Main/Knoxville:  (865) 588-7000
Nashville:  (615) 557-4296
(800) 588-7001


Workers’ compensation is a system of no-fault insurance. Workers’ compensation insurance provides wage replacement and medical benefits to employees for work-related injuries and diseases. The Tennessee Workers’ Compensation Law (TWCL) determines the process for handling workers’ compensation claims. The information below summarizes the current state of the TWCL, as it applies to injuries that occur on or after July 1, 2014. Prior versions of the TWCL may apply for earlier dates of injury.

The Division of Workers’ Compensation (Division), part of the Tennessee Department of Labor and Workforce Development, investigates and handles workers’ compensation claims in the state. The processing of a claim typically begins with a notice of injury and may end up in administrative or judicial appeal.

EMPLOYEE’S REPORT OF INJURY

Employees must notify a supervisor or manager of any work-related injury either immediately or as soon as reasonable and practicable after an accident. If the employer does not have actual notice of the injury, the injured employee must provide written notice to the employer within 30 days. Any compensation or medical expenses that accrue between the date of injury and the time when written notice is provided are not payable unless the employer had actual notice or unless the employee has a reasonable excuse for failing to provide notice. Employees who fail to provide a written notice altogether may forfeit any compensation.

For gradual or cumulative trauma, the employee’s written notice is due within 30 days after the employee knows or reasonably should know he or she sustained a work-related injury that resulted in permanent physical impairment or inability to continue normal work activities. For occupational diseases, the employee’s written notice is due within 30 days of the first distinct manifestation of the disease, except in cases involving asbestos-related diseases and coal workers' pneumoconiosis.

EMPLOYER’S REPORT OF INJURY AND CLAIM INVESTIGATION

Employers must notify their insurance carriers of an injury claim within one working day of receiving an employee’s verbal or written notice of an accident or condition. Employers must also notify the Division of the claim. Claim investigation must begin within two working days.

MEDICAL PANEL

Within five days of receiving notice of an injury that requires medical attention, employers must provide the injured employee with a list of at least three medical treatment providers. Injured employees must receive treatment from one of the providers on the employer-provided list, or they risk losing all workers’ compensation coverage.

DETERMINING INITIAL COMPENSABILITY

The TWCL requires employers to accept or deny a claim within 15 days after receiving notice of an injury. Upon accepting or denying the claim, an employer must notify the injured employee and the Division.

If the claim is accepted, the first payment of benefits must occur within the first 15 days after the employer has notice of the injury as well. Medical expenses must be paid within 45 days of receiving an invoice.

CLAIM DENIAL

Employers can deny a claim within the first 15 days after the notice of injury or at any time after the employer begins paying benefits. Employers must immediately notify injured employees and the Division whenever they decide to deny a claim. Employers must be able to support their decision to deny a claim with the documented results of the claim investigation.

DISPUTED CLAIMS

If the claim is denied before benefits are paid, employees can dispute the denial within one year from the date of injury.  Employees that do not file a Petition for Benefit Determination with the Division within one year forever waive their right to contest the denied claim. In cases involving death after injury, the petition is due within one year of death.

If the claim denial occurs after the employer has previously accepted a claim by paying benefits, the employee’s Petition for Benefit Determination is due within one year of either the last authorized treatment or the date the employer last issued a payment, whichever is later.

ALTERNATIVE DISPUTE RESOLUTION (MEDIATION)

After an employee files a timely Petition for Benefit Determination, the Division assigns a workers’ compensation mediator, who schedules Alternative Dispute Resolution Proceedings (also called mediation). Mediation is a mandatory first step for all disputed claims.

Mediation may be held in person, by telephone, electronically or by any other means the mediator may find practical for resolving the disputed issues. All parties are required to cooperate with the mediator and participate in mediation in good faith.

Settlement

If the parties resolve all of the disputed issues during mediation, the mediator prepares a Settlement Agreement and files it with the clerk of the Court of Workers Compensation Claims (WC Court). A WC Court judge must then approve the settlement before it becomes effective. Settlements reached through any other means must also be approved by the WC Court in order to be effective. 

Dispute Certification Notice

If the parties are not able to reach full resolution at mediation, the mediator must issue a Dispute Certification Notice, which lists:

· Issues the parties agreed upon at mediation;

· Issues remaining in dispute; and

· Defenses raised during mediation.

