Monday, January 31, 2011

How can i claim from my insurance co for dental work required as a result of a broken jaw?

Hi - when on a trip to Bolivia in February '09, i was in a cycling accident which resulted in me breaking my jaw in 4 places and breaking a number of back teeth. I was in hospital for a week and had an operation to fix my jaw. Because i wasn't physically able to open my mouth for the dentist to repair the damage done this work was not carried out. The insurance company i am with informed me they would cover the costs of ALL work required. After a week they advised i travel back to Ireland (as travelling on would mean they wouldn't cover me for any additional damage i might do to myself) On travelling home i visited my dentist however as my jaw remained to be wired shut there wasn't anything he could do to help. He advised in writing that i should get treatment as soon as i arrived in Sydney. I visited a dentist on numerous occasions since arriving in Sydney and he drafted up a dental report stating quite clearly what work i require, all of which is as a result of my cycling accident. When i mentioned this to my insurance company they kept saying because i travelled home this ended the cover on my policy. I have been trying to argue the point i only travelled home becuase that is what they told me to do - but that they had already agreed to cover ALL costs (they were aware at the time that i required extensive dental treatment) The dentist in Sydney has estimated this is going to cost in excess of $35,000 to repair (broken roots etc...). What are my entitlements here? Although i travelled home - because of the nature of this case am i entitled to get the insurance company to cover my treatment?
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I've never heard of a clause that says you can't be covered because you returned home (although anything is possible and I'm not familiar with Australian insurance). I would have the dentist submit a pre-estimate of the work needed and be sure to include info that it was due to an accident (details and paperwork.) If you receive a denial then I would ask them to provide a copy of the exact wording in the contract that they are using to deny the coverage. Also see if you can be provided with a copy of the contract/policy. You might need to consult an insurance commissioner (if you have those) or whatever group oversees insurance. If you do so, be sure to have as much as possible in writing.
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