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.
The designated Discovery Attorney is a statutorily-created position, authorized to:
- Resolve disputes between parties regarding exchange of information in a workers’ compensation claim involved in settlement discussions. The attorney may issue subpoenas where appropriate.
- Average of 20-30 referrals per months
- Disputes are usually resolved within 10-12 days of receiving the request from the Specialist.
For all Benefit Review Orders issued on or after May 26, 2006 a party may file a Request for an Administrative Review. This review of a Workers’ Compensation Specialist’s Order helps to ensure that a Workers’ Compensation Specialist has made an appropriate decision when applying the Tennessee Workers’ Compensation Law to the facts of a disputed workers’ compensation case pursuant to TCA 50-6-238.
- An Informal Conference must be held within 10 calendar days. The conference is a telephone conference call for the parties to present their arguments to a senior member of the Division.
- The Division must produce an Order within 7 calendar days of the Informal Conference.
- The parties must comply with the Order within 10 calendar days.
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.
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.
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:
When the medical necessity of a recommended treatment is disputed or when otherwise required by the workers’ compensation statutes or medical fee schedule (e.g., hospital admissions, physical or occupational therapy, chiropractic care, clinical psychological treatment).
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 where the medical necessity of a recommended treatment is disputed.
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 through a third party administrator.
The UR Agent conducting the review services must be registered with the Division of Workers’ Compensation.
Please note that the adjuster can not deny a recommended treatment but has three business days after being notified of the recommended treatment to authorize the treatment or send the recommendation to its utilization review agent. The recommended treatment can only be denied by an Advisory Medical Practitioner (an actively TN-licensed practitioner, who is board-certified and in the same or similar general specialty as the authorized treating physician). Recommended treatments may be approved by a registered nurse or an Advisory Medical Practitioner. Utilization Review Agents may employ or contract with individual Advisory Medical Practitioners and registered nurses.
The utilization review agent has seven business days to make a decision on the recommended treatment and notify all parties of the decision. If the utilization review agent does not possess all necessary information in order to render the utilization review determination, then they shall request additional information in writing from the authorized treating physician, who shall comply with the request within five business days of receipt of the written request. The seven business days are tolled until the utilization review agent receives the necessary information or until the five business day timeframe expires, whichever occurs first. The decision shall only address medical necessity and not causation and/or compensability. An approval of the treatment by the utilization review agent is final and not subject to appeal.
Any denials of recommended treatment must be accompanied by a utilization review report that gives the reasons for denial and contact information for the utilization review physician. Denials must also be accompanied by an utilization review appeal form (Form C-35A) so that the injured worker and treating physician are informed of the proper procedure to request an appeal with the Department. After a denial, the injured worker, their attorney or treating physician has 30 calendar days from receipt to appeal the utilization review decision to the Department at the address listed on the form. Once a complete medical record is received, staff provides a copy of the record for the Medical Director’s review. The Medical Director determines if he agrees or disagrees with the utilization review decision. If he disagrees with the utilization review decision, an order for the treatment as recommended by the authorized treating physician will be issued.
A copy of the Department’s Utilization Review rules, Chapter 0800-02-06, may be found at http://www.tn.gov/sos/rules/0800/0800-02/0800-02-06.20091112.pdf and the appeal form (Form C-35A) may be found at http://www.tn.gov/labor-wfd/forms/c35a.pdf.
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.
An employer, insurer, third party administrator, or UR Agent who is found to have violated the UR rules may be subjected to a penalty of not less than $100 nor more than $1,000 per violation. The Division may also institute a temporary or permanent suspension of the right to perform utilization review services for workers’ compensation claims, if the utilization review agent has established a pattern of violations.
FIRST REPORT OF WORK INJURY, FORM C20
Employers covered by the Tennessee Workers’ Compensation Act must submit all known or reported injuries or illnesses to their insurance carriers on Tennessee Employer’s First Report of Work Injury or Illness (Form C-20) within one (1) working day of knowledge of the injury or illness. Insurance carriers and self-insured employers must file the Form C-20 with the Division through Electronic Data Interchange (EDI) as soon as possible, but not later than fourteen (14) days after knowledge of the injury or illness.
A workplace injury or illness that causes an employee to receive medical treatment outside of the employer’s premises, their death, their absence from work, or their retention of a permanent impairment must be reported.
