The United States Bureau of Labor Statistics found that in 2021, Tennessee had 2.5 cases of work-related harm for every 100 full-time workers in the state. This incidence rate translated into more than 53,400 cases of nonfatal injuries and illnesses. While Tennessee was among the 12 states in the country that had a lower incidence rate compared to the national average of 2.7, it still highlights the relative frequency of workplace accidents that result in bodily harm.
To help injured employees receive the aid they need, the Tennessee Bureau of Workers’ Compensation continues to streamline its efforts in expediting compensation claims and assisting workers in line with the 2013 Workers’ Compensation Reform Act. More recently, the bureau has helped more than 16,000 employers and employees resolve disputes under its Ombudsman Program. Over 85% of all the disputed claims in 2022 were resolved with the help of assigned mediators without the parties involved going to court.
Additionally, the number of workers who returned to their employer increased from 61% to 72% after the reform was implemented. On average, the bureau paid more than $26,000 in medical expenses per claim within the same year.
It must be noted that the process of filing a workers’ compensation claim in Tennessee involves various statutory guidelines and requirements. In order to help employees throughout the state understand the process better, this article will present a general overview of these rules, along with the responsibilities that all parties involved have and the options that an injured worker can take if they encounter difficulties related to their claim.
Tennessee Workers’ Compensation Insurance Requirements
Under Tennessee law, all employers with five or more employees must have workers’ compensation insurance, regardless of whether their workers are part-time or full-time. The requirement is stricter for employers in the coal mining, construction, and trade industries, where workers’ compensation insurance is needed if they have at least one employee. They will use the policy to cover the potential losses of workers who suffer injuries or fall sick due to work-related hazards.
In Tennessee, employers can obtain workers’ compensation insurance by:
Purchasing a policy from a licensed insurance provider in the state.
Applying for a policy at the Department of Commerce and Insurance if they qualify as self-insured employers.
Submitting an individual self-insurance application or applying for a group self-insurance pool or trust approved by the department.
Obtaining coverage through a company that is part of the Assigned Risk Plan; this option is viable if the employer has been refused by two or more agents or firms that are not affiliated with the plan.
Employers who are subject to the requirements related to workers’ compensation must also display the Tennessee Workers’ Compensation Insurance Posting Notice in visible areas throughout their place of work or business. This notice will serve to inform employees of what they need to do if they suffer any work-related harm. It must contain:
The name and title of an employer representative who will be notified about an injury.
The name of another representative who can be notified in place of the previous one.
The telephone number and address of both representatives; multiple addresses require separate postings.
Those who fail to comply with the Workers’ Compensation Act in the state will face a variety of sanctions that will be enforced by the Penalty Program. If an employer fails to provide proof of coverage, they must pay a specific monetary fine or a percentage of the annual workers’ compensation premium, whichever is greater and depending on how many times they have failed to comply. If they fail to pay any temporary disability benefits to an injured worker, or if they do not pay on a timely basis, they will face a 25% penalty.
Exemptions to the Workers’ Compensation Requirements in Tennessee
It should be noted that those who employ domestic helpers or farm laborers in Tennessee are not required to obtain workers’ compensation insurance; the same counts for local and state government agencies. However, these types of employers can still choose to get insurance coverage that they can use if one of their workers is injured.
Additionally, Tennessee excludes sole proprietors, partners, and members of limited liability companies from the count of employees, which determines whether an employer is covered by and thus subject to the requirements of the state’s Workers’ Compensation Act. Corporate officers can also opt out of a workers’ compensation policy, though they will still be counted among other employees unless they receive no compensation.
An employee who suffers an injury will not be entitled to any benefits related to workers’ compensation if their employer is not required to maintain a policy. However, they are still allowed to pursue compensation through a lawsuit against their employer.
Tennessee Workers’ Compensation Benefits
The benefits that an injured or sick employee can receive through a workers’ compensation claim can include:
Medical treatment that is administered free of charge and for as long as the employee needs it; an employee can choose one physician among at least three that their employer will designate.
