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Old 09.02.2015, 10:53
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Cracked tooth: can I claim accident insurance?

Hi all

I recently had a cracked tooth found out by my dentist, on a tooth that already had a filling. He replaced the filling and it was only after I got swollen that he saw the crack.

Since a cracked tooth can only happen by accident, is that something I can claim from my employer's accident insurance? Can they reject it for any reason?

Has anyone gone through this before (any dental work really) through UVG?

As I will need a root canal and if that doesn't work an extraction and dental implant the cost will be more than 5000 at the end.

I read other threads here but they are not exactly my case as these were proper accidents(falls, car accidents etc) while mine probably happened at some point while eating.
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Old 09.02.2015, 11:02
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Re: Cracked too: can I claim accident insurance?

Forget it, it won't fly if it didn't happen due to a fall, etc.

BTDT.

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Old 09.02.2015, 11:05
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Re: Cracked too: can I claim accident insurance?

Why do you think a cracked tooth can only happen by accident? I've got several all due to simple wear and tear over the years. The enamel wears down and and so the teeth crack and bits fall off.
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Old 09.02.2015, 11:19
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Re: Cracked too: can I claim accident insurance?

It's more because of what the dentist said, that because of the location of the crack and its depth that it must have had a big hit recently. I did slip and had a hard fall due to snow 2 weeks ago but I landed on my ass and can't remember if I had hit my teeth together. He said it could have happened anytime during the past 2 months.

I see what you mean by teeth wearing out but that wouldn't be normal to someone under his 30s would it? In any case, would the dentist decide if this is insurance-worthy or myself? Since this involves my employer I would want to be sure I follow the rights steps, even if it is rejected down the road.
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Old 09.02.2015, 11:25
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Re: Cracked too: can I claim accident insurance?

If you damage a tooth in an accident, then yes! But you'd have to be pretty sure about how and when it happened!

Dental is a grey area. I have neck and face pain due to clenching jaw at night. Orthodontist has made me a night splint, in my eyes this is a health issue, but krankenkasse are having none off it! God knows why your teeth aren't classes as part of your health anyway!!
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Old 09.02.2015, 11:30
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Re: Cracked too: can I claim accident insurance?

I am the most clumsiest person, ever, when it comes to ladders, stairs and steps - I'm forever slipping and banging myself.
I'm a danger to myself and a liability to my insurers.
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Old 09.02.2015, 11:44
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Re: Cracked too: can I claim accident insurance?

This is not the one I have but Versana also covers food related dental accidents as well as falls etc:

http://www.helsana.ch/en/individuals.../zahnunfall_en

I have contacted my dentist for now and will wait to see. This is such a gray zone as something like that can happen and not present itself until weeks later. That fall I had could be it or my love for chest nuts...or something else entirely.
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Old 09.02.2015, 11:55
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Re: Cracked too: can I claim accident insurance?

What you could do is to contact your HR department and file an accident claims report with your accident insurer. The insurance will probably revert with questions and/or ask for a statement from your dentist. If they will accept the claim? But it´s worth a try, you´d need to be make it plausible that this is related to your fall.
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Old 09.02.2015, 11:56
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Re: Cracked too: can I claim accident insurance?

I was in a similar situation (cracked tooth which already had a filling), I cracked it by eating a quite hard muesli-bar. My employer advised me to try and have Suva pay for the treatment but they refused.
You can try your luck but it can take several weeks for them to decide if they will pay or not and the dentist should know this fact before starting the procedure; they have to do things differently if Suva pays, so I was told.
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Old 09.02.2015, 12:17
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Re: Cracked too: can I claim accident insurance?

Although most tooth cracks are caused by simple strain, a crack that occurs after an accident is an insurance matter. It needn't be a fall, it can also be caused by accidentally biting on a very hard foreign body inside food where you don't have to expect such a thing, hence NOT by chewing a muesli-bar, where hardness is a feature.

If the accident happened during work, the employer has to file a report. Otherwise you have to report it to the insurance. They will send a report form either to your dentist or to you. The dentist will assess the situation and file the report if appropriate.

For obvious reasons, insurance companies handle such things with much care in view of the fact that just about everybody could claim a damage caused by accident, which in reality is caused by mere neglect. According to my experience of 40 years, insurance companies handle such cases in a strict but fair manner.

