Tennessee Department of Labor & Workforce Development
Workers’ Compensation Division
710 James Robertson Pkwy 2nd Floor
Nashville, Tennessee 37243-0661
(615) 741-2395
Toll Free 1-800-332-2667
TDD 1-800-848-0299
MAXIMUM/MINIMUM BENEFIT CHANGES
Temporary Benefits - The maximum weekly benefit rate for injuries occurring July
1, 2004 through June 30, 2005 is 105% of the state’s average weekly
wage, $670.00.
Permanent Benefits - The maximum weekly benefit rate for injuries occurring July
1, 2004 through June 30, 2005 is 100% of the state’s average weekly
wage, $638.00.
Minimum Weekly Benefit - The minimum weekly benefit rate for injuries occurring
July 1, 2004 through June 30, 2005 for both temporary and permanent
benefits is $95.70.
APPROVAL OF ATTORNEY FEES
For the year beginning July 1, 2004 and ending June 30, 2005, the
adjusted threshold amount for attorney fees subject to review/approval by the
Commissioner of Labor and Workforce Development is $13,459.90.
LEGISLATIVE CHANGES
This overview is general. For a complete and detailed review of this information please
read the legislation in its entirety by going to www.legislature.state.tn.us. The legislation
will be listed as SB3424/HB3531.
MEDICAL FEE SCHEDULE
The workers’ compensation reform legislation provides for a medical fee
schedule to apply to all manner of treatment of a work related injury to deliver
quality medical care while controlling prices and system costs. The fee schedule
is to be effective July 1, 2005. The fee schedule will be developed through
consultation with the Medical Care and Cost Containment Committee and the
Workers’ Compensation Advisory Council and other experts in the medical field.
Before adoption the schedule will be reviewed by the House Consumer and
Employee Affairs Committee and the Senate Commerce, Labor and Agriculture
Committee.
FUTURE MEDICAL BENEFITS
The bill prohibits an employee from selling his/her right to future medical benefits
until three years after the date of settlement approval or trial order on injuries to
schedule members with a value of 200 weeks or more and to body as whole
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injuries. The right to future medical benefits for permanent total disability can
never be closed. This provision is effective for injuries on or after July 1, 2004.
Allows closure of future medical benefits on any schedule member injury for
which the injured worker is eligible to receive benefits for a period of less than
200 weeks.
The legislation provides for disputed and controverted claims to be settled as
long as the total amount paid is no more than 50 times the minimum weekly
benefit rate as of date of the claimed injury. This provision is effective for injuries
on or after July 1, 2004. Settlements made pursuit to this section have no right to
future medical benefits.
PANEL OF PHYSICIANS
The bill requires the Department of Labor and Workforce Development establish
a form for employers to use to provide a panel of physicians. The form requires
the employee to document his/her selection of the attending physician by
signature and date. The employer must maintain the original form and provide a
copy to the employee. The employer is required to provide a copy to the
Workers’ Compensation Division upon request. This provision is effective for
injuries on or after July 1, 2004.
PENALTY FOR UNTIMELY PAYMENT OF TEMPORARY DISABILITY
BENEFITS
The legislation requires the Department of Labor and Workforce Development to
assess a penalty against an employer, pool or trust, or an employer’s insurer who
fails to make a payment or who makes an untimely payment of temporary
disability benefits to which the injured worker is entitled. The penalty will be
assessed when temporary benefits are unpaid or untimely paid 20 or more days
after the employer had knowledge of the injury. The penalty amount is 25% of
untimely paid or unpaid temporary disability benefits and is made payable to the
injured employee. This provision is effective for injuries on or after July 1, 2004.
PERMANENT IMPAIRMENT CAP OF MULTIPLIER FOR IMPAIRMENTS
WORTH 200 WEEKS OR MORE
The bill establishes a cap of 1.5 times the permanent impairment rating for claims
in which the injured worker returns to work with same employer at same or
greater wage. This cap applies to all body as a whole impairments and
scheduled member impairments worth 200 weeks or greater. This provision is
effective for injuries on or after July 1, 2004.
RECONSIDERATION RIGHTS
Provides for reconsideration of settlements for body as a whole injuries capped
at 1.5 if injured employee loses his/her job within 400 weeks of the date of return
to work. The reconsideration of settlements for schedule member injuries
capped at 1.5 is for the number of weeks the schedule member involved is worth
and begins with the day he/she returns to work. The bill provides two exceptions
that prohibit an employee from filing for reconsideration: 1. Voluntary resignation
or retirement unrelated to the work-related disability. 2. Employee misconduct.
The bill retains the six times cap on non-return to work permanent partial
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disability settlements on body as a whole injuries and also applies this six times
cap on non return to work permanent partial disability settlements for scheduled
members worth 200 weeks or more. Clarifies that employees are not permitted
to waive or forfeit and the parties are not permitted to compromise and settle, the
employee’s rights to reconsideration. These provisions are effective for injuries
which occur on or after July 1, 2004.
IMPAIRMENT RATING GUIDELINES
The legislation requires physicians to use the applicable edition of the AMA
Guides to Permanent Impairment. In cases not covered by the AMA Guides, an
impairment rating by any appropriate method used and accepted by the medial
community is allowed. The division Administrator determines which edition is
applicable. The full title of the most recent edition and the date it became
effective will be maintained on the website of the Tennessee Workers’
Compensation Division (www.state.tn.us/labor-wfd/wcomp.html). This provision
is effective for injuries which occur on or after July 1, 2004.
