Court Rules Against Maximum Fines for Zirconia Implant Restorations

Korea: In a recent court ruling, the Seoul Administrative Court declared that imposing fines at the maximum legal limit without considering the motives, purposes, processes, and outcomes of using zirconia implant restorations is illegal. 

The lawsuit was filed by an unnamed Foundation against the Ministry of Health and Welfare, and the court ruled in favor of the plaintiff on June 23. The foundation had been fined 600 million won (US$460k) for using zirconia as a restorative material in implant procedures for patients aged 65 and older and claiming reimbursement for the costs. Dissatisfied with the fine, the foundation took legal action against the Ministry of Health and Welfare.

Ruled an Abuse of Discretion

The court acknowledged the arguments presented by the foundation and reportedly deemed the Ministry of Health and Welfare’s imposition of the maximum fine amount as an abuse of discretion with regards to the foundation’s choice of restorative materials. 

It determined that the use of zirconia in the case was not an excessive medical procedure but rather a suitable material selected for the patients’ treatment. The court also noted that the patients were not burdened with additional costs.

Additionally, the court found that there was no significant difference in the benefits obtained from reimbursed implant procedures and zirconia implant procedures. It clarified that the selection of restorative materials was related to the third stage of the three-tiered care standard and not directly linked to the initial two stages of treatment and procedures. 

Demand for Zirconia Restorations in Insurance

Within the dental field, there has been a growing demand to include zirconia restorations in dental implant health insurance for the elderly. The 72nd regular general assembly of the Korean Dental Association held this year saw the approval of proposals related to the application of zirconia implant insurance, as presented by the Gyeongbuk, Seoul, and Gangwon branches. 

These proposals highlighted the need to update insurance coverage to align with advancements in dental materials, particularly zirconia and custom abutments. The prohibition on using these materials under insurance coverage has been viewed as an unjust act that places dentists in a difficult position when determining necessary treatments for their patients.

Mitigating Factors for Certain Stages

Park Chan-kyung, a legal adviser, commented on the court ruling, stating that it “mentions that there are mitigating factors specified in the National Health Insurance Act Enforcement Ordinance Appendix for the first and second stage treatments.” 

Park goes on to speculate that “considering these factors, the fines for the first and second stages may be reduced. However, there are no mitigating factors for the third stage, so the fine for the third stage cannot be reduced. Therefore, it is expected that the total fine will be reduced.”

This court ruling holds significant weight as it challenges the previous administrative standards set by the Ministry of Health and Welfare, which initially imposed the maximum fine without considering the motives, purposes, processes, and outcomes of using zirconia as a restorative material in implant procedures. The ruling sets a precedent that may have an impact on similar cases moving forward.