@ivr: Actually the treatment should be exactly the same, and immediate treatment can be done without waiting for a reply from the insurance; anything else would be plain nonsense. However, some dentists like to add expensive stuff to the estimate if it is an insurance matter.
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Old 09.02.2015, 12:33
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Re: Cracked too: can I claim accident insurance?

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@ivr: Actually the treatment should be exactly the same, and immediate treatment can be done without waiting for a reply from the insurance; anything else would be plain nonsense. However, some dentists like to add expensive stuff to the estimate if it is an insurance matter.
Yes, the dentist wanted to make a full X-ray scan of all of my teeth, for start. He said that the paperwork would also be different and that he had to know from the start how to do it. I also thought that it was a bit strange that I had to wait for the treatment until this is sorted so I just ended paying for it myself. A month or two later, after a several letters to and fro Suva office, they told me that they will not pay, which I found somewhat fair. I would never even think about claiming accident money if my boss didn't tell me to do it.

Last edited by 3Wishes; 09.02.2015 at 22:46. Reason: fixed quoting
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Old 13.02.2015, 09:52
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Re: Cracked tooth: can I claim accident insurance?

Here are some articles which explain some of the problems of claiming against an accident insurance policy for tooth damage. The main issue is the definition of an accident. It has to be something sudden, with external cause, unusual and unexpected.

This definition causes long arguments. For example, if the damage to the tooth is caused by a cherry stone in some cherry jam is that an accident (because one would not expect a cherry stone in cherry jam) or is it bad luck (because, by the nature of the manufacturing process, some cherry stones get into the jam).

The following articles are in german:
http://www.beobachter.ch/geld-sicher...t-zahnschaden/
http://www.beobachter.ch/archiv/arti...em-zahnunfall/
http://www.srf.ch/konsum/themen/vers...ng-muss-zahlen
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Old 13.02.2015, 10:07
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Re: Cracked tooth: can I claim accident insurance?

Dentist advised against claiming as the tooth already had work done on it (fillings etc) so probability was close to 0.

As always with insurances, they are more useless than helpful when you need them.
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Old 13.02.2015, 10:43
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Re: Cracked tooth: can I claim accident insurance?

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Dentist advised against claiming as the tooth already had work done on it (fillings etc) so probability was close to 0.

As always with insurances, they are more useless than helpful when you need them.
I found this quotation in Google for another case: "Turns out your policy covers falling off the roof, all right, but not hitting the ground".

Yes. Insurance companies are very good at building exclusions into a policy, which render it more or less useless for the client.
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Old 13.02.2015, 11:15
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Re: Cracked tooth: can I claim accident insurance?

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Dentist advised against claiming as the tooth already had work done on it (fillings etc) so probability was close to 0.

As always with insurances, they are more useless than helpful when you need them.
so did you or did you not have an accident? If you can't be clear here how do you expect an insurance company to take you seriously?
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Old 13.02.2015, 11:19
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Re: Cracked tooth: can I claim accident insurance?

You're not listening. It doesn't matter as the tooth already had work done on it so there's 0 chance to claim successfully.

I could have bitten a rock inside a toblerone and they still wouldn't allow it. Only if the tooth was the original, healthy and no work done on it and then it broke off or something very clear.

When you crack your tooth there's no 'aha' moment. It happened sometime during the last few weeks/months or even days. You don't always understand exactly when and that's the problem.

Even the 2 different dentists failed to notice the crack during my first 2 visits as they worked on it..
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Old 13.02.2015, 11:36
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Re: Cracked tooth: can I claim accident insurance?

so why are you talking about trying to claim under accident insurance if there was no accident?
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Old 13.02.2015, 11:41
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Re: Cracked tooth: can I claim accident insurance?

This must be the most useless posts ever in this forum, no I am not. I just explained that I asked my dentist and since he said not to do it, I won't.

Try to read the whole thread first before asking.
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Old 13.02.2015, 11:54
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Re: Cracked tooth: can I claim accident insurance?

did you land on your ass or your head or both?

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Old 13.02.2015, 11:55
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Re: Cracked tooth: can I claim accident insurance?

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This must be the most useless posts ever in this forum, no I am not. I just explained that I asked my dentist and since he said not to do it, I won't.

Try to read the whole thread first before asking.
Be careful about this display of gnashing of teeth, you may get an expensive dentist's bill.
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