OSHA REQUIREMENTS: The "Tennessee First Report of Work Injury" (First Report) is an allowable substitute for the Occupational Safety and Health Administration (OSHA) 301 form "Injury and Illness Incident Report". 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.
- Fill out a Form C-20, as described above, and file the form with its insurer within one (1) working day of knowledge of injury. The claim must be reported to the insurer even if the employer feels the claim is not work-related. The insurance carrier can investigate and deny the claim if appropriate.
- Provide the injured employee a panel of at least three physicians on Agreement Between Employer/Employee Choice of Physician Form (Form C-42). If the injury is to the back, the panel must include a chiropractor. If specialized treatment is required, the authorized treating physician may refer the employee for such specialized treatment at which time another panel of specialized physicians should be offered. The named-providers 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.” A Form C-42 designating the chosen physician and signed by the employee 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 provide a copy to the Division of Workers' Compensation upon request.
If the employer does not have a panel of physicians, it should call its insurer and develop one. The employer should post the panel of physicians in a conspicuous place for employees to review.
- Have the injured employee sign a Medical Waiver and Consent Form (Form C-31). This form allows the employer, insurance carrier, third party administrator, case manager, utilization review agent and Division to communicate with the treating physician about the treatment for the injury.
- Inform the employee of the name and telephone number of the employer’s workers’ compensation insurance carrier/adjuster.
- Submit a statement of the employee's wages to their workers’ compensation insurer. The statement should show the gross wages earned by the injured employee each week for the fifty-two (52) weeks prior to the injury. If the injured employee was employed less than 52 weeks, the statement should show all of the weeks worked and gross wages earned each week, including overtime, bonuses, etc.
- Make a personal or telephone contact with the employer and the injured employee within two (2) working days of its notice of injury.
- Accept or deny the claim within fifteen (15) days of its knowledge of the injury. The insurance carrier must notify the employer and the claimant of its decision within those fifteen (15) days.
- For accepted claims, issue compensation payments to the claimant, if required. All required workers' compensation benefits must be issued timely (on or before due date). File all appropriate claims forms as required by the Tennessee Department of Labor and Workforce Development, Division of Workers' Compensation. Additional information on filing may be found under Electronic Date Interchange (EDI).
- For denied claims, timely file all appropriate claims forms as required by the Tennessee Department of Labor and Workforce Development, Division of Workers' Compensation.
CLAIMS HANDLING STANDARDS OVERVIEW
Claims handling standards may be found in the Rules of the Tennessee Department of Labor and Workforce Development, Division of Workers' Compensation, Chapter 0800-02-14. Those Rules can be obtained from the Secretary of State's Web page at http://www.tn.gov/sos/rules/0800/0800-02/0800-02.htm. 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 apply to all employers in the State of Tennessee covered by the Tennessee Workers’ Compensation Act and to all insurers processing Tennessee workers’ compensation claims.
All aspects of contacting and attempts to contact employers, claimants and/or physicians must be documented and kept within the insurer’s file. The insurer must:
- Upon the verbal or written notice of any injury from an employer, 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.
- Make personal or telephone contact with the employer within two (2) working days of the notice of the injury to verify details of the claim. Insurance carriers and employers must obtain a description of the job and prior claim information of the claimant within five (5) working days.
- Contact all pertinent witnesses as they become known.
- After obtaining a signed Medical Waiver and Consent Form (Form C-31) from the injured employee, contact physicians who have rendered medical services to a claimant within seventy-two (72) hours to confirm details concerning the injury and treatment and to make a preliminary compensability determination.
Decisions on workers’ compensation insurance coverage and compensability must be made within fifteen (15) days of a verbal or written notice of an accident or injury. Claimants and employers must be notified of the decision of compensability within fifteen (15) days of the notice.
If an insurance carrier denies a claim, a Notice of Denial of Claim For Compensation Form (Form C-23) must be filed with the Division and a copy of that form must be provided to the claimant at the same time. The insurance carrier must provide documentation which meets the statutory criteria for denial on that form. The denial of a claim must also be supported with documented results of an investigation.
Upon making its determination after a proper investigation, the employer, self-insured employer, or insurance company must file, with the Division, the following appropriate forms:
- Notice of Denial of Claim For Compensation Form (Form C-23). Employers, self-insured employers, and/or insurance carriers shall file Form C-23 on a paper form and may file through Electronic Date Interchange (EDI) in addition to the paper form.
