Department of Labor and Workforce Development
James G. Neeley, Commissioner
Frequently Asked Questions - Workers' Compensation
BENEFIT REVIEW
The Workers' Compensation Division has representatives that can assist employers, employees, and insurance carriers. If you have questions or problems relating to a workers' compensation injury, call 1-800-332-2667 (within Tennessee) or 615/532-4812. If the representative cannot resolve the issues, a Workers' Compensation Specialist can assist in resolving disputes and settling claims at no cost to the employer or employee.
The role of the Representative is:
To be the "first line of assistance" in cases with problems and/or disputes.
To examine claims to insure accurate processing of benefits to injured employees.
To advise employees and employers of rights and requirements under workers' compensation laws.
To visit and consult with employers to verify coverage and compliance with safety requirements and to insure posting of the Tennessee Workers' Compensation Insurance Notice.
To explain to all interested parties the laws, rules, and policies governing workers' compensation.
A Workers' Compensation Specialist will also conduct a benefit review conference for all injuries occurring on or after January 1, 1997, that do not reach a final settlement and where the parties do not waive this requirement. A benefit review conference is a non-adversarial mediation that takes place with the Specialist mediating the case between the employee and the employer/insurance carrier.
The role of the Specialist is:
To resolve/arbitrate the question of compensability in disputed workers' compensation cases.
To conduct benefit review conferences for the purpose of trying to resolve disputed issues through the process of mediation.
To review and approve or reject proposed settlement agreements in disputed workers' compensation cases.
The Reform Act of 1996 authorizes the Commissioner of Labor and Workforce Development, or his designee (workers' compensation specialist), to approve proposed settlements between the parties if:
The settlement has been signed by the parties; and,
The Commissioner of Labor and Workforce Development or a workers' compensation specialist has determined the employee is receiving, substantially, the benefits provided by law or is in the best interest of the employee; and,
The settlement agreement is reviewed by a specialist not associated with the employee's case.
A settlement approved by the Tennessee Department of Labor and Workforce Development shall be entitled to the same standing as a judgment of a court of record.
CASE MANAGEMENT AND UTILIZATION REVIEW
Medical Case Management
The purpose of this program is to coordinate the medical care services provided to employees claiming benefits under the Law.
Employers may, at their own expense, utilize case management. If utilized by employer, employee must cooperate.
At least one face-to-face visit between the case manager and the employee will be required within 14 calendar days after referral. Documentation of this meeting must be provided to the Medical Director of the Division of Workers' Compensation.
Case Management services shall include, but not be limited to:
Development of a treatment plan to provide appropriate medical services.
Monitoring the treatment and medical progress.
Assessing whether medical services are appropriate and delivered in a cost-effective manner, based on acceptable medical standards.
Ensuring that the injured employee is following the prescribed medical care plan.
Formulating a plan for return to work, with due regard for the employee's recovery, restrictions, and limitations, if any.
Utilization Review
The purpose of utilization review, together with medical case management, is two-fold:
To ensure that quality medical care services are available to injured and disabled employees.
To establish cost control mechanism to ensure cost-effective delivery of medical care services and to control increasing medical costs in workers' compensation cases.
The "UR" system provides for:
Review of selected outpatient and inpatient health care providers; and
Pre-admission review of all hospital admissions, except for emergency services.
Utilization review is required in every case which exceeds $5,000 in total medical costs.
Utilization review services must be provided or contracted for by:
Each insurer who provides workers' compensation insurance in Tennessee.
Every self-insured employer.
The insured employer may choose to provide the services on its own or though a third party administrator.
A health care provider who is found to have rendered excessive or inappropriate services may be subjected to:
Forfeiture of the right to payment for the services rendered;
Payment of civil penalty of up to $1,000;
Temporary or permanent suspension of the right to provide medical care services for workers' compensation claims.
What is case management?
Case management is the ongoing facilitation and coordination of medical care services provided to an injured employee. This is done to promote the most cost-effective medical treatment without compromising the patient's quality of care.
What is utilization review and when is it required?
Utilization review is the evaluation, by an outside source, of the necessity, appropriateness, efficiency, and quality of medical care services provided to an injured employee. Utilization review is required:
If outpatient care results in medical costs in excess of $5,000.00.
For pre-admission of all hospital admissions except for emergency services, which shall begin within one (1) working day of all emergency hospital admissions.
CLAIMS
FIRST REPORT OF WORK INJURY, FORM C20
The Workers’ Compensation Division has released a new version of the Tennessee First Report of Work Injury, Form C20. The form has been modified to meet Occupational Safety and Health Administration (OSHA) requirements and the International Association of Industrial Accident Boards and Commissions (IAIABC) standards for Electronic Data Interchange (EDI).
OSHA REQUIREMENTS: The OSHA 200 log has been replaced with the OSHA 300 log. The OSHA 101 form has been replaced with the OSHA 301 "Injury and Illness Incident Report".
Historically, the "Tennessee First Report of Work Injury" (First Report) has been an allowable substitute for the OSHA 101 form. The First Report has been revised to meet the new OSHA requirements so that the substitution can continue. Use of the revised First Report will eliminate the need for filing the OSHA 301.
OSHA requires employers to maintain a copy of either the First Report or the OSHA 301 on site and available to Tennessee Occupational Safety and Health Administration (TOSHA) representatives.
WHEN AN EMPLOYEE IS INJURED, THE EMPLOYER SHOULD:
Fill out a Form C-20, First Report of Work Injury.
It is mandatory to offer the injured employee a panel of three physicians. If you do not have a panel, call your insurance carrier and develop one. Post the panel so your employees will know who they are allowed to see if they are injured. A signed C-42, "Agreement Between Employer/Employee Choice of Physician" is the employer's proof that the employee was offered a choice of physicians. A copy of this completed form must be provided to the employee. The employer must keep the original form on file and upon request provide a copy to the Division of Workers' Compensation.
Inform the employee of the name and telephone number of the insurance carrier/adjuster.
Submit a statement of the employee's wages to the insurance carrier. The statement should show the gross wages earned each week for the past fifty-two (52) weeks. If employed less than 52 weeks, the statement should show number of weeks worked and gross wages earned each week. Include overtime, bonuses, etc.
File the First Report of Work Injury with your insurer within one working day of knowledge of injury. A wage statement should accompany the First Report or be sent to the insurer as soon as possible. The claim must be reported to your insurer even if you feel the claim is not compensable. The insurer can investigate and deny the claim if appropriate.
WHEN AN INJURY OCCURS THE INSURER MUST:
Make personal or telephone contact with the employer and the injured employee within two (2) working days of notice of injury.
Accept or deny the claim within fifteen (15) days of the knowledge of the injury. You must notify the employer and the claimant of your decision within fifteen (15) days.
