or other nerve deficit uses its neurological method only where the sensory or motor findings are supported and not already duplicated.
Method illustration
This is a non-numeric illustration of the assessment sequence. It does not predict a WPI result.
- Accepted condition and findings
- Dental injury may involve fractured or lost teeth, damage to supporting bone, bite change, nerve injury, infection, or a jaw or temporomandibular condition affecting mastication. Dental and maxillofacial evidence should record permanent tooth or supporting-structure loss, occlusion, chewing function, sensation and whether restoration has stabilised the condition.
- Method to apply
- Permanent masticatory impairment is assessed under the applicable AMA5 Chapter 11 function method as retained by NSW Chapter 6; a facial deformity instead uses NSW Table 6.1.
- Why no percentage can be assumed
- Pain, tenderness or the dental injury diagnosis alone does not establish WPI without the measurements and criteria of the controlling method.
What usually does not increase WPI
Pain, tenderness or the dental injury diagnosis alone does not establish WPI without the measurements and criteria of the controlling method.
Treatment, surgery or imaging does not automatically select a class or percentage.
A facial, visual, dental, masticatory and nerve consequence should not be counted twice under overlapping methods.
Evidence checklist
The records for dental injury should include the accepted injury and insurer decision identifying the precise facial, visual, dental or jaw condition and relevant ophthalmology, maxillofacial, dental, ENT, plastic-surgery or neurological specialist report. They are most useful when the diagnosis, examination and practical restrictions are consistent.
- Objective measurements, imaging, operation records and clinical photographs where appropriate and consented.
- Pre-injury records if a deduction for a prior condition is proposed.
- A report naming the NSW/AMA method, class or table and explaining the selected result.
How this injury commonly happens at work
Work-related dental injury can arise through impact to the face and falls, assaults, flying particles or equipment incidents. The chronology should identify the actual task or event and when symptoms or function changed.
Work-related dental injury can arise through clenching or jaw symptoms after trauma. The chronology should record the actual task or event and the point at which symptoms or function changed.
Common insurer disputes
For dental injury, an insurer may dispute whether dental, eye or jaw treatment is related to the work incident and whether symptoms are cosmetic only. The written decision should be answered with evidence directed to those reasons.
Further disputes about dental injury may concern whether ongoing treatment is reasonably necessary. The decision notice should identify which issue is relied on and the evidence said to support it.
Treatment and surgery issues
Depending on the diagnosis and treating opinion, management of dental injury may involve specialist dental, ophthalmology, ENT, maxillofacial or physiotherapy care where supported. The request should explain the expected functional benefit and its connection to the accepted injury.
Weekly payments and work capacity
Capacity evidence for dental injury should address cognitive load, balance, driving, machinery, screen work, fatigue and pain tolerance and risk-sensitive duties where symptoms may affect safety. Proposed duties must be sustainable for the proposed hours, not merely possible once.
For dental injury, capacity evidence should address graded duties based on treating restrictions and weekly payments where functional limits are disputed. The question is whether those activities can be performed safely, reliably and for the proposed hours—not whether a task can be attempted once.
How NSW Work Injury Claim can help
For dental injury, a claim review can help to organise incident, medical and symptom evidence and separate treatment, capacity and impairment issues. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
For dental injury, a claim review can help to identify gaps in IME or insurer reasoning and consider dispute options where the evidence supports them. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
Common questions about dental injury claims
How can work cause or aggravate dental injury?
For dental injury, the relevant work history may include impact to the face, falls, assaults, flying particles or equipment incidents, and clenching or jaw symptoms after trauma. A claim still depends on the actual chronology and medical evidence. The records should identify what changed, when symptoms began or worsened, and how the diagnosed condition affects the worker's duties.
How is WPI assessed for dental injury?
For dental injury, permanent masticatory impairment is assessed under the applicable AMA5 Chapter 11 function method as retained by NSW Chapter 6; a facial deformity instead uses NSW Table 6.1. Dental and maxillofacial evidence should record permanent tooth or supporting-structure loss, occlusion, chewing function, sensation and whether restoration has stabilised the condition. The assessor must apply the NSW Guidelines to the accepted, stable condition; the diagnosis or an operation does not by itself determine a percentage.
Which records are most useful for a dental injury assessment?
A dental injury assessment commonly needs the accepted injury and insurer decision identifying the precise facial, visual, dental or jaw condition, relevant ophthalmology, maxillofacial, dental, ENT, plastic-surgery or neurological specialist report, objective measurements, imaging, operation records and clinical photographs where appropriate and consented, and pre-injury records if a deduction for a prior condition is proposed. Those records are most useful when they describe the same diagnosis, examination findings, treatment history and practical work restrictions.
What does an insurer commonly dispute about dental injury?
For dental injury, common issues include whether dental, eye or jaw treatment is related to the work incident, whether symptoms are cosmetic only, and whether ongoing treatment is reasonably necessary. The response should address the insurer's stated reason with the relevant chronology, clinical findings, investigations and duties evidence rather than relying on the diagnosis alone.
How can dental injury affect weekly payments and suitable duties?
Capacity evidence for dental injury may need to address cognitive load, balance, driving, machinery, screen work, fatigue and pain tolerance, risk-sensitive duties where symptoms may affect safety, and graded duties based on treating restrictions. A certificate should describe what the worker can do safely and sustainably. Proposed duties should then be checked against those restrictions and the real demands of the job.
What does not establish WPI for dental injury by itself?
For dental injury, pain, tenderness or the dental injury diagnosis alone does not establish WPI without the measurements and criteria of the controlling method. WPI depends on the accepted injury, objective findings and the method required by the NSW Guidelines after the condition has stabilised.
Request a calm claim position review
If you have received an insurer decision or you are unsure how your injury evidence fits together, we can help you identify the issue, organise the documents and consider the next step. Where ILARS funding is approved, eligible legal costs and necessary disbursements may be covered.
Related NSW workers compensation guides
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- Head, brain and neurological WPI assessment
- Traumatic brain injury
- Seizure disorder after neurological injury
- Cranial nerve injury
- Balance and neurological gait disorder
- Peripheral nerve injury
- Complex regional pain syndrome
- Neurological bladder, bowel and sexual dysfunction
- Workers compensation claims
- Weekly payments
- Claim denied
- Work capacity decisions
- IME guide
- WPI assessment guide