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Overview of Tennessee Workers’ Compensation—2014 Avoid some of the most common mistakes, cut your workers’ comp costs and prepare for the upcoming Reforms. Jeff Francis, Assistant Administrator firstname.lastname@example.org. During this presentation, I am going to introduce you to the
Overview of Tennessee Workers’ Compensation—2014Avoid some of the most common mistakes, cut your workers’ comp costs and prepare for the upcoming Reforms.Jeff Francis, Assistant Administratorb.email@example.com
Five Most Common Mistakes
that drive-up your workers’ comp costs and the
Employers do not handle reported injuries correctly.
Form C-20 (Tennessee Employer’s First Report of Injury or Illness) should be filed in all cases where the injury or illness results in:
Employers are not providing injured employees with a panel of physicians.
C-42—Choice of Physician Form
Employers lose control of claims when they don’t take reported injuries seriously.
Several types of panels.
SB1574/HB1472provides specific procedures for obtaining medical information from authorized treating medical providers—medicalwaiver. (Deals with Overstreet case)
there is no covenant of confidentiality or prohibition against communications with authorized treating medical providers if guidelines/procedures (waiver) are followed.
Employers are not taking full advantage of recent reforms passed by the legislature.
Created as part of the Workers’ Compensation Reform Act of 1996, the DFWP has three basic objectives:
While participation is voluntary, this program offers the employer several significant benefits, among them:
The goals of the Benefit Review Program are:
The Benefit Review Program offers service in four main areas:
2222 Rosa L. Parks Blvd.
Nashville, TN 37228
444-A Neal Street
Cookeville, TN 38501-4027
Knoxville, TN 37921-6741
170 N. Main Street, 11thFl
Memphis, TN 38103-1820
845 Esther Lane
Murfreesboro, TN 37219
540 McCallie Ave, Ste W600
Chattanooga, TN 37402
1908 Bowater Drive
Kingsport, TN 37660-4136
225 Dr. MLK Drive, 1st Fl
Jackson, TN 38301-6985
Employers do not have the proper workers’ compensation coverage as required by law.
The UEF strives to have covered employers comply with the Workers' Compensation Act. The Program has offices in Jackson, Nashville, Memphis, Knoxville & Kingsport, Tennessee.
In most industries, employers with five or more employees, including part-time employees, must carry workers’ compensation insurance.
Family members are included in the count if they meet the definition of employee.
In fiscal year ending June 30, 2013the program collected $995,592in monetary penalties.
We also conducted 1,308 onsite inspections.
Also, 324 employers were penalized for non-compliance.
Employee Misclassification Education and Enforcement Fund (EMEEF) was created.
Effective March 1, 2011, new legislation requires everyone in the construction industry must:
be covered by workers’ comp, or
be specifically exempted.
Who may request an exemption?
Up to 5 officers of a corporation
Members of LLCs that own at least 20% of the business (maximum of 5)
Partners that own at least 20% (maximum of 5)
Up to 5 owners of certain family owned businesses
Other restrictions apply (licenses, etc.)
Requests for exemptions are sent to the Secretary of State’s office, not the Dept. of Labor, and cost $200.00 for two years
For more info about the exemption registry:
Employers or their insurance carriers are not handling a claim timely.
The Penalty Program enforces several penalties, including:
2) a $10,000+ penalty for failure to comply with a Specialist’s order;
3) a penalty for failure to timely file Claims forms.
$1.50 - $1.99
$2.00 - $2.49
$2.50 - $2.99
$3.00 - $3.49
Tennessee’ s system is different from other states:
Reforms are effective for injuries or diseases that occur on or after July 1, 2014
Rules will be formulated for various sections of the reform bill
Definition of Injury
Change in Construction of Law
Move from Chancery/Circuit Courts to Workers’ Compensation Court in DWC
Change in Medical Provider Panels
Change in Physician Communications
Change in PPD benefit calculations
Currently, there is a “could be” standard when it is supported by lay testimony
New Law: Injury is compensable if it arose “primarily in the course and scope of work” when all other possible causes are considered
An injury arises primarily out of the employment if the employee can show that it “contributed more than fifty percent (50%)in causing the injury, considering all causes.”
Treating physician must state that work
primarily caused the injury to a
“reasonable degree of medical certainty.”
Will replace current construction that the law must be liberally construed in favor of the employee.
New: Statute must be construed fairly, impartially and in accordance with basic principles of statutory construction.
Will render and decisions on appeals of decisions by WC judge.
3 Appeal Judges
Parties will still have right of appeal to the Supreme Court.
PC 289 simplifies the process by requiring only one panel.
Initial Treating physician may refer injured worker to a specialist
Providers must be willing to treat the injured worker.
Maintains the “community” rule, but allows a 100-mile radius if not available in the community.
NEW—Division can enforce a penalty for improper panels
New: Employer is allowed to communicate with treating physician (orally or in writing), only about the treatment for the workers’ compensation injury.
Guidelines for the diagnosis and treatment commonly occurring workers’ compensation injuries
Intended to reduce disputes, improve quality and timeliness of medical treatment
In consultation with medical advisory committee
If worker does not return to work for any ER at 100% wage after initial disability period
Date of Injury
Date Injured Worker Reaches Maximum Medical Improvement
If EE does not return to work or does, but makes less than the pre-injury wage, the EE is eligible for additional benefits.
The additional benefit is determined by multiplying the initial benefit by all that apply:
A workers’ compensation system