Issue compensation payment to the claimant no later than fifteen (15) days after notice of injury. All workers' compensation benefits must be issued timely (on or before due date).
Send a copy of the First Report and the Notice of First Payment or Notice of Denial to the Division of Workers' Compensation no later than fourteen (14) days after notice of injury.
Effective February 28, 1998, Chapter 0800-2-14, Claims Handling Standards, were added to the General Rules and Regulations of the Tennessee Department of Labor and Workforce Development, Division of Workers' Compensation. Additional information on filing this information can be found under Electronic Date Interchange (EDI).
The purpose of the Claims Handling Standards is to assure that employees sustaining an injury arising out of and in the scope of employment are treated fairly and to assure that workers' compensation claims are handled in an appropriate and uniform manner. The provisions shall apply to all employers in the State of Tennessee subject to the provisions of the Workers' Compensation Law.
CLAIMS HANDLING STANDARDS OVERVIEW
EMPLOYERS SHALL:
Report verbally or in writing all known reported accidents to their insurer within one working day of knowledge of injury.
Submit a statement of the employee’s wages to the insurance carrier. The statement should show the gross wages earned each week for the past fifty-two (52) weeks. If employed less than 52 weeks, the statement should show number of weeks worked and gross wages earned each week. Include overtime, bonuses, etc.
FILING REQUIREMENTS
Every insurer shall file with the Division a report of accident on Form C-20 (Tennessee Employer’s First Report of Work Injury) pursuant to Rule 0800-2-1-.06.
A wage statement to insure the correct rate of compensation shall be filed with the Division and shall accompany the Form C-22 (Notice of First Payment of Compensation) or Form C-23 (Notice of Denial of Benefits). Filings shall be made pursuant to Rule 0800-2-1-.07.
Form C-23 (Notice of Denial) shall be filed with the Division within ten (10) days of denial and a copy of Form C-23 shall be provided to the claimant within the same time frame.
REQUIRED CONTACTS
Upon verbal or written notice of any injury from an employer, the insurer shall make verbal or written contact with the claimant within two (2) working days to confirm facts of the claim, history of prior claims, work history, wages, and job duties. This may include a recorded statement.
Insurers shall make personal or telephone contact with the employer within two (2) working days of notice of accident to verify accident details. Insurers and employers shall obtain a description of the job and prior claim information of the claimant within five (5) working days. All pertinent witnesses shall be contacted by the insurer as they become known.
Insurers shall contact physicians who have rendered medical services to a claimant within seventy-two (72) hours of verbal or written notice to confirm injury and treatment and make preliminary compensatory determination.
All aspects of contacting and attempts to contact insureds, the claimant and physicians shall be documented within the insurer’s file.
COMPENSABILITY DETERMINATION
Decisions on workers’ compensation insurance coverage and compensability shall be made within fifteen (15) days of verbal or written notice of accident. All pertinent documents of the division of workers’ compensation shall be filed within fifteen (15) days of verbal or written notice of accident. Claimants and employers shall be notified of the decision of compensability within fifteen (15) days of verbal or written notice of accident.
Denial of a claim shall be supported with documented results of the investigation. Form C-23 (Notice of Denial) shall be filed with the Division within ten (10) days of denial and a copy of Form C-23 shall be provided to the claimant within the same time frame.
If an insurer denies a claim, the insurer shall provide documentation which meets the statutory criteria for denial on Form C-23 upon request by the Division, employer, claimant, and/or their legal representatives.
PAYMENT OF BENEFITS
Compensation payments for an injury shall be received by the claimant no later than fifteen (15) days after notice of injury.
All workers’ compensation benefits shall be issued timely to assure the injured employee receives the benefits on or before the date they are due.
RESOLUTION PROCESS
A medical impairment rating and date of maximum medical improvement by the treating physician, and information needed to settle a claim shall be documented in writing.
Insurers shall make an offer of settlement in writing within thirty (3) days of receipt of information specified above, 0800-2-14-.06(1). The claimant shall sign the offer of settlement indicating approval or rejection of the offer.
An agreed settlement shall be finalized by order of a court or approval by the Division as required by TCA §50-6-206. A copy of the court order or division approval shall be filed with the Commissioner of Tennessee Department of Labor.
If settlement is not agreed upon a Benefit Review Conference may be requested pursuant to TCA §50-6-237.
MEDICAL COSTS
All medical costs owed under the Tennessee Workers’ Compensation Law shall be paid within forty-five (45) days of receipt of bill or invoice. Also within forty-five (45) days, if additional documentation is required for payment, the party requesting payment shall be informed of the needed information. There is no obligation to make payment until adequate documentation is received.
Medical invoices shall contain the following characteristics:
(a) CPT (Procedure) Code
(b) ICD 9 (Diagnostic) Code
ENFORCEMENT
In addition to other penalties provided by applicable law and regulation, violations of any of the above rules shall be subject to enforcement by Commissioner of the Tennessee Department of Labor pursuant to TCA §50-6-419(c).
CLAIMS FREQUENTLY ASKED QUESTIONS
How and when does a workers' compensation claim need to be filed?
An injured employee should immediately report an injury in writing to their employer.. If circumstances of an injury prohibit immediate reporting, an injured employee must report the injury no later than thirty (30) days after the injury.
Employers should fill out Form C-20, Employers' First Report of Work Injury on every reported injury that results in the employee seeking medical attention. The First Report should be sent to the employer's workers' compensation insurance carrier within one working day of knowledge of the injury. Note: Employers should report the injury or illness to the insurance carrier even if it is not clear the claim is valid. The insurance carrier has authority to investigate and determine, in their opinion, if the claim is compensable.
The First Report and any other available information such as a doctor's statement or a wage statement should be sent to the employer's workers' compensation carrier. The insurance carrier or self insured employer should report the injury to the Division of Workers' Compensation as soon as possible, but not later than fourteen (14) days after the injury.
Upon reporting a workplace injury, what information should be given to the injured employee?
Upon reporting a workplace injury, an employer should provide the employee, in writing, a choice of three (3) physicians not associated together in practice. In the event of a reported back injury, the choice of physicians is expanded to four (4) physicians, one of whom must be a chiropractor. The choice of physicians should be located in or near the employee's community of residence. The employee has the privilege of choosing one physician from the list. This selected physician becomes the “treating physician.” The employee is then required to accept treatment from the treating physician and should not seek treatment from any other physician unless the treating physician makes a referral. Form C-42, "Agreement Between Employer/Employee Choice of Physician" must be completed, a copy given to the employee, and the original kept on file with the employer.
The employer should have a "Tennessee Workers' Compensation Insurance Notice" posted so the injured employee can see the name of the insurance carrier. If the notice is not posted, the employer should tell the injured employee who the insurance carrier is and how to reach the insurance carrier.
How and when are payments made to the injured employee?