- Notice of First Payment of Compensation (Form C-22). Employers, self-insured employers, and/or insurance companies shall file Form C-22 through EDI.
- Notice of Change or Termination of Compensation Benefits (Form C-26). immediately upon each change or termination of compensation benefits through EDI.
- Notice of Controversy (Form C-27) shall be filed in those cases where payments have been made without an award and the employer or insurance carrier subsequently elects to controvert its liability.
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.
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.
All medical costs owed under the Tennessee Workers’ Compensation Law must be paid according to the Rules of the Medical Fee Schedule, Chapters 0800-02-17, 0800-02-18 and 0800-02-19. Those Rules are available on the Secretary of State's Web page at http://www.tn.gov/sos/rules/0800/0800-02/0800-02.htm.
The employer or insurer must file the following reports with the Division when applicable:
- Attending Physician’s Report (Form C-30)
- Final Medical Report (Form C-30A) shall be filed in accordance with Rule 0800-02-17-.25, although a party, in lieu of a deposition, may utilize the Standard Form Medical Report For Industrial Injuries (Form C-32).
In addition to other penalties provided by applicable law and regulation, violations of any of the above rules may be subject to enforcement by the Commissioner of the Tennessee Department of Labor pursuant to TCA §50-6-419(c). The Penalty Program rules, Chapter 0800-02-13, are available on the Secretary of State's Web page at http://www.tn.gov/sos/rules/0800/0800-02/0800-02.htm
A medical impairment rating and the date of maximum medical improvement, as determined by the treating physician, and all other information needed to settle a claim must be documented in writing on the Attending Physician’s Report (Form C-30). Insurance carriers must make an offer of settlement in writing within thirty (30) days of their receipt of this information. The claimant must indicate approval or rejection of the offer and sign the offer of settlement.
An agreed-upon settlement must be finalized by either an order of a court or an approval by the Division as required by TCA §50-6-206. A copy of the court order or Division approval must be filed with the Commissioner of Tennessee Department of Labor. If a settlement is not agreed upon a Benefit Review Conference may be requested.
Employees and/or employee representatives shall submit to the Division notice of filing of any lawsuit concerning workers’ compensation benefits. A (Notice of Lawsuit (Form C-28) must be filed to satisfy this notice requirement.
Final Report of Payment and Receipt of Compensation (Form C-29) must be submitted in all cases that are not settled, are not tried, and do not result in permanent disability payments. Employers, self-insured employers, and/or insurance carriers must file a Form C-29 with the Division through Electronic Data Interchange (EDI) within thirty (30) days following the final payment of compensation. Form C-29 shall include all compensation benefits paid on a claim, including all medical expenses, hospital expenses, funeral expenses, and legal costs.
Statistical Data Form (Form SD-1) shall be filed for every workers’ compensation matter that is concluded by settlement, either by a court or the Division. Each employer or employer’s agent that is a party to a workers’ compensation case must file Form SD-1 with the clerk of the court in which the case is concluded and also with the Division at the conclusion of the case. An order of the court is not final until a Form SD-1 is fully completed and filed with the clerk of the court. In cases involving a workers’ compensation settlement which is submitted to the Division for approval, a copy of Form SD-1 shall also be completed and submitted to the Division at the time of the submission of the settlement for approval. A settlement approved by the Division is not final until a Form SD-1 is fully completed and received by the Division. The employee and any agent of the employee must cooperate with the employer in completing Form SD-1.
FREQUENTLY ASKED QUESTIONS—CLAIMS
What should I do if I am injured at work?
An injured employee should immediately report any work-related accident, injury or illness to their employer. Employer notification, preferably in writing, is required by law within 30 days of the date of injury or when a physician first tells the employee that his/her injury is work related. Employers covered by the Tennessee Workers’ Compensation Act must submit all known or reported injuries or illnesses to their insurer on Tennessee Employer’s First Report of Work Injury or Illness (Form C-20) within one (1) working day of knowledge of the injury or illness. Insurance carriers and self-insured employers must file a Form C-20 with the Division through Electronic Data Interchange (EDI) as soon as possible, but not later than fourteen (14) days after knowledge of the injury or illness.
Can an employee be fired for reporting a work injury?