BENEFIT REVIEW CONFERENCE PROCESS
The bill prohibits filing a case in court until after the Benefit Review Conference
process has been exhausted. If a date for a conference is not agreed upon
within 45 days of request or date of maximum medical improvement, the
Workers’ Compensation Division will set the date of the Benefit Review
Conference. If the Division fails to conduct the Benefit Review Conference within
60 days, the parties may elect, at their own expense, to hire a private Rule 31
mediator to conduct a mediation conference. Any agreement reached through
private mediation must be approved by either the department or a court. There is
an exception for cases in which there is no dispute and parties reach a
settlement without the need for a Benefit Review Conference. In these
settlements the parties can proceed to court or to the division for approval.
These provisions are effective for injuries which occur on or after January 1,
2005.
AUTHORITY TO CONTINUE, WAIVE OR DISMISS A BENEFIT REVIEW
CONFERENCE
The legislation gives authority to the Workers’ Compensation Specialist, within
their sole discretion, to continue, waive or dismiss a Benefit Review Conference.
This provision is effective for injuries which occur on or after January 1, 2005.
ELIMINATION OF CRIMINAL COURT JURISDICTION TO HEAR WORKERS’
COMPENSATION CASES
The bill eliminates criminal court jurisdiction to hear workers’ compensation
cases. This provision is effective July 1, 2004.
TEMPORARY AND PERMANENT DISABILITY BENEFIT CAPS
The legislation raises the cap on weekly temporary disability benefits to 105% of
the state’s average weekly wage for injuries which occur on July 1, 2004 through
June 30, 2005. It raises cap on compensation benefits in temporary cases only
to 110% of the state’s average weekly wage for injuries which occur on July 1,
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2005. The cap on permanent partial benefits remains at 100% of the state’s
average weekly wage.
INDEPENDENT MEDICAL EXAMINATION REGISTRY
The bill establishes an Independent Medical Examination Registry to settle
disputes as to an injured worker’s impairment rating. The opinion of the
physician selected through the Registry process shall be presumed to be
accurate and can only be rebutted by clear and convincing evidence.
Independent medical examinations are paid for by the employer or insurer. No
physician may serve as an independent medical examiner in a case where that
physician was listed on the panel provided to the employee to chose his/her
treating physician. This provision is effective for injuries which occur on or after
July 1, 2005.
SECOND INJURY FUND
Limits Second Injury Fund exposure to permanent total cases only and applies to
injuries which occur on or after July 1, 2005.
CASE MANAGEMENT
Case Management is no longer mandatory and if utilized it is at the employer’s
expense and the employee must cooperate. This provision is effective July 1,
2004.
WORKERS’ COMPENSATION ADVISORY COUNCIL REVIEW
REQUIREMENTS
The bill requires the Workers’ Compensation Advisory Council to review
restrictions on employee’s choice of treating physician, review definition of
“injury”, and review replacing present workers’ compensation system with an
administrative commission or review board. The Council will also study
occupational health and safety in Tennessee’s workplaces. The bill requires the
Council to include in the annual report significant workers’ compensation court
decisions and a breakdown of awards by judicial districts. Standing committees
of the General Assembly may refer workers’ compensation bills to the Council for
comment.
JUDICIAL TRAINING
This legislation requires judicial training on workers’ compensation laws,
requirements, and procedures and the use of the AMA Guides to be provided by
the Administrative Office of the Courts effective July 1, 2004.
MEDICAL CARE AND COST CONTAINMENT COMMITTEE
The Medical Care and Cost Containment Committee’s composition will increase
from 8 to 14 members. New members consist of 1 additional member from the
Tennessee AFL-CIO, 2 additional members from the Tennessee Hospital
Association, 1 additional member from the Tennessee Chamber of Commerce
and Industry, 1 new member from the Tennessee Pharmacists Association, and
1 new member from the health insurance industry. This provision is effective
July 1, 2004.
DEPARTMENT OF COMMERCE AND INSURANCE – SELF INSURED
EMPLOYER BONDS AND FINANCIAL STATEMENTS
The minimum bond amount required by the Department of Commerce and
Insurance from a single self-insured employer is $500,000.00. This section of
the bill sets forth certain requirements for deposits of negotiable securities,
certificates of deposit, letters of credit and bonds filed by a self-insurance with the
Department of Commerce and Insurance. Financial statements required to be
filed biennially with the Department of Commerce and Insurance must be
actuarially certified. This provision is effective January 1, 2005.
The Department of Commerce and Insurance may assess a civil penalty of $100
per day against a single self-insured employer for each day that it fails to provide
its financial statement. The bill provides that a single self-insured employer must
have a certificate of authority issued by the Department of Commerce and
Insurance before it may transact business as a self-insurer. The Commissioner
of Commerce and Insurance has the authority to conduct examinations and
investigations of singe self-insured employers necessary for the protection of the
public. The Commissioner of Commerce and Insurance is also authorized to
examine the financial condition of all employers who are self-insured or members
of a self-insured pool or trust. These provisions are effective January 1, 2005.
DEPARTMENT OF COMMERCE AND INSURANCE – UNFAIR COMPETITION
AND DECEPTIVE ACTS
The bill expands the power of the Department of Commerce and Insurance to
regulate “unfair competition and deceptive acts” to include self-insured employers
or members of a self-insured pool or trust. This provision is effective July 1,
2004.
DEPARTMENT OF COMMERCE AND INSURANCE – UNTIMELY PAYMENT
OF WORKERS COMPENSATION BENEFITS IS UNFAIR CLAIM
SETTLEMENT PRACTICE
The bill makes the general practice of failing to make timely payment of workers’
compensation benefits an unfair claim settlement practice subject to the
Department of Commerce and Insurance’s enforcement powers. This provision
is effective July 1, 2004.