When the treating physician takes an employee off work due to a work related injury, workers' compensation insurance carrier makes payments to the injured employee. The amount of payment is 66 2/3 of the employee’s average weekly wage for the fifty-two (52) weeks prior to the date of injury. (There are statutory minimum and maximum amounts for workers’ compensation benefits.) First payment is due within fifteen (15) days of knowledge of injury and benefits should be paid at least semi-monthly. Claims Handling Standards state, "All workers' compensation benefits shall be issued timely to assure the injured employee receives the benefits on or before the date they are due."
In order to qualify for workers’ compensation payments, an injured employee must have a doctor's statement for time out from work. Count every calendar day covered by the doctor's off work statement. Do not count the date of injury. Days off work do not have to be consecutive. If an injured employee is returned to work and then has to miss additional days, count every day covered by the doctor's excuses.
Workers’ compensation payments are not paid to an injured employee for the first seven (7) days of disability. Workers’ compensation payments commence on the eighth (8th) day the treating physician takes an injured employee off work. Beginning on the 8th day, an employee is eligible for one day's benefits. On the ninth (9th) day, an employee is eligible for two days' benefits, and so on. If the employee continues to lose time from work through the fourteenth (14th) day, the seven-day waiting period will be picked up and the employee will be due benefits retroactive to day one (1) of the period of time the treating physician has taken an injured employee off work.
PRESCRIPTION MEDICATION ORDERED BY TREATING PHYSICIAN: Generally, an injured employee pays the pharmacy when the prescription is filled. Injured employee should file receipt for medication with the insurance carrier for reimbursement.
How much will the injured employee receive in benefits? How are the payments figured?
An employee is entitled to 66 2/3% of his/her average weekly income, within statutory maximum or minimum amounts. The employer must submit a wage statement, using Form C-4, Tennessee Department of Labor and Workforce Development Wage Statement, to the insurance carrier. This wage statement will list an injured employee’s gross earnings for the past fifty-two (52) weeks prior to the date of injury. The wage statement should reflect all earnings, including overtime. Gross earnings are totaled, then divided by 52. The result is the employee's average weekly wage. Multiply the average weekly wage by .6667. The result is the employee's weekly compensation rate. The weekly compensation rate may not be higher or lower than maximum and minimum rates in effect on the date the employee was injured. Note: If an employee has worked at the place of employment fewer than fifty-two (52) weeks, the weekly compensation rate may be figured by one of the following methods:
A. Total the number of weeks an injured employee has been employed. Calculate gross earnings for those weeks. Divide gross earnings by the number of weeks employed.
or
B. Calculate the average weekly wage over 52 weeks being earned by a person employed with the same employer performing the same job as the injured employee.
When do workers' compensation benefits stop?
There are several circumstances under which benefits stop:
The injured employee should be offered a settlement in writing within thirty (30) days of receipt of the medical impairment rating. This applies only to those employees whose injuries result in permanent disability. It is unlikely a offer of settlement will be made if an employee recovers completely from the injury.
How is a settlement determined?
A settlement is appropriate when, after an injured employee reached maximum medical improvement, the employee retains a disability resulting from the work-related injury. The employee’s treating physician will determine in writing a percentage of Impairment and state the part of the body affected. This is called an “impairment rating.” There are many variables in the computation of a rating but the percentage will be based on standard criteria used by all physicians to determine the percentage of impairment retained. A Workers' Compensation Specialist can assist in figuring an appropriate range of settlement for vocational disability, however, the Specialist will need to know the exact wording the doctor used when giving the rating, percentage of Impairment the treating physician assigned, which body part was injured, and Employee's weekly compensation rate.
What happens if the injured employee is released to return to work on light duty, but light duty is not available?
Following a work related injury, during the course of treatment, the treating physician may determine an injured employee can return to work “light duty.” Employee should get a detailed description of work restrictions from the doctor to provide the Employer. If the employer can provide work within those restrictions, they should do so. However, if the employer is unable to meet those guidelines, the injured employee could remain off work and his/her lost time pay would continue. If the employee earns less while restricted to light duty, the employee is entitled to "temporary partial disability" benefits. These payments are figured at 66 2/3% of the difference between light duty pay and full duty wages, subject to the maximum and minimum workers' compensation rates in effect on the day the employee was injured.
Example:
Employee was earning $300.00 per week.
Employee is earning $200.00 per week on light duty.
$300.00 minus $200.00 equals $100.00 difference in pay on light duty.
66 2/3% of $100.00 equals $66.66.
Employee will earn $200.00 in wages and receive $66.66 in workers' compensation benefits.
Is the injured employee paid for work time lost to attend doctor appointments during work hours?
No, not unless it is company policy.
Should the injured employee receive doctor's bills?
When an injury is treated under workers’ compensation, a health care provider should not bill or sue the injured employee for all or part of the costs of health care services provided to the injured employee unless:
COVERAGE
Tennessee Code Annotated, §50-6-407 has been amended effective July 1, 2003. The requirement for the Certificate of Compliance has been deleted.
Now, every employer is required to display the 'Tennessee Workers' Compensation Insurance' notice. This notice should provide the name, telephone number and address of the employer representative that can confirm if an employer is subject to the workers' compensation law and if so to obtain the name of the workers' compensation insurance company. The notice should also contain the name, telephone number, and address of the employer representative that should be notified in the event of an injury. The employer should add the contact information to the notice and post it in an area accessible to all employees.
This notice will be distributed to all parties upon request and will also be available from the Division's website www.tn.gov/labor-wfd/wcomp.html.
COVERAGE FREQUENTLY ASKED QUESTIONS
How many employees do I have to have before I am required to have workers' compensation insurance?
Generally, Tennessee employers with five (5) or more full or part-time employees are required to carry workers’ compensation insurance. Corporate officers and family members, if they meet the definition of employee, are included in the count towards the total, regardless of whether the officer(s) elects to decline coverage. Also, employers in any construction related business or coal mining with one or more employees are required to have coverage.
What happens if I am not required to have workers' compensation insurance and one of my employees has a work-related injury?
The employee is not entitled to workers' compensation benefits, but is not barred from filing a lawsuit against the employer. Note: Employers with a policy in force are protected from lawsuit. The injured employee under workers' compensation could only file a lawsuit against the insurance carrier over a disputed claim.
How much will workers' compensation coverage cost?
Rates may vary with each insurance carrier. Contact several licensed insurance agents to obtain rate information and to find the best possible deal.
If I have less than five employees, can I still get workers' compensation coverage?
Yes, you should file Form I-8, Exempt Employers Notice of Acceptance of the Workers' Compensation Act of Tennessee. You should then keep current workers' compensation coverage at all times. If you drop your workers' compensation coverage, you must file Form I-9, Exempt Employers Withdrawal of Notice of Acceptance. Important: You will remain subject to the workers' compensation requirements until Form I-9 is received by this Division. If you drop your coverage and do not file Form I-9 and an injury occurs, you could be held responsible for that claim.
