In the state of Tennessee, you have the right to appeal a denial of your workers' compensation claim. You also have the right to appeal any determinations regarding your workers' compensation benefits, including benefit amounts. This procedures described in this article apply to injuries occurring on or after July 1, 2014. (If your injury happened before then, different rules apply; see the Tennessee Bureau of Workers' Compensation Mediation Program Option page to learn more.)
To begin the appeals process, you must file a Petition for Benefits Determination with the Tennessee Bureau of Workers' Compensation. You must file this form within one year of your accident or injury, your last authorized medical treatment, or your last benefit payment—whichever happens later. You should file the form with the regional office closest to where you live; the form provides the mailing addresses for all regional offices.
For disputes early on in your case, over medical treatment or temporary disability benefits, your case will be sent to mediation. A mediating specialist, a neutral third party from the Bureau, will try to help you and the insurance company reach a voluntary agreement. This informal meeting may happen over the phone or in person. The Bureau aims to have this meeting take place within 20 days of receiving a petition.
If mediation is unsuccessful in resolving the dispute, the mediating specialist will issue a Dispute Certification Notice and transfer the dispute to the Court of Workers' Compensation Claims. You will need to request an expedited hearing before a workers' comp judge within 60 days. Depending on the nature of the dispute, the judge may order a formal hearing to receive evidence from the parties. The judge will issue a written order after the hearing.
The process is slightly different for workers who have reached maximum medical improvement and are involved in a dispute over permanent disability benefits. The first step is also mediation. The parties can either use the Bureau's mediation process or use a private mediation service.
If the mediation is successful and the parties reach an agreement, the case will be transferred to the Court of Workers' Compensation Claims for approval. A judge will hold an approval conference to review the terms of the settlement and make sure that the terms are fair.
If mediation is not successful, either party can request a scheduling hearing with the court within 60 days. The scheduling hearing will take place over the phone, and the judge will ask questions and set deadlines relating to the case. After both sides have an opportunity to gather evidence, the judge will hold a formal compensation hearing. At the compensation hearing, the judge will review documents and listen to testimony from witnesses. Afterwards, the judge will issue a written order.
If you're not satisfied with the judge's decision, you may appeal to the Workers' Compensation Appeals Board within 30 days. A panel of three workers' comp judges will review the compensation hearing decision and either affirm or modify it. Alternatively, you may appeal directly to the Tennessee Supreme Court.
While you're not required to have a lawyer at any stage of the appeals process, it is often very beneficial. It can be difficult to negotiate with the insurance company at a mediation if you don't understand the value of your case. A lawyer can help make sure that you don't accept an unfair offer or hold out for an unreasonable one. In most cases, a lawyer is essential if you're going to a compensation hearing. These hearings follow very specific rules and procedures, which you will be expected to know if you represent yourself. This could result in costly mistakes, such as the judge not reviewing evidence that support your case. (For information on worker's comp benefits, see our article on the basics of Tennessee worker's compensation.)