Database Search Result Details
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First Name
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THOMAS
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Last Name
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LASH
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Decision Date
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12/20/1988
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Docket Number
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35-88-147
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ALJ
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NK
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Respondent
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OHIO COUNTY BOARD OF EDUCATION
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Employment Type
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PROF
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Job Title
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PROFESSIONAL
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Topics
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EMPLOYEE BENEFIT; INSURANCE
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Primary Issues
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ALLOWABLE CHARGES ON EMPLOYEE'S DENTAL INSURANCE PLAN
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Outcome
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GRANTED
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Statutes
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Related Cases
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Keywords
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INSURANCE; BENEFIT; COVERAGE; DENTAL;
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Intermediate Court of Appeals
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Circuit Court
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Supreme Court
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Synopsis
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Grievant is an employee of the BOE; he and his family are covered under the board's dental insurance plan. Grievant's son has been under dental care since the age of three for congenitally missing teeth. The St. Superintendent made an administrative decision to expand/enhance the plan's state benefits, which allowed only for replacement of teeth lost by damage or injury, to include replace of grievant's sons' teeth. St. Supt disallowed replacement of the missing teeth by implant and stated his reason that implants were not covered by the plan. Grievance Granted; in this instance, when the superintendent expanded coverage of the school board's dental plan, an employee benefit, to allow for replacement of congenitally missing teeth with the least expensive professionally adequate treatment, he was then reasonably bound to allow coverage for treatment deemed professionally adequate by the dental experts familiar with the insured's specific needs. Disallowance of coverage for the tooth implants deemed only professionally adequate treatment by two professionals was unreasonable and arbitrary.
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