If I have five or more employees and my workforce drops below five, can I drop my workers' compensation coverage?
Yes. File Form I-3, Reduction of Workforce and notice of withdrawal from coverage of the Tennessee Workers' Compensation Law. You will then be an exempt employer and will not be required to have workers' compensation coverage as long as your workforce remains below five employees.
What if I can't get an insurance company to write a workers' compensation policy for me?
Your agent can go through the Tennessee Workers' Compensation Insurance Plan - Aon, P.O. Box 681089, Franklin, TN 37068 (800) 471-6767 or www.twcip.com. Your agent should have the application on hand.
Who can I exclude from my workers' compensation policy?
Corporate officers may be excluded by filing Form I-6, Corporate Officer Election Not to Accept provisions of workers' compensation. Note: The election of a corporate officer to be excluded does not reduce the number of employees for the purposes of determining the requirements of coverage.
Sole proprietors and partners are excluded from a workers' compensation policy, but may elect to be covered by filing Form I-4, Sole Proprietor/Partner Election to come within the provisions of the Tennessee Workers' Compensation Law. Note: Both the I-4 and the I-6 forms are effective 30 days after the Tennessee Department of Labor and Workforce Development's accepted stamp date. The original should be sent to the Division of Workers' Compensation with all parts filled out and properly sworn to before a notary public or other official.
Subcontractor and General Contractor Information
Any person engaged in the construction industry, including principal contractors, or intermediate contractors, or subcontractors are required to carry workers' compensation insurance on their employees, even if they have less than five.
The subcontractor acting as a self-employed individual is not an employee of the general contractor and has no coverage as long as he is not working as an employee. To determine whether an individual is an employee or subcontractor, the following factors should be considered:
(a) The right to control the conduct of the work;
(b) The right of termination;
(c) The method of payment;
(d) The freedom to select and hire helpers;
(e) The furnishing of tools and equipment;
(f) Self-scheduling of working hours; and
(g) The freedom to offer services to other entities.
A subcontractor can elect to be covered by the general's workers' compensation insurance by filing Form I-15 with the Division of Workers' Compensation. This form allows the general contractor to withhold premiums from the sub's payroll to cover the subcontractor. Form I-15 must be signed and notarized by the general contractor and the subcontractor and filed with the Tennessee Department of Labor and Workforce Development. Failure of the general contractor to file with the Department of Labor and Workforce Development does not relieve the obligation of the insurance company to provide coverage to a subcontractor when the subcontractor can produce evidence of payment of premiums to the insurance company.
The law prohibits the employer from deducting any portion of the workers' compensation premium from the wage or salary of any employee. There is no form that will waive the rights of employees of subcontractors. The subcontractor must provide coverage for his employees.
A subcontractor can have his own workers' compensation coverage and furnish proof of this coverage to the general contractor. A general contractor can require the subcontractor to have workers' compensation insurance. NOTE TO SUBCONTRACTORS OBTAINING WORKERS' COMPENSATION COVERAGE: Most subcontractors are sole proprietors or partners. Sole proprietors and partners are not covered by their workers' compensation policy when it is written; only the employees are covered. The subcontractor who is a sole proprietor or partner may elect to be covered by his own workers' compensation policy by filing Form I-4 with the Tennessee Department of Labor and Workforce Development.
DRUG FREE WORKPLACE PROGRAM
Who to contact for information?
Tennessee Department of Labor and Workforce Development
Drug Free Workplace Program
Lance Wheaton, Program Coordinator, 615/532-1321
Dr. Robert Kirkpatrick, Medical Director
220 French Landing Drive
Nashville, TN 37243-1002
1-800-332-2667
Website: www.tennessee.gov/labor-wfd/dfwp.html
When an employee/applicant is drug tested, is the employer required to utilize a Medical Review Officer (MRO)?
Yes. As defined in the Rules and Guidelines, "Medical Review Officer" or "MRO" means a licensed physician, employed with or contracted with a covered employer, who has knowledge of substance abuse disorders, laboratory testing procedures and chain of custody collection procedures; who verifies positive, confirmed test results; and who has the necessary medical training to interpret and evaluate an employee's positive test result in relation to the employee's medical history or any other relevant biomedical information. The MRO should be used to review all positive tests with the employee or applicant before the employer is advised of the test results. Using an MRO provides the employer with a medically qualified interpretation of a positive test result, which would be defensible in a court of law. The MRO helps to protect both the employer and the employee.
How accurate are the drug testing methods that I will be required to use?
If testing is done in accordance with the Rules and Guidelines, ( Chapter 0800-2 ), the results are highly accurate and reliable. Sometimes, you'll hear that urine drug tests can be "beaten". Once, this was true; people could add water, soap, ammonia, vinegar or even table salt to a specimen and produce a negative test result. Today, collection site and laboratory procedures make tampering nearly impossible. At the collection site, employees must leave coats, purses and briefcases outside the cubicle where they provide the specimen. The person collecting the specimen adds a bluing agent to the toilet bowl and remains in the area directly outside the stall while the specimen is being given. Immediately afterward, the collector applies a temperature strip to the specimen to make sure that it matches body temperature. The collector also checks the specimen for unusual color and odor. Later, when the specimen arrives at the laboratory, technicians perform simple tests for gravity and acidity to detect adulterated specimens. Another misconception is that drug testing is prone to inaccuracy with so-called "false" positives. Several years ago, some over-the-counter drugs such as ibuprofen or diet pills could cause false positives for illicit drugs. Today, tests have been refined to the point where this does not occur. A more legitimate concern is that of true "false" positives. That is, where the laboratory accurately determined the presence of a drug, but its presence is not the result of abuse or illicit use. Certain foods and medicines do contain detectable amounts of "controlled" drugs. For example, poppy seeds used in bagels and other baked goods can sometimes contain enough morphine to produce a detectable level in urine. Over-the-counter drugs that are sold in countries outside the U.S. often contain codeine. Codeine is also found in commonly-prescribed cough and cold medicines, such as Tylenol with codeine, and can produce a positive result in drug tests. In all these cases, a Medical Review Officer ( MRO ) is able to determine if the drug is being properly and legitimately used.
While there have been some reports of errors, they can usually be traced to the fact that a confirmation test was not performed to verify an initial positive result.
Could there be legal challenges?
