Tennessee Workers Comp Claims: Eligibility, Filing and Appeals

If you were injured on the job in Tennessee, you should be able to file a workers’ compensation claim  if you became injured on the job as a direct result of a work-related accident or develop an occupational disease due to an exposure at the workplace. This can include exposure to toxins, as well as conditions that are the result of repetitive stresses and chronic injuries that develop over time due to environmental conditions in the workplace. The Tennessee Department of Labor and Workforce Development manages Tennessee workers’ compensation claims.

Generally, employers with five or more employees in Tennessee are required to have workers’ compensation insurance. All construction companies, regardless of the number of employees, must have workers’ compensation insurance.

All benefits related to your work-related injury or occupational disease come through the workers’ compensation system. Your employer usually has a release of all liability for the injury, meaning you cannot sue the employer for the injury. There are rare exceptions to this general principle; talk to an attorney if you believe a traditional lawsuit against your employer is appropriate for your situation.

Covered Injuries and Illnesses

Under Tennessee workers’ comp law, any industrial (work-related) injury or occupational disease that necessitates medical care, or results in the employee’s death or absence from work, is considered a valid workers’ compensation injury or illness. However, the injury or illness must have arisen in the course and scope of employment.uts and scrapes needing only first aid are insufficient for a workers’ compensation claim.

If your injury or illness meets the requirements for a workers’ compensation claim, you should report your claim immediately.

Covered Workers

Tennessee workers’ compensation law does not cover all workers working in Tennessee. Separate federal workers’ compensation laws cover federal employees. And like most states, Tennessee excludes independent contractors, domestic workers, and some agricultural workers from coverage under state workers’ compensation law. (Sole proprietors and business owners can elect to opt-out of coverage if they meet certain criteria.) 

Filing a Workers' Compensation Claim

You should report your injury or occupational disease to your employer as soon as possible, and no later than thirty days from the injury, or when your doctor first tells you your injury or illness is work related. Your employer will complete the Tennessee Employer’s First Report of Work Injury or Illness form, Form C-20, to acknowledge your report of a possible workers’ compensation claim. The employer must complete this form within one day of your report of the injury or illness. Your employer should complete the reporting forms even if your employer disputes that the claim is related to your work.Your employer will also file your claim with OSHA using OSHA Form 301.

You do not need to give notice to your employer of the injury or illness in writing. However, it's best to do so anyway, to avoid any question of when you reported the injury or illness.

The employer will notify its workers’ compensation insurance carrier of your workers’ compensation claim.  The insurance carrier may approve or deny your claim.

What If Your Claim Is Denied?

Within fifteen days of receiving notice of your claim, the workers’ compensation insurance carrier for your employer must accept or deny your claim. The insurance carrier will notify you and your employer of the decision sometime within the fifteen-day window. 

Under Tennessee workers' compensation claim laws, your employer's insurance carrier can deny your claim for several reasons. For example, if there is a lack of information on the proper forms, or your employer says the injury was not work related, your claim can be denied. If there is a dispute over your claim, the insurance company may hold your claim pending further investigation. The notification the insurance company sends you must include documentation showing the reasons for the denial.

Workers' Compensation Benefits

If your workers’ compensation claim is accepted, you should begin to receive the workers’ compensation benefits you are eligible for depending on your particular situation.

Medical Treatment

Your employer, or its workers’ compensation insurance carrier, is responsible for paying all claim-related medical care. This includes doctor visits, hospitalization, prescriptions, physical therapy, and even mileage reimbursement if it's necessary to travel more than fifteen miles for a medical appointment. Your employer may require that you choose a physician from a list of three physicians provided to you by your employer.

Lost Wages

If your doctor determines you are physically unable to work due to your injury or occupational disease, Tennessee law provides compensation for lost or reduced wages due to your inability to work. These benefits are available only if you cannot work for more than seven consecutive days.

Your temporary disability benefits will be two-thirds of your average weekly wage at the time of your injury, subject to a statutory maximum. As of July 1, 2016, the maximum weekly benefit is $976.80. You will receive payment directly from your employer or its insurance carrier on a weekly basis.

Permanent Disability

Once your doctor has determined you have reached maximum medical improvement (MMI), which means that further treatment isn't expected to improve your condition, your doctor will assess whether you have any permanent impairment resulting from your injury or illness. Your doctor will give you an impairment rating. This rating, plus your vocational abilities (for example, your prior training), are combined to come up with your permanent disability award.

The permanent disability award will be a certain number of weeks of payment of two-thirds of your average weekly wage at the time of injury, subject to a statutory maximum. As of July 1, 2016, the maximum benefit for permanent disability is $888 per week. The number of weeks is set by statute, and is determined by your permanent impairment rating and vocational factors. You can also negotiate a lump-sum settlement with your employer or their insurance company so that you can be paid all the weeks at once.

Settlement

Your doctor will complete an Attending Physician’s Report once you have reached maximum medical improvement. Your doctor will note your permanent impairment rating, if any, on this form. Within thirty days of receiving this form, your employer’s workers’ compensation insurance carrier must make an offer of settlement to you in writing. If you are concerned about whether the offer represents a fair settlement of your case, you should review this offer of settlement with a worker's comp attorney in your area. To accept the offer, you must sign the offer of settlement and return the form to your employer or its insurance carrier. If you approve the settlement, the insurance carrier will submit the settlement to the Workers' Comp Division for approval, with a copy to the Commissioner of the Tennessee Department of Labor. Alternatively, if you do not agree with the settlement offer, you or your employer may request a benefit review conference (see below).

Appealing a Tennessee Workers' Compensation Denial

If you've been denied workers' compensation benefits or are unhappy with settlement offers made by your employers' insurance company, you can request a benefit review. For more information on appeals, see our article Appealing a Worker's Comp Claim in Tennessee.

Tennessee Workers Compensation Office Locations

There are eight workers' compensation "benefit review" offices in Tennessee, including one in many larger communities. The main three offices are:

Memphis Office
170 North Main Street, 11th Floor
Memphis, Tennessee 38103-1820

Jackson Office
225 Dr. Martin Luther King Jr. Drive
Jackson, Tennessee 38301-6985

Nashville Office
2222 Rosa L. Parks Blvd
Nashville, Tennessee 37228

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