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
Insurance– Department of Labor and Workforce
Development Workers’ Compensation law is a
compromise between employer and employee
Claims
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 Chiropractic
– 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 days
– Select an “authorized treating physician”
– Follow medical provider’s instructions– Cooperate with all parties
EDI 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 electronically.
– Tennessee receives the claim transaction and returns an acknowledgment transaction to the Claims administrator.
– 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 [email protected]
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
Coverage
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’
compensation– Initial Dispute resolution– Send Request for Assistance
Benefit Review
Workers’ Compensation Specialist Functions
– Temporary Disability & Medical Treatment Issues
– Mediation of Permanent Disability Issues
– 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 Tennessee
Discourage alcohol and drug abuse Advantages Observations
Fraud
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)
[email protected] Claim Forms Filing and Electronic Data
Interchange [email protected]
Benefit Review [email protected]
Medical Case Management & Utilization [email protected]
Drug-Free Workplace [email protected]