Yes. The United States Constitution, which restricts governmental but not private actors from arbitrarily interfering with individual rights, prohibits the Government from unreasonably infringing on workers' rights relating to privacy and job security. With respect to workplace privacy, the Fourth Amendment to the U.S. Constitution prohibits unreasonable "searches." In l989, the Supreme Court, considering the issue of workplace drug testing for the fist time, concluded that a public employer taking of blood, urine, or breath specimen for the purpose of alcohol and other drug testing, (or testing conducted by a private employer at the request of the Government), constitutes a search under the Fourth Amendment because it implicates significant privacy concerns. The Court further held that the determination of whether such testing is "reasonable" and therefore constitutionally valid, requires a balancing of the degree of invasion on the individual's privacy interest against the promotion of the employer's legitimate interests. Employment decisions based on a substance abuse test result can be contested. The Courts favor employee testing that is based on procedures that are clear, fair, consistent, and communicated in a written policy statement.
FRAUD
All provisions regarding the detecting, prosecuting, and/or preventing of workers’ compensation fraud shall be governed by TCA §50-6-127 and Title 56, Chapter 47.
To report workers' compensation fraud, please begin by reporting any information available to your insurance carrier or third party administrator. They should have a process in place for fraudulent claims. The Workers' Compensation Division cooperates with persons reporting fraud to refer allegations of fraud to the appropriate District Attorney General.
MEDICAL IMPAIRMENT RATING (MIR) REGISTRY PROGRAM FAQs
Who to contact for help?
Tennessee Department of Labor and Workforce Development, Workers Compensation Division
J. Edward Blaisdell - MIR Program Coordinator
220 French Landing Drive
Nashville, TN 37243
Phone: (615) 253-1613
Fax: (615) 253-5263
cg.wcmirprogram@state.tn.us
What is the purpose of the MIR Registry?
The sole purpose of the Medical Impairment Rating (MIR) Registry is to establish a resource to resolve disputes as to the degree of permanent medical impairment ratings given for injuries or occupational diseases to which the Tennessee Workers’ Compensation Act is applicable. A dispute is recognized whenever at least two different physicians have issued differing permanent medical impairment ratings and the parties disagree as to those ratings; or whenever a physician has issued an opinion that no permanent medical impairment exists, yet the physician has issued permanent physical restrictions to the injured employee. Registry physicians agree to provide evaluations in a manner consistent with the standard of care in their community and in compliance with the MIR Program Rules.
What is the advantage of using the MIR Registry?
Only Registry physicians who are selected pursuant to the Rules of this program shall have his/her impairment rating awarded the legal presumption of accuracy afforded under the Act. Physicians who are selected in a manner other than pursuant to the Program Rules shall have no greater legal presumption of correctness given to their opinion than any other provider’s impairment rating.
Who can request a MIR evaluation?
The Registry is available to a party who disputes the impairment rating of a physician in a Workers’ Compensation claim for injuries or occupational diseases that occur on or after July 1, 2005. A dispute means that either: (a) two different physicians have issued differing permanent medical impairment ratings and the parties disagree as to those permanent impairment ratings; or, (b) a physician has issued an opinion in compliance with the Act that no permanent medical impairment exists, yet the physician has issued permanent physical restrictions to the injured employee. Requests for an evaluation must be submitted by paper or electronic application to the Program Coordinator pursuant to the Rules.
What if more than one impairment rating is disputed?
If there is an insufficient number of physicians on the Registry who are qualified to perform all aspects of the evaluation, separate evaluations may be required, each being separate application and physician-selection processes and fees.
What is the process for obtaining the Medical Impairment Rating?
The following is a brief outline of the Workers’ Compensation Medical Impairment Rating process. This general information may not include all circumstances and is not meant as legal advice.
What resource is used to determine the impairment rating?
All MIR rating reports must be based on the guidelines set forth in the applicable edition of the AMA Guides to the Evaluation of Permanent Impairment. In cases not covered by the applicable AMA Guides, an impairment rating allowed under the Act is appropriate.
How is the MIR physician selected?
Once requested, the Program Coordinator will supply the parties with the names of Registry physicians. The listing provided will be comprised of physicians qualified, based on the information provided by the physician, to perform evaluations on the body part(s) and/or medical condition(s) designated on the application for an evaluation and who practice in the appropriate geographic area. If the parties agree with a physician on that listing, they should notify the Program Coordinator, who will schedule the appointment. If the parties do not agree on a physician, either party may request a three (3) physician listing.
Within five (5) business days of the receipt of the completed “Application for a Medical Impairment Rating” the Program Coordinator will produce a listing of three qualified physicians drawn from its Registry. Psychiatric or psychological evaluations regarding mental and/or behavioral impairment must be performed by a psychiatrist. To guarantee randomness, all physician listings will be derived from qualified physicians who have no conflicts of interest.
Within three (3) business days of the issuance of the three-physician listing by the Program Coordinator, the employer must strike one name and inform the employee and the Program Coordinator of that name. Within three (3) business days of the date of receipt of that name from the employer, the claimant must strike one of the two remaining names and inform the Program Coordinator and the employer of the name of the remaining physician, who will perform the evaluation. If one party fails to timely strike a name from the listing, the other party should notify the Program Coordinator, within ten (10) calendar days, and at the same time provide to the Program Coordinator the name that it wishes to strike. In that situation, the Division’s Medical Director may select one physician from the remaining two, and that physician will perform the evaluation. In all instances, the Program Coordinator will inform the parties of the name of the selected physician in writing.
If a selected physician is unable to perform the evaluation, the Division’s Medical Director will provide one replacement name to the original listing using the same criteria and process set forth above, and present that revised listing to the parties where each must again strike one name according to the procedures set forth. Additionally, if a physician is removed from the three-physician listing for any reason other than having been struck by one of the parties, the Division’s Medical Director will issue one replacement name using the same criteria set forth.
Can the parties still choose a physician, outside the Program, to perform an evaluation?
Yes. Prior to Division participation, the parties may attempt to negotiate the selection of any physician to conduct an evaluation. However, physicians who are selected in a manner other than pursuant to the Program Rules shall have no greater legal presumption of correctness given to their opinion than any other provider’s impairment rating.
Who schedules the evaluation?
Within three (3) business days of providing or receiving notice of the physician selection, the Program Coordinator will contact the MIR physician to schedule the evaluation, and will immediately notify both parties, and the Workers’ Compensation Specialist if currently assigned, of the date and time of the evaluation. Only after this notification should the employer or insurance carrier contact the MIR physician and only to arrange for payment and for medical records submission required by the Rules. All parties are expected to cooperate with the Program Coordinator in scheduling the evaluation and with the requests of the MIR physician to allow the physician to make accurate findings.
Who pays for the MIR evaluation?
The physician performing the evaluation must be pre-paid by the employer a total evaluation fee, as outlined in the table above, for each evaluation performed.
How much does an MIR evaluation cost?
