Tennessee Workers Compensation Attorney by cru18323


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									   What’s Going On At The
Workers’ Compensation Division
Our Mission
   To promote the benefits and
    responsibilities of the Workers’
    Compensation Act
   To make available the services
    provided by the Act
   To act in a manner that is fair,
    consistent, professional, and
    impartial to everyone
Profile of WC in Tennessee
   Court administered
   Regulatory and administrative
    responsibilities divided
    – Department of Commerce and
    – Department of Labor and Workforce
   Workers’ Compensation law is a
    compromise between employer and
   Employers obligated by Law

    – To provide all medical services
    – Present panel of three physicians, except if
      back injury, panel of physicians must be
      expanded to four, with one being Doctor of
    – Indemnify lost wages to employee
    – Compensate permanent impairment
    – Report injuries / occupational illnesses to
      Division; this includes lost time and medical
      only claims
    – Process all claims according to Claims
      handling standards
Claims, continued
   Employees required by Law

    – To report injury to employer within 30
    – Select an “authorized treating
    – Follow medical provider’s instructions
    – Cooperate with all parties
   Electronic Data Interchange (EDI)
   Process
    – Employer reports all lost time and medical only claims
      to Claims administrator in the usual manner.
    – Claims Administrator reports the claim to Tennessee
    – Tennessee receives the claim transaction and returns
      an acknowledgment transaction to the Claims
    – The acknowledgment transaction notifies the Claims
      administrator that the transaction was received and
      tells if the transaction was accepted or rejected. If
      rejected, information about the rejection is included in
      the acknowledgment.
    – The acknowledgment transaction returns the State File
      Number (called the Agency Claim Number or ACN) to
      the Claims administrator.
EDI, continued
   The Division is no longer accepting paper forms
    on the following:
    – First Report of Injury (C-20)
    – Notice of First Payment of Compensation (C-22)
    – Notice of Denial of Claim for Compensation (C-23)
      However, a paper copy of the form with reason for
      denial or a copy of denial letter is required
    – Notice of Change or Termination of Compensation
      Benefits (C-26)
    – Final Report of Payment (C-29)

   Detailed information available by emailing a
    request to Patsy.Bumbalough@state.tn.us
Employer Requirements
   Every employer who has five (5) or more
    employees is required to have workers’
    compensation coverage; except that any
    employer in construction industry or
    engaged in mining & production of coal
    who has one (1) or more employees is
    required to have coverage
   Some employers and employees are not
    covered by the Law
   State and local governments are exempt
    from the Law
   Every employer subject to law is
    required to provide coverage
   Three types of coverage
   Every employer required to provide
    proof of coverage
   Every employer required to display
    Tennessee Workers’ Compensation
    Insurance Notice
Uninsured Employer Fund
   Investigates and penalizes
    employers who fail to have workers’
    compensation coverage
   Goals
   Penalty Process
   Injunction
Benefit Review
   Purpose

    – To resolve disputes
    – To minimize adversarial relationships
    – Decrease litigation
    – Reduce overall costs of claims
Benefit Review
   Staff

    – Workers’ Compensation Representatives
    – Workers’ Compensation Specialists
    – Administrative Support Staff

   Locations (Six area offices):
    –   Nashville
    –   Memphis
    –   Jackson
    –   Knoxville
    –   Chattanooga
    –   Kingsport
Benefit Review
   Workers’ Compensation
    Representative Functions

    – Toll-free number: 1-800-332-2667
    – General Information about workers’
    – Initial Dispute resolution
    – Send Request for Assistance
Benefit Review
   Workers’ Compensation
    Specialist Functions

    – Temporary Disability & Medical
      Treatment Issues
    – Mediation of Permanent Disability
    – Approval of Settlements
Benefit Review
   Request for Assistance

    – Statute of Limitations is Tolled
    – Handled in area where employee lives
    – Establishes a State File Number
Medical Case Management
   Definition
   Thresholds
   Qualifications
   Elements
Utilization Review
   Provisions
   Requirements
Permanent Total Disability
   An employee determined to be
    permanently totally disabled by trial
    or settlement may be reexamined
    after twenty-four months from the
    entry date of the final order.
   Each year an employee who is
    receiving permanent total disability
    benefits is required to certify that
    he/she continues to be permanently
    totally disabled
Medical Care & Cost Containment Committee

           Eight Voting Members

           Review cases involving medical
            cost disputes
Drug-Free Workplace Program
   Promote drug-free workplaces in
   Discourage alcohol and drug abuse
   Advantages
   Observations
   Employee fraud is referred to the District
    Attorney General
   Employer fraud is referred first to the
    Uninsured Employer Fund then to the
    District Attorney General
   Insurer fraud is referred first to the
    Department of Commerce & Insurance
    then to the District Attorney General
   Fraud Hotline: 1-888-243-7283
Contact Information
   Toll-free number: 1-800-332-2667
   Website: www.state.tn.us/labor-wfd/wcomp
   Coverage & Uninsured Employers Fund (UEF)
   Claim Forms Filing and Electronic Data
   Benefit Review
   Medical Case Management & Utilization Review
   Drug-Free Workplace Program

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