Travel expenses or mileage reimbursement if the employee lives more than 15 miles away from the location where they are medically treated.
Temporary disability benefits that cover the employee’s lost wages starting from the eighth day of their disability due to their sickness or injury; if the disability lasts for more than 14 days, the employee will be paid back to the first day of their disability.
Permanent disability benefits if the employee can no longer work due to their sickness or injury.
Burial benefits worth up to $7,500 if the employee dies from their sickness or injury; additionally, their dependents will receive survivors’ benefits equal to 66 ⅔% of the employee’s average weekly pay.
However, before a worker can become eligible for these benefits, they must first prove that their injury occurred while they were working and that they were injured due to a work-related incident. In short, the worker must show that their injury was caused by their job. Any harm they suffer outside of the workplace will not make them eligible for compensation benefits.
Pre-existing conditions or injuries are also typically not covered by workers’ compensation unless they have been aggravated by a work-related accident.
In general, the types of injuries that can be reported in line with a compensation claim include:
Those that cause the injured employee to seek medical treatment outside of the workplace.
Those that result in the employee’s permanent impairment or absence from work.
Those that result in the employee’s death.
How to File a Workers’ Compensation Claim in Tennessee
The procedures involved in filing a workers’ compensation claim in Tennessee involve both the injured employee and their employer. To put it simply, the worker must meet the requirements that the process will require, while their employer must adhere to the state’s guidelines in terms of accepting and processing a claim.
When Is the Deadline for Workers’ Compensation Claims in Tennessee?
In accordance with Tennessee law, a worker must notify their employer or supervisor about any injury or sickness they have suffered at the workplace within 15 days of the incident that caused it. If the worker is not initially aware of any injury or sickness caused by a work-related incident, the same deadline starts counting down instead of the date when the worker first learned about the harm they have suffered or on the date when they should have reasonably learned about it.
On the other hand, once an employee has given their employer notice regarding their injury, the latter has a maximum of one day to submit the First Report of Work Injury or Illness form to the insurance provider from whom they obtained their workers’ compensation coverage. The provider will then have 15 days to review the information related to the injured worker’s situation, including the nature of their injury or sickness and how it affected their capacity to work, before approving or denying their claim.
If the worker encounters any issues related to their claim, or if their claim is denied even if their injury is work-related, they have up to one year to resolve these issues or challenge a claim denial, starting from the date of the work-related accident that caused their injury. In this case, the deadline starts counting down from the date when the injured employee received their last medical benefit payment or the date when they discovered or should have reasonably discovered their injury.
Step-By-Step Guide on Filing a Workers’ Compensation Claim in Tennessee
The following is a basic guide on how to file a workers’ compensation claim in Tennessee and what processes are involved in between:
1. Get Treatment and Report the Injury
Upon being injured, an employee must seek immediate medical treatment, after which they have up to 15 days to notify their employer or supervisor regarding their injury.
2. Make Sure That the Correct Form Is Filed
After receiving the notice regarding the employee’s injury, the employer or supervisor must then submit the First Report of Work Injury or Illness form to their insurance provider within one day. The employer will also assist the employee in seeking any further medical care from a panel of approved physicians; if the employer does not have any physicians chosen, they must work with the insurance provider in order to create a panel immediately.
In addition to the injury report, the employer must submit a Wage Statement form detailing the gross wages, bonuses, and overtime pay that the injured employee had received weekly for the 52 weeks preceding their injury.
The employee should check with their employer if these forms are filed promptly to avoid encountering issues in the long run.
3. Keep Track of the Claim Status
After filing the forms, the employer must work with the insurance provider to review the employee’s case based on the information given and the nature of the injury; a decision regarding the claim must be made within 15 days, as stated above.
If the insurance provider approves the employee’s claim, they must submit the Notice of First Payment of Compensation form to the Department of Labor & Workforce Development’s Workers’ Compensation Division via Electronic Data Interchange; this step can also be done by self-insured employers.
If the injured employee’s benefits are changed or terminated, the insurance provider must submit the Notice of Change or Termination of Compensation Benefits form to the division through EDI.