No. It is unlawful for an employer to terminate an employee for reporting a work injury. Wrongful termination is not addressed under Tennessee Workers' Compensation Law. The employee may wish to consult an attorney to pursue this cause of action through the court system
After receiving a report of a workplace injury, what information should be given to the injured employee?
Upon the report of a workplace injury, an employer should provide the employee, in writing, a choice of three physicians not associated together in practice. An Agreement Between Employer/Employee Choice of Physician (Form C-42) must be completed, a copy given to the employee, and the original kept on file with the employer. In the event of a reported back injury, the choice of physicians is expanded to four names, one of whom must be a chiropractor. The physicians listed should be located in or near the employee's community of residence. The employee has the privilege of choosing a physician from the list. The one selected becomes the “treating physician.” The employee is then required to accept treatment from the treating physician and should not seek treatment from any other medical provider unless the treating physician makes a referral.
The employer should also 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.
Is the injured employee paid for the time involved attending physician’s appointments during work hours?
Generally no, unless it is company policy.
Should the injured employee receive doctors' bills?
No. A health care provider should not bill or sue an injured employee for all or part of the costs of health care services provided to the injured employee unless:
- The injury is found not to be compensable under workers’ compensation law
- 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
- The employee knew the physician was not authorized and it was not an emergency.
What if the employee is unhappy with the physician he/she 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, the insurer or employer MAY provide a second panel. An 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.
Who pays Workers' Compensation benefits?
Benefits are paid by the employer or the employer's workers’ compensation insurer. The Tennessee Department of Labor and Workforce Development does not pay workers' compensation benefits.
What is an injured employee entitled to?
Employees who have suffered a compensable workplace injury are entitled to receive the following:
A. Disability Benefits:
If the employee’s injury is determined to be compensable and the employee is unable to work, temporary benefits will be paid. Compensation is not paid by this division, but by the employer's insurance carrier, unless the employer is self-insured. If the employer is self-insured, compensation is paid directly by the employer or its representative.
Weekly benefits are paid if the authorized treating physician finds that the employee is unable to work due to the injury and misses more than seven days of work. If the employee is out more than 14 days, benefits will be paid from the first day the physician finds that the employee is unable to work due to the injury.
The Workers' Compensation Law sets limits on the maximum and minimum amounts of weekly compensation paid to injured employees. The average of the employee's gross wages will determine the weekly rate. The amount of the benefits are calculated using two-thirds of the employee's average weekly wage over the 52 weeks prior to the injury.
B. Medical Benefits:
The employer should provide the employee a Agreement Between Employer/Employee Choice of Physician" (Form C-42) as explained above.
If specialized treatment is required, the authorized treating physician may refer the employee for such specialized treatment at which time another panel of specialized physicians should be offered.
Medical treatment, at no cost to the employee, extends for as long as required by the authorized treating physician. If appropriate, the physician will provide the employee with off-work excuses and light or restricted duty limitations. It is very important that the authorized treating physician's instructions and restrictions be followed at all times.
Mileage reimbursement for travel to and from medical treatment is allowed if travel, either to or from medical treatment, exceeds 15 miles. The mileage rate is based on current mileage allowance for Tennessee state employees.
C. Permanent Disability and Final Settlement:
When the injury has healed and maximum medical improvement (MMI) is reached, the injured employee will be released from the physician's care.
If the injured employee does not recover completely, the physician should assign a permanent impairment rating.
The impairment rating, combined with vocational factors, may result in a permanent disability award.
Workers' Compensation Specialists with the Tennessee Department of Labor and Workforce Development conduct, 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 the Request for Benefit Review Conference (Form C40B) and submit it to the Workers' Compensation Division to request a Benefit Review Conference.
Second or middle finger
Third or ring finger
Fourth or little finger
Any other toe
Hearing (one ear)
Hearing (both ears)
*Body as a whole
*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: The workers’ compensation law places a cap on permanent partial disability awards in those cases where an employee returns to work for the same employer at the same or greater rate of pay as before the compensable injury. If the injury is to a scheduled member rated 200 weeks or more (as identified in the Tennessee Workers’ Compensation Act), and if the injured employee loses his/her job within those number of weeks (following the date the injured employee returned to work), he/she may be entitled to a reconsideration of his/her original permanent partial disability settlement. The job loss must be due to factors other than quitting or being fired for cause. For example, if the employee lost his/her job due to a lay-off, he/she 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, benefits are available to the surviving dependents.
