Bowden v. Hillsborough County Sheriff’s Office
OJCC Case No. 13-004600MAM
Denial of Authorization for Dental Treatment
The claimant, a Sheriff’s Deputy, was involved in a motorcycle accident on 1/23/2010. He sustained multiple injuries to the right side of his body including his teeth and mouth. The Employer/Carrier authorized dental treatment which included crowns, root canals and a bridge. He did have a fair amount of dental work done prior to the accident including some of his teeth “exploding” due to decompression while deep sea diving.
The course of restorative dental treatment authorized by Employer/Carrier and provided in the months following the work accident concluded toward the end of 2010. Thereafter, claimant did not seek authorization of further dental treatment through workers’ compensation until 2020 (NOTE: Claimant continued to see his authorized orthopedist for other injuries 1x a year to prevent the SOL from tolling). At that time, the authorized doctor testified that the industrial accident was not the major contributing of his current dental issues.
The claimant obtained a dental IME who testified that the industrial accident was the major contributing cause due to dry mouth caused by use of opioid medications as a result of the industrial accident. That IME doctor was mistaken in concluding that the claimant was taking the opioid medication due to the work accident but was actually taking it due to cancer treatment unrelated to the industrial accident. In his deposition, that doctor changed his opinion and testified that the need for treatment was not due to dry-mouth but due to the trauma related to the industrial accident. The IME doctor attempted to cite a number of studies to support his theory of late onset but was unable to identify which teeth were immediately affected and treated after the industrial accident.
The Employer/Carrier obtained its own IME who testified that the clamant had very poor dental hygiene, and that the industrial accident had little to no effect on the claimant’s current medical conditions. The IME doctor stated that the dental damage from the industrial accident had been restored but just not maintained. JCC Clark accepted the opinions of the treating and E/C IME doctors citing his shift of focus from the xerostomia to the late-onset theory negatively impacted his credibility and brought his objectivity into question.
The takeaway? Know pre-existing conditions and know personal treatment as it may affect arguments and defenses tied to compensability. Also, know what the providers are going to opine before deposition (not at deposition) and always elect an IME, just in case an opinion “flips” despite your best efforts.