Non-specialist physician's combined first report and invoice for every first visit on a work injury.
- Completed by
- Physician (general practitioner / non-specialist)
- Issued by
- WCB-Alberta
- Format
- Online portal or EMR
- Language
- English
WCB Alberta Dental Report C055/C887 (First/Progress)
WCB-Alberta's dental report records a work-related dental injury, any emergency treatment and the treatment still needed, with one form serving as the first report (C-055) or a progress report (C-887). It is completed at the first examination and sent with a cost breakdown of the proposed treatment, because all dental care other than the examination and emergency treatment must be pre-authorized.
Who completes it
The examining dentist completes the whole form: worker details, history of injury, damage to teeth or prostheses, emergency and further treatment, pre-existing conditions, complicating factors, X-rays and any specialist referral. The worker does not complete a section.
Submitting and payment
- How to submit it
- Email the report, the standard dental claim form and dated diagnostic-quality X-rays and photos (.jpeg) to WCB-Alberta's dental inbox within 2 business days of the examination.
- Who pays
- WCB-Alberta pays general practitioner and specialist first and progress reports at Alberta Dental Association fee guide rates, and the worker cannot be billed directly under section 86 of the Workers' Compensation Act.
Good to know
- Submit pre-authorization for the treatment plan on a standard dental claim form with the WCB claim number; TMJ treatment and dental implants must be pre-authorized by a WCB Dental Consultant.
- WCB covers restoring dental function to the pre-accident state only; cosmetic refinements are not covered, and pre-accident oral hygiene affects which procedures are authorized.
- Incomplete or illegible reports are returned unpaid. Type or print in black ink, since every form is electronically scanned.
- Implant replacement is limited to once every 10 years and denture replacement to once every 5 years when ongoing responsibility is accepted.
Get the official form
Download the current version from the source each time; forms change without notice.
Dental report - C055/C887
Fill it with Vero
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Frequently asked questions
When is the WCB-Alberta dental report due?
Complete it at the time of the examination and send it to WCB within 2 business days, together with a cost breakdown of the proposed treatment. The Dental Guide (C-616) says X-ray images, photos and panorex are required for all claims and should be dated and of diagnostic quality.
Can I bill the injured worker for dental treatment?
No. The form states that the worker cannot be charged directly, and the Dental Guide cites section 86 of the Workers' Compensation Act: no part of the cost of treatment related to the compensable injury is payable by the worker. WCB pays only for workers entitled to benefits under the Act.
Does WCB-Alberta need a medical-legal report from the dentist?
Generally not. The Dental Guide says medical-legal reports are not required unless WCB specifically requests one, and requested reports are paid according to the current WCB fee guide. Additional or sensitive information can be sent on a separate sheet attached to the dental report.