Workers' Compensation/No-Fault Insurance

Update: The New York State Workers’ Compensation Board has adopted a new Dental Fee Schedule, effective November 13, 2025.
Beginning August 1, 2025, all dental providers must submit the CMS-1500 form electronically through a Board-approved submission partner.

When treating a patient injured on the job (Workers' Compensation) or in a motor vehicle accident (No-Fault), dentists must abide by the rules and regulations of the NYS Workers' Compensation Board or the NYS Department of Financial Services, respectively. Dental claims are billed to the patient's Workers' Compensation or No-Fault insurance carrier. For both of these programs, dentists cannot collect fees in excess of those allowed by the  NYS Workers' Compensation Dental Fee Schedule. Both Workers' Compensation and No-Fault share the same fee schedule.

Dentists are not compelled to treat patients injured in these types of accidents; however once they agree to do so, they are required to accept the fees established by the carrier as payment in full. The treating dentist cannot balance bill the patient for any difference between the NYS Workers' Compensation Dental Fee Schedule and the usual office charge for the same treatment procedures. Patients cannot establish “private pay” arrangements with their dentists. If a dentist chooses not to accept the Dental Fee Schedule, the patient's only option is to obtain care from a doctor who will.

As part of an initial examination, dentists should question patients about the source of any apparent injuries and document the source of the injuries in the patient record. Not knowing whether an injury occurred in the workplace or involved a motor vehicle accident does not exempt the doctor from Workers' Compensation or No-Fault program requirements.