Evaluation Fee Table
Completed reports received and accepted by the Program Coordinator within thirty (30) calendar days of scheduling the appointment $1,000.00
Completed reports received and accepted by the Program Coordinator between thirty-one (31) and forty-five (45) calendar days of scheduling the appointment $ 850.00
Completed reports received and accepted by the Program Coordinator between forty-six (46) and sixty (60) calendar days of scheduling the appointment $ 500.00
Completed reports received and accepted by the Program Coordinator later than sixty (60) calendar days of scheduling the appointment No fee paid
This fee includes normal record review, the evaluation, and production of a standard “MIR Impairment Rating Report.” It is expected that all non-routine test(s) for an impairment rating essential under the applicable edition of the AMA Guides to the Evaluation of Permanent Impairment will have been performed prior to the evaluation.
Late fees and penalties — Failure of the employer to timely submit the evaluation fee will allow the physician to charge the employer an additional $100.00 late fee for the evaluation. If the evaluation fee and/or late fee remain unpaid fifteen (15) calendar days following the date of the evaluation, an additional $250.00 penalty is authorized. If any portion of a fee or penalty remains unpaid after an additional thirty (30) calendar day period, an additional $500.00 penalty is authorized, and again for each additional thirty (30) calendar day period, or portion thereof, that it remains unpaid until all fees and/or penalties are fully paid.
Failure of a MIR physician to timely refund an overpayment will allow the paying party to charge the physician an additional $100.00 late fee for the evaluation. If the overpayment and/or late fee remain unpaid fifteen (15) calendar days following the Program Coordinator’s request for refund, an additional $250.00 penalty is authorized. If any portion of a fee or penalty remains unpaid after an additional thirty (30) calendar day period, an additional $500.00 penalty is authorized, and again for each additional thirty (30) calendar day period, or portion thereof, that it remains unpaid until all fees and/or penalties are fully paid.
What if an interpreter is needed?
The claimant must notify the Program Coordinator of the necessity for a language interpreter concurrently with his/her notification of the chosen physician’s name. The Program Coordinator will be responsible for arranging for the services of an interpreter, but the employer is responsible for paying for the interpreter. The interpreter will be impartial and independent, and have no professional or personal affiliation with any party to the claim or to the MIR physician.
Where are MIR evaluations conducted?
MIR evaluations are conducted only in a professional medical office suitable for medical or psychiatric evaluations where the primary use of the site is for medical services.
Is a physician-patient relationship established by the MIR evaluation?
No physician-patient relationship is created between the Registry physician and the claimant. The sole purpose of the evaluation is to establish an impairment rating and not to recommend future treatment or to provide a diagnosis or other medical advice.
Who provides medical records to the MIR physician?
Both the employer and the employee must concurrently provide to the MIR physician a complete copy of all pertinent medical records pertaining to the subject injury, postmarked or hand-delivered at least ten (10) calendar days prior to the evaluation. The claimant must promptly sign a “MIR Waiver and Consent” permitting the release of information to the MIR physician.
In cases involving untimely medical record submission by either party, the Commissioner, at his/her sole discretion, may elect to reschedule the evaluation to allow the physician adequate time for record review. Otherwise, the physician will perform the evaluation and will produce an Impairment Rating Report utilizing the information properly made available to the physician.
Form/Content of Medical Records Package — The medical file should include a dated cover sheet listing the claimant’s name, MIR physician’s name, MIR case number, date and time of the appointment, and the state file number. The medical file must be in chronological order, by provider, and tabbed by year.
Medical bills, adjustor notes, surveillance tapes, denials, vocational rehabilitation reports, case manager records or commentaries to the MIR physician will not be submitted.
What if you want to cancel the evaluation?
An evaluation may be canceled or rescheduled only after obtaining the consent of the Program Coordinator. To be considered timely, notice of a party’s desire to cancel must be given to the Program Coordinator at least three (3) business days prior to the date of the evaluation. If the request to cancel is not timely, the MIR physician will be entitled to collect/retain a $300.00 cancellation penalty/fee. The Commissioner will decide whether or not an evaluation is rescheduled within ten (10) calendar days of a request to reschedule. If the evaluation is rescheduled, the MIR physician is entitled to the entire evaluation fee (for the rescheduled evaluation) in addition to this fee.
What happens if the injured worker fails to attend a scheduled evaluation?
If the claimant fails to appear for the evaluation with good cause, the evaluation will be rescheduled. If the claimant fails to appear for the evaluation without good cause, as determined by the Commissioner, this may be deemed a refusal to comply with a reasonable request for medical examination and the injured employee’s right to compensation may be suspended pursuant to the Act, and no compensation shall be due and payable while the injured employee continues such refusal.
What tests will be performed during the MIR evaluation?
All non-routine tests for an impairment rating essential under the applicable edition of the AMA Guides should have been performed prior to the MIR evaluation. Routine tests necessary for a complete evaluation, such as range of motion or spirometry tests, may be performed by the MIR physician as part of the evaluation.
Can the MIR physician become the treating physician?
No. The MIR physician cannot become the treating physician for the claimant regarding the work-related injury. Nor can he/she refer any MIR claimant to another physician for any treatment or testing nor suggest referral or treatment.
What is required in the “MIR Impairment Rating Report?”
The MIR physician must first review the determination by the attending physician that the claimant has reached Maximum Medical Impairment (MMI). If, after reviewing the records, taking a history from the claimant and performing the evaluation, the MIR physician concurs with the attending doctor’s determination of MMI, the report must contain the following:
“It is my opinion, both within and to a reasonable degree of medical certainty that, based upon all information available to me at the time of the MIR impairment evaluation and by utilizing the relevant AMA Guides or other appropriate method as noted above, that the claimant has the permanent impairment so described in this report. I certify that the opinion furnished is my own, that this document accurately reflects my opinion, and that I am aware that my signature attests to its truthfulness. I further certify that my statement of qualifications to serve on the MIR Registry is both current and completely accurate.”
If, after reviewing the records, taking a history from the claimant and performing the evaluation, the MIR physician does not concur with the attending doctor’s determination of MMI, a report must be completed similar to the one outlined above which documents and certifies to, in sufficient detail, the rationale for disagreeing.
Are impairment rating reports reviewed for accuracy and completeness?
All MIR Impairment Rating Reports are subject to review for appropriateness and accuracy by an individual or organization designated by the Commissioner at any time. Repeated failure to properly apply the AMA Guides in determining an impairment rating, as determined by the Medical Director, will result in penalties up to and including removal from the Registry.
What if I disagree with the MIR physician’s rating?
The parties are forbidden from seeking a second MIR impairment rating for the same injury. The permanent impairment ratings given by MIR physicians subsequent to their selection in compliance with the Program Rules will be presumed to be accurate, as defined in the Act. This presumption may be rebutted only by clear and convincing evidence to the contrary. Opinions reached by any physician(s) not selected in compliance with the Program Rules are not legally presumed to be accurate and shall carry no additional weight in any proceedings, even in cases where the physician selected serves on the Registry.