Burial expenses for the deceased employee are paid, not to exceed $7,500.
When the deceased employee leaves no dependents, $20,000 shall be paid to his or her estate.
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 provides a job within the restrictions, the employee MUST return to work and attempt the light duty.
The employee may qualify for temporary disability benefits if the employer does not provide a job within the restrictions given by the authorized physician.
The authorized physician determines what duty is appropriate for the restrictions. The physician should be contacted for clarification if the employee believes the work is beyond the restrictions. Failure to report for light duty may terminate disability benefits.
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 on “light duty.” The 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, it should do so. If the employee is paid a lesser pay or is restricted to fewer hours because of the light duty, the employee is entitled to "temporary partial disability" benefits. These benefits are figured at 66 2/3% of the difference between the light duty wages and full duty wages, subject to the same maximum and minimum workers' compensation rates described above.
An Employee was earning $300.00 per week before being injured.
The same Employee is earning $200.00 per week while on light duty.
$300.00 minus $200.00 equals $100.00 difference in pay due to the light duty restrictions.
66 2/3% of $100.00 equals $66.66.
Therefore, the Employee will earn $200.00 in wages and receive $66.66 in workers' compensation temporary partial disability benefits.
However, if the employer is unable to meet the restrictions provided by the treating physician, the injured employee will remain off work and his/her disability benefits will continue.
Will I have to use my own sick time to cover my time off work?
Generally, no. However, an employee injured and off work fewer than 14 days is not paid for the first seven days under Workers' Compensation Law. Consult the employer about the use of sick or Family Medical Leave time for this time period.
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, the workers' compensation insurance carrier may be required to make temporary total disability benefit payments to the injured employee. The first payment is due within fifteen (15) days of the employer’s knowledge of the injury and benefits should be paid at least semi-monthly.
In order to qualify for workers’ compensation payments, an injured employee must have a doctor's statement for time off from work. Workers’ compensation payments are not required to be paid for the first seven (7) days of missed work. However, payments begin with the eighth (8th) missed workday. If the employee continues to miss time from work through fourteen (14) missed workdays, the original seven-day waiting period will be paid and the employee will be due benefits retroactive to the first day of missed work.
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 as long as the amount is within the established maximum or minimum amounts. To determine this, the employer must submit a wage statement to the insurance carrier. This wage statement will list an injured employee’s gross earnings for the fifty-two (52) weeks prior to the date of injury and should reflect all earnings including overtime. The weekly disability benefit rate may not be higher or lower than maximum and minimum rates in effect on the date the employee was injured.
To determine the benefit, gross earnings are totaled and divided by 52 (the number of weeks in a year). The result is the employee's average weekly wage. The average weekly wage is multiplied by .6667 to determine the employee's weekly compensation rate.
Note: If an employee has worked for that employer for less than 52 weeks, the weekly compensation rate must be figured by one of the following methods:
A. By counting the number of weeks the injured employee has been employed by the employer and calculating gross earnings for those weeks. The gross earnings are divided by the number of weeks employed;
B. By calculating the average weekly wage earned by a person employed with the same employer performing the same job as the injured employee during the 52 weeks prior to the injury.
When do workers' compensation benefits stop?
There are several circumstances under which benefits stop:
- When an injured employee is released by their treating physician to return to work.
- Whenever an injured employee refuses to comply with a reasonable request for medical examination or to accept medical treatment, compensation may be stopped for the period of time an employee continues the refusal.
- Whenever the employer or insurance carrier has been paying benefits and discovers those payments were made in error, the insurance carrier can stop payment but must file a Notice of Controversy (Form C-27).
- When an injured employee’s treating physician determines the employee has reached maximum medical improvement (MMI), and the compensability has not been contested. Payments must continue until the earlier of the following events:
- an injured employee accepts or rejects a job offered by the employer at a wage equal to or greater than the employee's pre-injury wage, or
- a benefit review conference is held and a report is filed.
Payments for employees whose injuries result in a permanent disability cannot exceed a) 60 days beyond the determination of MMI or b) the value of the permanent partial disability award calculated by using the medical impairment given by the treating physician. The injured employee should be offered a settlement in writing by the insurance carrier within thirty (30) days of receipt of the medical impairment rating.
