TMD MED-LEGAL

As trauma, especially the trauma of whiplash injury, has been identified as a precipitating factor for temporomandibular disorders, TMD med-legal disputes frequently arise. This is specifically because casualty insurance, personal health insurance and dental insurance carriers do not want to be responsible for diagnostic and treatment costs. These companies then routinely deny coverage and compensation.

tmjd med legalThe general topic of temporomandibular disorders is a point of contention within the worlds of personal health and dental insurance because of the lack of specificity in identifying the signs and symptoms of TMD, a complete lack of standardization of protocol for diagnosing and treating them and the prevailing myth that TMD is a dental disorder. This allows any health insurance company to pass off diagnostic and treatment costs to the patients’ dental insurance. The dental insurance may well have a TMD exclusion (or not recognize TMD) and then the bills are then routinely denied.

The issue of traumatic causation is another issue. Casualty insurance carriers do not want to be responsible for TMD treatment delivered when causation is linked to trauma to persons insured by their companies. While coverage here is denied aggressively on the basis of causation, the same issues of diagnostic accuracy, need for treatment(s), acceptable treatment protocol(s) and prognosis are shared by all of these insurance entities.

Financial responsibility rests more heavily with the casualty insurance carriers however, as they do not have the same TMD exclusion clauses found in the health and dental insurance policies. Thus, for one reason or another, many TMD cases come to be litigated. This places a burden on all health professionals treating TMD and brings them into the world of lawyers and litigation. The good news is that examination, diagnosis and treatment of TMD is held to a higher standard. This is good for all concerned.

These issues will be addressed in detail on this blog.


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