Claims Kit

Penalties for Late Reporting  0800-02--01-.10  0800-2-14-.04 50-6-118 (2)

The Bureaus will assess and collect civil penalties as defined in the Bureau'sRules.  A violation of any Workers' Compensation Rule included in Chapters 0B00-02 without a defined penalty may result in a civil penalty of not less than fifty dollars ($50.00) nor more than five thousand dollars ($5,000), per violation.

The bureau of workers' compensation will by rule promulgated pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, establish and collect penalties for  late filing of accident reports 

Physician Selection 0800-02-01.06

After an injury, and an employee requesting the need for medical treatment, an employer must provide the employee with a panel of physicians as soon as possible but no later than 3 business days. 

 A medical provider must be qualified. willing and able to treat in a timely manner the injury or condition reported to be listed on a panel

For injuries on or after July 1, 2014   50-6-204

Upon the report of a workplace injury, an employer should provide the employee, the C-42 Agreement Between Employer / Employee Choice Of Physician

If the date of injury is on or after July 1, 2014, the form should include:

At least three independent physicians;
Not practicing at the same location; and
Within the community of the injured employee.  If three physicians cannot be located within the community of the injured employee, the employer may create a list of three independent physicians within a 100-mile radius of the community of the injured employee.

Effective until 7/1/14  50-6-204

If the date of injury is prior to July 1, 2014, the form should include:

At least three physicians;
Not associated together in practice together; and
Within the community of the injured employee, if available.  If there are not enough physicians available within the community of the injured worker, names of physicians from outside the community should be added.
If the injury involves the employee’s back, the number of named physicians listed must be expanded to at least four (4) names, one of whom must be a chiropractor. 

The employee has the right to choose a physician from the list.  The physician selected by the employee becomes the “authorized treating physician”.  The employee is required to accept treatment from the authorized treating physician and should not seek treatment from any other medical provider unless the authorized treating physician makes a referral.  The C-42 form must indicate the name of the physician chosen by the injured employee, be signed by the employee with a copy given to the employee, and the original kept on file with the employer.  Employees may also be asked to sign a C-31 Medical Waiver and Consent Form. to allow the employer and/or insurance adjuster to receive copies of medical notes and reports from the chosen physician.

Reporting of Claim by Employer 0800-2-01-.05 

In order to ensure that claims are acted on promptly, employers should report verbally or in writing all known or reported accidents to their insurer within one working day of knowledge of injury. The Form C-20 must be filed by the employer, self-insured employer, and/or insurer with the Division in all cases where the injury or illness results in the receipt of medical treatment outside of the employer premises, absence from work, retention of a permanent impairment, or death. The requirement to file does not differ based upon the number of days between the injury or illness and the day of return to work.

An employer must accept any notice of a claim for workers' compensation benefits from any employee or emplovee's representative alleqinq an injury.

Employers, must report the injuries or illnesses to their "adjusting entity" within 1 business day of knowledge of the injury or illness

Posting Requirements

50-6-407 [Applicable to injuries occurring on and after July 1, 2014.]

50-6-407 [Applicable to injuries occurring prior to July 1, 2014.]

Every employer subject to the Workers’ Compensation Law is required to display the Tennessee Workers' Compensation Insurance Notice. This posting notice should be posted conspicuously in the place of business for easy viewing by all employees and must contain the business’:

Name
Telephone number
Physical address of the employer representative that can be used to confirm if the employer is subject to the workers' compensation law and, if so, to obtain the name of the employer’s workers' compensation insurance carrier
The employer representative’s telephone number and physical address that should be notified in the event of an injury.   If the employer has multiple locations, a separate Posting should be posted at each location.

Tennessee Workers' Compensation Insurance Posting Notice

Tennessee Workers' Compensation Insurance Posting Notice Spanish