How do physicians apply to join the Registry?
Physicians seeking appointment to the Registry must complete the “Application for Appointment to the MIR Registry”, available upon request from the Program Coordinator or on-line at https://ecmats.state.tn.us/MIR/
How long do physicians serve on the Registry?
Appointment to the Registry will be for a two year term, except as outlined by the Rules. Physicians must seek renewal appointments by the same process as the initial application described herein. The Division reserves the right to charge physicians a non-refundable application fee upon appointment, renewal, or reinstatement to the Registry.
What are the minimum qualifications for physicians who serve on the Registry?
Physician seeking appointment to the MIR Registry must satisfy the following qualifications:
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Possess a license to practice medicine or osteopathy in Tennessee which is current, active, and unrestricted;
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Be Board-certified in his/her medical specialty by a board recognized by the American Board of Medical Specialties, the American Osteopathic Association or another organization acceptable to the Commissioner;
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Have successfully completed a training course, accepted by the Commissioner, dedicated to the proper application of the applicable edition of the AMA Guides to the Evaluation of Permanent Impairment in impairment evaluations and furnish satisfactory evidence thereof; and
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Furnish satisfactory proof of carrying the minimum medical malpractice insurance coverage.
Who approves a physician’s application to join the Registry?
The Commissioner or his designee, upon the advice of the Medical Director, shall have the sole and exclusive authority to approve or reject applications for the Registry.
What factors does the Commissioner consider in approving, disapproving, suspending, or removing doctors from the MIR Registry?
The Commissioner may consider several factors. Examples include, but are not limited to,
How do I file a complaint about a MIR physician?
Written complaints regarding an MIR physician should be submitted to the Program Coordinator. The Commissioner or his designee, upon the advice of the Medical Dirctor, may remove a physician from the Registry permanently or temporarily.
How do physicians voluntarily remove themselves from the Registry?
If a physician wants to be taken off the Medical Impairment Registry, they should contact Jeff Francis, the MIR Program Coordinator, at (615) 253-1613.
PENALTY
The Division of Workers' Compensation is required by statute to establish and collect penalties. Click here for a summary of workers' compensation penalties.
SAFETY COMMITTEES
Experience has proven conclusively that a properly endorsed and administered safety program will reduce both the number and severity of injuries in the workplace. Consequently, Tennessee in 1992 initiated a program to emphasize the promotion of safety and health in the workplace. The provisions of this program encourage every employer to establish and administer a safety committee according to guidelines developed by the Tennessee Department of Labor and Workforce Development.
Promoting workplace safety is an important priority of the Department of Labor and Workforce Development, and I am confident that you share our interest. Injury prevention is perhaps the single most effective method of cost containment; it's also very good business. So I invite and encourage you to join with us in a "safety partnership" whose only goal is making Tennessee workplaces as safe and healthy as possible.
The purpose of the safety requirements in the workers' compensation law is two fold:
· To prevent as many accidents and injuries in the workplace as possible.
· To reduce the severity of the accidents and injuries which do occur in the workplace.
Every employer whose experience modification factor is 1.20 or greater is required to establish and administer a safety committee in the workplace.
The safety committee must be maintained for as long as the experience modification factor remains at 1.20 or greater.
SECOND INJURY FUND
The purpose of the Fund is to encourage employers to hire workers with existing handicaps or permanent disabilities. To claim benefits from the Fund, an employee must prove that he/she previously sustained a permanent disability and that, as a result of a second injury, he/she has become permanently and totally disabled. The Fund limits the employer's liability to the amount of disability caused by a new, or "second", injury.
The Fund also reimburses employers for all amounts paid pursuant to an order of a workers' compensation specialist, when a court subsequently finds that the injury was not compensable.
Funding for the Second Injury Fund is provided from the workers' compensation premium tax.
UNINSURED EMPLOYERS PROGRAM
The purpose of the Fund is to:
· Ensure that all employers comply with insurance coverage provisions of the workers' compensation Law.
· Penalize those employers who fail to provide workers' compensation protection for their employees.
The Uninsured Employers' Program provides an administrative process to investigate and penalize employers who fail to carry workers' compensation insurance or to qualify as self-insured employers, as required by the Workers' Compensation Law. The administrative process includes notifying employers of possible penalties for violations of the insurance requirements of the Workers' Compensation Law. The administrative process also involves holding legal hearings called show cause hearings. The purpose of the administrative process is to assure that, when it is required by the Workers' Compensation Law, employers in the State of Tennessee provide workers' compensation insurance to their Tennessee employees.
COVERAGE REQUIREMENTS
The insurance carrier providing coverage to an employer must file proof of coverage electronically through an approved vendor.
The employer should have a "Tennessee Workers' Compensation Insurance" Notice posted so the injured employee can see the name of the insurance carrier.
EMPLOYER PENALTY
The penalty for not maintaining current workers' compensation coverage as required by law may be up to 2.5 times the average yearly workers' compensation premium. Additionally, the Commissioner of Labor and Workforce Development may seek an injunction in state court to close the business of any employer which continues not to provide workers' compensation insurance coverage after being ordered by the Commissioner to provide such coverage in accordance with law pursuant to TCA Section 50-6-412.
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INSURANCE CARRIER PENALTY
The penalty for not providing proof of existing workers' compensation coverage to the Workers' Compensation Division is $100.00 for each fifteen (15) days past the required date for filing until proof of coverage is filed electronically through an approved vendor.
INJURED EMPLOYEE ASSISTANCE
If you have issues with any part of your claim, the state has a benefit review system that assists employees with resolving disputes with workers' compensation claims. The Tennessee Department of Labor and Workforce Development's Workers' Compensation Division can be contacted at 1-800-332-COMP (2667) (TDD) or 615-532-4812.
Who pays Workers' Compensation benefits?
Benefits are paid by the employer or the employer's insurance carrier. The Tennessee Department of Labor and Workforce Development does not pay workers' compensation benefits.
What should I do if I am injured at work?
· Report all injuries immediately to your employer.
· Employer notification is required by law within 30 days of the date of injury, preferably in writing.
· The employer completes a First Report of Work Injury and offers the employee a panel of three medical providers for treatment. In the event the injury is a back injury, the panel of medical providers is expanded to four (4) and must include a chiropractor.
· The employee selects one of the providers, who becomes the authorized treating physician and provides treatment at the employer's expense.
· A signed Form C-42, "Agreement Between Employer/Employee Choice of Physician", must be completed and provided to the employee. The employer must keep the original form on file and upon request provide a copy to the Division of Workers' Compensation.
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To what am I entitled?
Employees who have suffered a compensable work injury are entitled to receive the following:
A. Disability Benefits
· Weekly benefits are paid if the authorized physician finds that the employee is unable to work due to the injury.