How is a settlement determined?
A settlement is appropriate in cases when an injured employee reached maximum medical improvement but the employee has a permanent impairment resulting from the work-related injury. The employee’s treating physician will determine, in writing, a percentage of impairment and will 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 for the Workers’ Compensation Division can assist in determining an appropriate range of settlement for the resulting vocational disability.
Who may I contact with additional questions?
Regardless of your role in the matter, if you have issues or questions concerning any part of a claim, the Division’s Benefit Review Program assists employees, employers and insurance carriers by answering questions and by resolving disputes with workers' compensation claims. The Benefit Review Program can be contacted at firstname.lastname@example.org or 1-800-332-2667 or 615-532-4812 (TDD).
Statute of Limitations
The right to receive workers' compensation benefits does not stay open forever. An injured worker must file Form C40B, "Request for Benefit Review Conference," before the time limit runs out. Generally, that is one year from the date of injury, or the date the employer last paid temporary disability or medical bills. Some special circumstances can extend the time to file.
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 Program 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 1-800-332-2667 or 615-532-4812.
The department has developed a statistical data form (SD-1) for collecting data relevant to assessing the workers' compensation system. The form must be filed for every workers' compensation matter that is concluded by settlement, whether approved by a court or the department. A settlement in a workers' compensation matter is not final until the statistical data form required by this section is fully completed and filed.
A form is not required to be filed in cases that involve reconsideration of a prior settlement or trial judgment order for which a form was filed at the time of submission of the prior order.
A form is not required to be filed if the only issue resolved by an order is the closing of future medical benefits that remained open pursuant to a prior order for which a form was filed at the time of submission of the prior order.
It is the responsibility of the employer or the employer's agent to complete and file the form required, contemporaneously with the filing of the final order or settlement. The employee and any agent of the employee are required to cooperate with the employer in completing this form.
In cases involving a workers' compensation settlement that is approved by a court, the completed form shall be filed at the same time as the order approving the settlement is filed and shall be filed with the clerk of the court in which the settlement order is filed. A clerk of the court shall not accept a settlement order for filing, unless it is accompanied by a fully completed statistical data form.
In cases involving a workers' compensation case that is resolved by trial, the completed form shall be filed at the same time as the final order is submitted to the trial court for approval and shall be filed with the clerk of the court in which the matter was tried. A clerk of the court shall not accept a trial order for filing, unless it is accompanied by a fully completed statistical data form.
A settlement approved by the department shall not become final until the statistical data form required by this section is fully completed and received by the department.
Every employer subject to the Workers’ Compensation Law is required to display the “Tennessee Workers' Compensation Insurance” notice. (Link http://www.tn.gov/labor-wfd/forms/WC_Certificate.pdf) 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 employer’s 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.
COVERAGE FREQUENTLY ASKED QUESTIONS
How many employees do I have to have before I am required to have workers' compensation insurance?
Generally, Tennessee employers, not in the construction or coal mining industry, with five (5) or more full or part-time employees are required to carry workers’ compensation insurance on those employees. Corporate officers and family members meeting the definition of employee are included in the count towards the total, regardless of whether or not the officer(s) elects to decline coverage.
Any person engaged in the construction industry is required to carry workers' compensation insurance on their employees. Effective March 28, 2011, construction employers in the contracting group designated by the National Council of Compensation Insurance (NCCI) must have workers’ compensation insurance on all of their employees and themselves unless you are a sole proprietors or partners with no employees being paid directly by the property owner).
Employers in the coal mining industry with one or more employees are required to provide workers’ compensation coverage. State and local governments and those employing farm laborers or domestic help are exempt, but may elect workers’ compensation coverage.
Subcontractor and General Contractor Information
A subcontractor can elect to be covered by the general's workers' compensation insurance by filing Agreement of General Contractor to Provide Workers’ Compensation Coverage to Subcontractor (Form I-15) with the Division of Workers' Compensation. This form allows the general contractor to withhold premiums from the subcontractor's payroll to cover the subcontractor. Form I-15 must be signed by the general contractor and the subcontractor, notarized 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 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.
The law prohibits an 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 that is a sole proprietor or partner may elect to be covered by his own workers' compensation policy by filing Form I-4 (Election of Sole Proprietor or Partner to Come Within the Provisions of the Tennessee Workers’ Compensation Law) with the Tennessee Department of Labor and Workforce Development.