If the insurance provider denies the employee’s claim, they must submit the Notice of Denial of Claim for Compensation form to the division on paper and through EDI, after which they must also provide a physical copy to the employee. When denying a claim, the provider must present the documents that show the results of its evaluation of the claim and form the basis of its denial in line with statutory rules.
What Should One Do If a Workers’ Compensation Claim in Tennessee Has Been Denied?
If a compensation claim is denied and the injured employee believes their injury is compensable, they can submit a Petition for Benefits Determination to the Tennessee Bureau of Workers’ Compensation. The petition must be filed within one year from the date of the incident that caused the employee’s injury, as mentioned above. Once the petition has been submitted, the bureau will assign a mediator who will oversee the case and help the employee and their employer reach an agreement regarding the denied claim. This is often done to resolve disputes without resorting to a hearing.
If both parties cannot agree on a resolution, the mediator will notify the Tennessee Workers’ Compensation Court using a Dispute Certification Notice. Additionally, the employee has a maximum of five days to request that the mediator add any information relevant to their case to the notice. Once the mediator has filed the DCN, the employee has up to 60 days to request a regular or expedited hearing before the Workers’ Compensation Court, where a judge will decide on their case.
If the employee does not agree with the judge’s decision, they can file another appeal with the Workers’ Compensation Appeals Board, where three judges appointed by the state governor will evaluate and decide on the case. However, the employee can only do so within 30 days (or 7 days if their hearing is expedited) from the judge’s verdict in the Workers’ Compensation Court, since an order will be made final after that time. If the employee fails to contest an order within the given time, they can submit an appeal to the Tennessee Supreme Court.
A member of the BWC’s Ombudsman program can offer legal assistance to an employee who does not have legal representation and wants to resolve their claim’s issue without attending a hearing. One requirement for appealing an order, however, is that the employee must have legal representation if their case goes before the Workers' Compensation Appeals Board.
Legal Resources for Injured Workers in Tennessee
Tennessee Department of Labor & Workforce Development - Workers’ Compensation Resources
The Tennessee Department of Labor & Workforce Development has a number of accessible resources that employees within the state can use to learn more about the process and requirements involved in filing a workers’ compensation claim. It has articles that discuss the basics of workers’ compensation law and the options that a person can take if their claim is denied. The department’s website also offers access to downloadable forms that an employee can use to fulfill other requirements when filing a claim.
Tennessee Bureau of Workers’ Compensation - Ombudsman Program
The Ombudsman Program is open to any worker who seeks to address any issues related to a denied compensation claim without having to appeal in a hearing before the Workers’ Compensation Court or the Appeals Board. An ombudsman from the program can help all parties communicate, oversee the exchange of medical records, investigate the details of the dispute in question, and present a potential resolution.
Additionally, they can inform employees about the procedures and requirements involved in a workers’ compensation claim, though they cannot provide any legal advice. Those who wish to use the program’s services can contact the Bureau of Workers’ Compensation at 800-332-2667.
Legal Aid Society of Middle Tennessee and the Cumberlands
The Legal Aid Society of Middle Tennessee and the Cumberlands offers legal assistance at no cost to individuals and families alike. Its team helps people navigate civil cases, including those that involve employment matters such as unlawful termination, though it cannot provide aid for those involved in criminal cases. Additionally, it helps workers file claims for work-related benefits and educates them regarding their legal rights and available options in case they are denied these benefits. For additional queries, the LAS can be contacted at 1-800-238-1443.
ABA Free Legal Answers - Tennessee
Free Legal Answers is a legal advice clinic that was established as a project of the American Bar Association and its Standing Committee on Pro Bono and Public Service. People can register on the clinic’s website to submit questions related to different civil law matters, such as health, disability, employment, and unemployment. An attorney will contact a user via e-mail and address their queries at no cost, after which more follow-up questions can be submitted. However, any lawyers who offer assistance through Free Legal Answers cannot provide legal representation or answer questions related to criminal law.
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