· Compensation begins on the eighth (8th) day of disability from work following the injury. The date of injury and the first seven (7) days following are a waiting period and no benefits are payable unless the disability lasts at least eight days. Benefits are due for each day over the seven-day waiting period until the lost time reaches fourteen (14) days; then, weekly temporary total disability benefits will be calculated beginning with the day following the injury. Temporary total disability benefits are based on 66 2/3% of the employee's gross average weekly wage for the last 52 weeks worked prior to the injury, subject to the minimum and maximum benefits as provided by the Workers' Compensation Law.
· Weekly benefits for the total disability are based on 66 2/3% of the employee's gross average weekly wage for the last 52 weeks worked prior to the injury, subject to the minimum and maximum benefits as provided by the Workers' Compensation Law.
· If you have problems with any part of your claim, please complete a C-40A Request for Assistance form and submit it to the Workers' Compensation Division.
B. Medical Benefits
· The employer is to provide, free of charge, a panel of three physicians [in case of a back injury a panel of three physicians plus one chiropractor] from which the employee selects one for treatment. Physician selected become the “authorized treating physician.” This physician will direct all medical treatment for the employee's workers' compensation injury.
· If a specialist is required, the treating physician may refer the employee; or, the employer may offer another doctor or panel of specialist from which to choose.
· Medical treatment extends for as long as required by the authorized treating physician. If appropriate, this physician will provide the employee with off-work excuses and light or restricted duty limitations. It is very important that the authorized physician's instructions and restrictions be followed at all times.
C. Permanent Disability and Final Settlement
· When the injury has healed, the injured employee will be released from the physician's care.
· If the injured employee does not recover completely, the employee will reach maximum medical improvement (MMI) and the physician will assign an Impairment rating.
· This Impairment rating, combined with vocational factors, may result in a permanent partial disability (PPD) rating.. A settlement from the workers' compensation insurance company or Employer may then be agreed upon.
· Not all injuries result in a permanent impairment; however, Workers' Compensation specialists with the Tennessee Department of Labor and Workforce Development do provide, at no cost to the parties, informal Benefit Review Conferences to assist the parties in reaching a final agreement or settlement of the claim. Please complete a C-40B Request for Benefit Review Conference and submit it to the Workers' Compensation Division.
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Scheduled Injuries
Thumb First or index finger |
60 weeks 35 weeks |
Second or middle finger |
30 weeks |
Third or ring finger |
20 weeks |
Fourth or little finger |
15 weeks |
Great toe |
30 weeks |
Any other toe |
10 weeks |
Hand |
150 weeks |
Arm |
200 weeks |
Foot |
125 weeks |
Leg |
200 weeks |
Eye |
100 weeks |
Hearing (one ear) |
75 weeks |
Hearing (both ears) |
150 weeks |
*Body as a whole |
400 weeks |
*The 400 weeks for body as a whole is used for a maximum for Permanent Partial Disability (PPD) but does not apply to Permanent Total Disability (PTD).
Reconsideration of a Permanent Partial Disability settlement
Workers’ compensation law places a cap on permanent partial disability awards when an employee returns to work at the same or greater rate of pay as before the compensable injury. For injuries to a scheduled member rated 200 weeks or more, in the event an employee loses their job within those weeks [following the date the injured employee returned to work], the employee may be entitled to a reconsideration of the permanent partial disability settlement. The job loss must be due to factors other than Employee quitting or being fired for cause. For example, if an employee loses their job due to a lay-off, the employee may be entitled to reconsideration. Contact the Tennessee Department of Labor Workforce Development's Workers' Compensation Division for additional information.
D. Death Benefits
· When an injury results in the death of a covered employee, leaving one beneficiary, such as a spouse and no dependent children or an orphan child, the one beneficiary is entitled to 50% of the deceased employee's average weekly wage, not to exceed the maximum total benefit.
· If the deceased employee leaves a spouse and one or more dependent children, 66 2/3% of the deceased employee's average weekly wages, not to exceed the maximum total benefit, is due.
· If a deceased employee leaves other relatives dependent on the employee for support, compensation may also be payable to those dependents.
· When the deceased employee leaves no dependents, $20,000 shall be paid to his or her estate.
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What if I am unhappy with the physician I have selected from the employer's panel?
· Under Tennessee Law, the employer or insurance carrier is not required to offer a second panel of physicians or a second opinion. If asked, however, many insurance carriers and employers will provide a second panel.
· The employee may always seek a second opinion or obtain treatment with any physician at his/her own expense; however, only the restrictions of the authorized physician must be followed by the employer.
What if the authorized physician orders light or restricted duty?
· If the authorized physician returns the employee to work with specific temporary restrictions (light duty) and the employer can provide a job within the restrictions, the employee MUST return to work and attempt the light duty. Failure of the injured employee to return to light duty, if offered by the employer, could result in termination of workers’ compensation weekly benefits.
· The employee may qualify for temporary total disability benefits if the employer cannot provide a job within the restrictions given by the authorized physician.
· The authorized treating physician determines what duty is appropriate for the restrictions. Injured employee should contact their treating physician for clarification if the employee believes the work is beyond stated restrictions. Failure to report for the light duty may terminate disability benefits.
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Should the injured employee receive doctors' bills?
A health care provider should not bill or sue the injured employee for all or part of the costs of health care services provided to the injured employee unless:
1. The injury is found by the court not to be compensable under workers’ compensation law;
2. The physician, who was not authorized by the employer at the time the services were rendered, knew that he/she was not an authorized physician; or
3. The employee knew the physician was not authorized and it was not an emergency.
Can I be fired for reporting a work injury?
It is unlawful for an employer to terminate an employee for reporting a work injury. Wrongful termination is not enforceable under Tennessee Workers' Compensation Law. The employee may wish to consult an attorney to pursue this cause of action through the court system.
Will I have to use my own sick time?
Generally, no. However, an employee injured and off work less than 14 days is not paid for the first 7 days under Workers' Compensation Law. Consult your employer about the use of sick time for this time period.
Is the injured employee paid for doctor's appointments during work hours?
Generally no, unless it is company policy.
Statute of Limitations
Generally, the right to workers' compensation benefits is barred unless within one (1) year after the injury occurred or (1) year after the injured worker was informed his condition is permanent and related to his employment or (1) year after workers' compensation benefits are paid, a Request for Benefit Review Conference (form C40B) is filed with the Department of Labor and Workforce Development. You can contact the Benefit Review Program for assistance by calling toll free 1-800-332-COMP (2667) (TDD) or 615-532-4812.
Where do I go if things do not work out?
If you have problems with any part of your claim, the state has a benefit review system that assists employees, employers, and insurance carriers with resolving disputes with workers' compensation claims. The Tennessee Department of Labor and Workforce Development's Workers' Compensation Division can be contacted at 1-800-332-COMP (2667) (TDD) or 615-532-4812.