What happens if I am not required to have workers' compensation insurance and one of my employees has a work-related injury?
The injured worker is not entitled to workers' compensation benefits, but he/she is not barred from filing a lawsuit against you, the employer.
If I have less than five employees, may I still obtain workers' compensation coverage?
Yes, you should file the Exempt Employers Notice of Acceptance of the Workers' Compensation Act of Tennessee (Form I-8). If you later decide to drop your workers' compensation coverage, you must file the Exempt Employers Withdrawal of Notice of Acceptance (Form I-9). Important: If you file a Form I-8, you will remain subject to the workers' compensation requirements until a Form I-9 is received by this Division. If you drop your coverage and do not file a 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, may I drop my workers' compensation coverage?
Yes, if you are not in the construction or the coal mining industry. You must file a Notice of Withdrawal from Coverage of the Tennessee Workers' Compensation Law (Form I-3). You will then be an exempt employer and will not be required to have workers' compensation coverage while your workforce remains below five employees.
What if I can not find an insurance company to write a workers' compensation policy for me?
Your agent may contact the Tennessee Workers' Compensation Insurance Plan at (800) 471-6767 or www.twcip.com.
Who can I exclude from my workers' compensation policy?
Corporate officers may be excluded by filing Corporate Officer Election Not to Accept Provisions of Workers' Compensation (Form I-6). 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 Sole Proprietor/Partner Election to Come Within the Provisions of the Tennessee Workers' Compensation Law (Form I-4). Note: Both the I-4 and the I-6 forms are effective 30 days after the Tennessee Department of Labor and Workforce Development receives the forms. The original fully-completed notarized form should be sent to the Division of Workers' Compensation.
Who may I contact with additional questions?
Regardless of your role in the matter, if you have issues or questions, the Division’s Benefit Review Program assists employees, employers and insurance carriers by answering questions and by resolving disputes with workers' compensation claims. The Benefit Review Program can be contacted at email@example.com or 1-800-332-2667 or 615-532-4812 (TDD).
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 Snyder, Medical Director
220 French Landing Drive
Nashville, TN 37243-1002
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.
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.
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
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.
- Either party may request a physician from the Registry to perform an impairment evaluation. The requesting party is responsible for completing the “Application for a Medical Impairment Rating (MIR).” The requesting party must send a copy of this application to the other party and to the MIR Program Coordinator.
- After receiving the request, the Program Coordinator will supply the parties with the names of the independent and qualified Registry physicians who practice within the appropriate geographical area.
- If the parties agree on a selection from that listing, the requesting party should notify the Program Coordinator, who will schedule the appointment.
- If the parties cannot agree on a selection, either party may request a three (3) physician listing from the Registry by completing another “Application for a Medical Impairment Rating (MIR).” The requesting party must send a copy of this application to the other party and to the MIR Program Coordinator.
- Within five (5) calendar days of receiving this application, Program Coordinator will produce a listing of three (3) qualified physicians from its Registry and provide those names to the parties. The employer has three (3) business days to strike one name from the listing and to notify the employee and the MIR Program Coordinator. The employee then has three (3) business days to strike a name and to notify the Program Coordinator and the employer of the remaining name.
- If one party fails to timely strike a name, the other party should promptly notify the Program Coordinator of the name that it wishes to strike. The Division’s Medical Director may select one name from the remaining two, and that physician will perform the evaluation.
- In all cases, the Program Coordinator will notify the selected physician and will schedule the appointment.
- The claimant must promptly sign a release form permitting the release of all pertinent medical records. The parties must submit all pertinent medical records to the chosen physician at least ten (10) calendar days prior to the evaluation. In cases involving incomplete medical record submission caused by either party, the Commissioner may elect to reschedule the evaluation to allow the physician adequate time for record review. Otherwise, the physician will perform the evaluation and will issue an impairment rating utilizing the information made available to him/her within these time limits.
- The employer is responsible for pre-paying for the MIR evaluation the amount determined by the Program Coordinator and the Program Rules.
- The physician will submit the MIR evaluation report to the Program Coordinator, only. The Program Coordinator will forward copies to the parties.
- If a party wants to cancel the MIR evaluation, they should contact the Program Coordinator immediately. Only the Program Coordinator can cancel a MIR evaluation.
