Jenkins v Accident Rehabilitation and Compensation Insurance Corporation

IN THE DISTRICT COURT Decision No. 96 / 96 AT WELLINGTON UNDER THE Accident Rehabilitation and Compensation Insurance Act 1992 AND IN THE MATTER of an appeal pursuant to Section 91 of the Act BETWEEN DOROTHY MAVIS JENKINS DCA No. 113/96 APPELLANT AND ACCIDENT REHABILITATION AND COMPENSATION INSURANCE CORPORATION a body corporate duly constituted under the provisions of the said Act RESPONDENT Date of Hearing: 25 July 1996 Date of Decision: 30 Sept 1996 Appellant in person Counsel for Respondent Ms R F Irving DECISION OF JUDGE J.H. LOVELL-SMITH The issue in this appeal is whether the respondent has any responsibility to pay the appellant for dental costs incurred over and above the limits set down in the Accident Compensation (Dentists' Costs) Regulations (No.2) 1990 ("The dental regulations"). 2 The appellant suffered severe injuries including severe facial and dental injuries in a car accident on 7 December 1990. As a result the appellant has required continuing dental care. The respondent received a form from the appellant on 30 June 1995 seeking approval a dental treatment costs in respect of a crown replacement and a possible root filling of one of her teeth. The estimated costs were $791.80. A DI Dental Treatment form was received by the respondent from the appellant's dentist specifying that the treatment would be to Tooth 15, and confirming the total fee would be $791.80. The appellant was advised in writing on 21 July 1995 that the respondent had approved the following payments for treatment costs: No. 21 - Root Therapy $136.75 No. 45 - Crown $462.85 No. 52 - Core $55.45 The appellant's dentist advised the respondent on 14 August 1995 that there was a $400 discrepancy between the costs the respondent had approved and the actual fee for the treatment and asked it whether the appellant could recover this cost through the respondent. The respondent's reply was that payments were made to the appellant based on the provisions of the dental regulations. 3 The invoice for dental treatment was received on 22 September 1995 and the dental treatment costs were paid in accordance with the Dental Regulations of 2 October 1995 which was less than the full amount incurred by the appellant. This decision was upheld by a review officer. The Dental Regulations provide: (1) Subject to these regulations, the respondent shall pay the costs of any treatment provided by a dentist to any claimant in respect of personal injury.... to the extent specified in the schedule to these regulations. (4) Respondent to pay certain costs (1). Subject to these regulations, the respondent shall pay the costs of treatment provided by a dentist to any claimant in respect of personal injury...to the extent specified in the schedule to these regulations. The Dental Regulations contain a schedule of maximum costs for 74 separate items of service payable by the respondent for treatment provided by dentists. The items in respect of the appellant's case are: 21. Septic root canal treatment and root filling, permanent teeth (per canal) $136.75 45. Porcelain baked, to metal crown, or full gold crown $462.85 52. Metal-parapost or similar $55.45 I agree with the approach adopted by Middleton J in Evison -v- ARCIC (22/96) that "the wording of the Dental Regulations is strict and provides no discretion for either the respondent or this Court to deviate from those provisions". In the appellant's case, the total work performed by the appellant's dentist exceeded the amount which the respondent was able to contribute under the Dental Regulations and the respondent is unable to make any further contribution to her dental costs. The appeal must be dismissed. There will be no order for costs. Jane H. Lovell-Smith District Court Judge