The parties must file any objections to the Dispute Certification Notice within five days. At his or her discretion, the mediator may file an amended version of the notice within 60 days. The final Dispute Certification Notice establishes a limited and final list of issues and defenses the parties may bring to the WC Court for further dispute resolution.

JUDICIAL PROCEEDINGS

To request judicial review of a disputed claim, the parties must file a Request for Hearing with the WC Court. The WC Court will review a dispute claim only if a mediator has issued a Dispute Certification Notice. However, the WC Court may dismiss a disputed claim if neither party files a request for hearing within 60 days after the Dispute Certification Notice is issued.

If a request for hearing is accepted, a WC Court judge will hold an initial hearing within 30 days. At the initial hearing, the parties discuss and agree on a schedule for further proceedings. Then the parties are given time to gather and exchange evidence. This process is generally informal but may be governed by the state rules of civil procedure. When the period for gathering evidence ends, the parties must once again participate in mediation as described above. If this secondary mandatory mediation also fails to reach a full settlement, the mediator files a new Dispute Certification Notice, and the WC judge either conducts a compensation hearing as scheduled in the initial order, or, if a party requests it, reviews the evidence without holding a hearing.

In a compensation hearing, the WC Court judge decides only the disputed issues included in the most current Dispute Certification Notice and sets forth the decisions in a compensation order. Compensation orders include findings of fact, conclusions of law and awards of compensation to be paid, if any. Expedited hearings are also available, but only for certain disputes. Following an expedited hearing, the judge issues an interlocutory order. The type of order (compensation or interlocutory) determines whether and how the order may be appealed.

APPEALS

Any party dissatisfied with a WC Court order can appeal for a review by the Board of Workers’ Compensation Appeals, or, if a compensation order is final, the state supreme court. The Board of Workers’ Compensation Appeals (WC Appeals Board) is a panel of three judges whose sole purpose is to review WC Court decisions. The panel’s review is generally limited to the evidence in the WC Court’s record, and it presumes that the findings and conclusions in the WC Court judge’s order are correct. Parties to an appeal are not allowed to present testimony or oral arguments before the WC Board.

The table below shows how appeals are affected by the order that is being reviewed.

 

 

Ordered Issued by WC Court

Deadline for Appeal to WC Appeals Board

Time to Issue Appeal Decision

Further Appeals

Interlocutory order

Seven business days after order is issued

Seven business days

The Board’s decisions are final. No further appeal is possible.

Compensation order

30 calendar days after order is issued (If no party files a timely appeal, the order becomes final and the parties may appeal to the state supreme court.)

Parties are given 15 days to submit supporting briefs.

The Board has 45 days to issue a decision.

Order may be appealed to the Tennessee Supreme Court

 STATE SUPREME COURT

Once a compensation order becomes final, dissatisfied parties have 30 days to file an appeal with the Tennessee Supreme Court. A compensation order becomes final when:

· No party files a Request for Appeal to the WC Board within 30 days after the WC Court entered the compensation order; or

· The WC Appeals Board certifies the court’s compensation order as final.

Appeals in the supreme court proceed under the state’s rules of civil procedure, which give parties an opportunity to submit briefs and present oral arguments.  Workers’ compensation cases may be assigned to a special three-judge panel, but all cases proceed in the same manner as they would if heard before the full supreme court.  

The supreme court only reviews decisions of the WC judge, and it presumes the findings and conclusions in the final order are correct. 

 

Posted 2:26 PM  View Comments

Share |


No Comments


Post a Comment
Name
Required
E-Mail
Required (Not Displayed)
Comment
Required


All comments are moderated and stripped of HTML.
Submission Validation
Required
CAPTCHA
Change the CAPTCHA codeSpeak the CAPTCHA code
 
Enter the Validation Code from above.
NOTICE: This blog and website are made available by the publisher for educational and informational purposes only. It is not be used as a substitute for competent insurance, legal, or tax advice from a licensed professional in your state. By using this blog site you understand that there is no broker client relationship between you and the blog and website publisher.
Blog Archive


View Mobile Version

   
         Main Office:   9700 Westland Dr, Suite 102, Knoxville, TN 37922
Nashville Office:   c/o Industrious, 1033 Demonbreun St, Suite 300, Nashville, TN 37203
 
This website is intended to stimulate dialogue about your protection and does not alter or interpret your insurance policies. Always refer to your policy for details about your coverage.