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.
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.
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.
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.
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.
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.
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:
- A brief description and overview of the claimant’s medical history as it relates to the subject injury, including reviewing and recapping all previous treatments.
- A statement of concurrence with the attending doctor’s determination of MMI;
- Pertinent details of the physical or psychiatric evaluation performed;
- Results of any pertinent tests performed (both positive and negative findings). Include copies of these tests with the report;
- An impairment rating consistent with the findings and utilizing a standard method as outlined in the applicable AMA Guides, calculated as a total to the whole person if appropriate. In cases not covered by the AMA Guides, an impairment rating by any appropriate method used and accepted by the medical community is allowed, however, a statement that the AMA Guides fails to cover the case as well as a statement of the system on which the rating was based must be included;
- The rationale for the rating based on reasonable medical certainty, supported by specific references to the clinical findings, especially objective findings and supporting documentation including the specific rating system, sections, tables, figures, and AMA Guides page numbers, when appropriate, to clearly show how the rating was derived; and
- A true or electronic signature and date by the MIR physician performing the evaluation certifying to 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.
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.
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.tn.gov/MIR/
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:
- Possess a license to practice medicine or osteopathy in Tennessee which is current, active, and unrestricted;
- 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;
- 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
- Furnish satisfactory proof of carrying the minimum medical malpractice insurance coverage.
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.
The Commissioner may consider several factors. Examples include, but are not limited to,
- Achieving and maintaining Board Certification.
- Having and maintaining a current active and unrestricted license to practice medicine or osteopathy in Tennessee;
- Having and maintaining the required malpractice insurance;
- Proof of completion of an accepted course regarding the application of the relevant edition of the AMA Guides:
- Geographical needs of the Department;
- Misrepresentation on the application for appointment to the Registry;
- Acceptance of the Department's established MIR fee;
- Ability to effectively convey and substantiate medical opinions and conclusions concerning impairment ratings;
- Quality and timeliness of reports;
- Complaints from parties about the conduct of the physician;
- Disciplinary proceedings or actions;
- Failure to report prior involvement or conflicts of interest in case assignments;
- Any other reason for the good of the Registry, as determined by the Commissioner.
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 the MIR Program Coordinator at (615) 253-1613.
The Division of Workers' Compensation is required by statute to establish and collect penalties. Click here for a summary of workers' compensation penalties.
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.
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.
The Uninsured Employers Fund (UEF) seeks to ensure that Tennessee employers comply with insurance coverage provisions of the Workers' Compensation Law. T.C.A. § 50-6-412.
The purpose of the UEF is to:
• Ensure that all employers comply with insurance coverage provisions of the Workers' Compensation Law. • Penalize those employers who fail to comply with the law and fail to provide workers' compensation protection for their employees.
The UEF provides an administrative process to investigate and penalize employers who fail to carry workers' compensation coverage 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 and holding legal hearings called Show Cause Hearings.
When it is mandated by the Workers' Compensation Law, employers in the State of Tennessee are required to provide workers' compensation insurance for their Tennessee employees.
The Employee Misclassification Education and Enforcement Fund (EMEEF) was created to address employee misclassification and other related unlawful employment practices. T.C.A. § 50-6-901 et seq. The program is particularly interested when employers misclassify workers as independent contractors instead of employees, inaccurately report the number of employees and the amount of payroll, misrepresent the type of work that is being performed, and when employers unlawfully deduct monies from employees’ wages or salary for workers’ compensation premiums.
EMEEF receives complaints and conducts investigations. If cases involve unlawful deductions, civil penalties are assessed by the Commissioner or Commissioner's Designee for an amount equal to the amount unlawfully deducted. If cases involve other unlawful employment practices, the program conducts thorough investigations and takes appropriate action including referrals to other state agencies. EMEEF receives guidance from the Employee Misclassification Advisory Task Force, and the task force is charged with studying and making recommendations regarding issues relative to employee misclassification in the construction industry. T.C.A. § 50-6-919. EMEEF and the task force became effective on March 1, 2011.
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.
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. To report non-compliant employers, please complete the Request for Investigation form. Requests for Investigation must be complete in order to assure proper investigation. Please visit Coverage Verification Services prior to submitting Requests for Investigation to research an employer's workers' compensation coverage.
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.