Dentures, Eyeglasses and Hearing Aids
Chief of Operational Policy, Analytics & Compliance
and procedures, directives or memos regarding damage to dentures, eyeglasses and
hearing aids that predate the effective date of this policy.
The purpose of
this policy is to ensure that requests for the repair or replacement of
dentures, eyeglasses and hearing aids damaged in the course of an allowed
industrial injury are processed appropriately.
applies to BWC Field Operations and MCO staff.
Denture: Artificial replacement of a
tooth or teeth.
Eyeglasses: For the purpose of this
policy, refers to any removable prescriptive corrective lenses (i.e., glasses
Hearing Aid: A removable electronic device used to amplify sound that is
worn in or behind the ear of a person with a hearing impairment.
A. General Policy Statements for
both repair or replacement
1. It is the policy of BWC to
ensure that the repair or replacement of dentures, eyeglasses and hearing aids
damaged in the course of an injury or industrial accident resulting in an
allowed claim is covered regardless of:
a. The allowed condition(s) in
the claim; and,
b. Whether or not the items were
in use at the time of the injury. For example, an injured worker (IW) has a
hearing aid in a pocket and not his/her ear at the time of the injury, but the
device is damaged in the course of the industrial accident.
2. BWC pays for repair or
replacement of an item one time for each industrial accident resulting in
B. Repair - The MCO shall
approve only a repair when:
1. The denture, eyeglasses or
hearing aid is repairable; and,
2. The cost of the repair would
be less than the replacement cost.
1. BWC shall only pay for
replacement dentures, eyeglasses or hearing aids when the IW submits
documentation from the original supplier or a servicing provider (e.g., a bill
or an itemized statement of the original item).
2. The MCO shall only approve a
deluxe feature (e.g., anti-reflective or scratch-resistant coating for glasses,
bluetooth-capable hearing aids) on a replacement of dentures, eyeglasses or
hearing aids when the IW submits documentation from the service provider
attesting that a deluxe feature was on the damaged item.
3. The MCO shall only approve a
replacement of dentures, eyeglasses and hearing aids based on the BWC fee
4. It is the responsibility of
the IW to pay for any exams necessary to obtain replacement dentures,
eyeglasses and hearing aids.
D. BWC shall not pay for any
other personal use items damaged in an industrial accident (e.g., shoes, jewelry,
E. Requests to reimburse an IW
directly for services the IW paid out-of-pocket must be submitted within the
1. One year of the date of
2. One year after the earlier
a. The Staff Hearing Officer
b. The final administrative or
judicial order allowing payment.
A. The MCO shall process
requests submitted via the Physician's Request for Medical Service or
Recommendation for Additional Conditions for Industrial Injury or Occupational Disease
(C-9) in accordance with the C-9 procedures.
B. Field Staff shall refer all
requests for repair or replacement submitted via a Motion (C-86) to the
MCO on an “MCO Referral” letter, in accordance with the Motions policy
C. When the MCO receives a
reimbursement request for repair or replacement of denture, eyeglasses or
hearing aid that the IW, employer or other third party has already paid, the
MCO shall request:
1. A receipt; and
2. Proof of payment.
D. The MCO shall review the
documentation provided to determine if it is payable.
1. If it is determined that the
service is payable, the MCO shall:
a. Submit to BWC a Service Invoice
(C-19) with the explanation of benefits code 771 referenced; and
b. Reimburse the IW, employer or
other third party.
2. If it is determined the
service is not payable, the MCO shall notify the party requesting