BENEFIT REVIEW
The Workers' Compensation Division has representatives that can assist employers, employees, and insurance carriers. If you have questions or problems relating to a workers' compensation injury, call 1-800-332-2667 (within Tennessee) or 615/532-4812. If the representative cannot resolve the issues, a Workers' Compensation Specialist can assist in resolving disputes and settling claims at no cost to the employer or employee.
The role of the Representative is:
To be the "first line of assistance" in cases with problems and/or disputes.
To examine claims to insure accurate processing of benefits to injured employees.
To advise employees and employers of rights and requirements under workers' compensation laws.
To visit and consult with employers to verify coverage and compliance with safety requirements and to insure posting of the Tennessee Workers' Compensation Insurance Notice.
To explain to all interested parties the laws, rules, and policies governing workers' compensation.
A Workers' Compensation Specialist will also conduct a benefit review conference for all injuries occurring on or after January 1, 1997, that do not reach a final settlement and where the parties do not waive this requirement. A benefit review conference is a non-adversarial mediation that takes place with the Specialist mediating the case between the employee and the employer/insurance carrier.
The role of the Specialist is:
To resolve/arbitrate the question of compensability in disputed workers' compensation cases.
To conduct benefit review conferences for the purpose of trying to resolve disputed issues through the process of mediation.
To review and approve or reject proposed settlement agreements in disputed workers' compensation cases. The Reform Act of 1996 authorizes the Commissioner of Labor and Workforce Development, or his designee (workers' compensation specialist), to approve proposed settlements between the parties if:
The settlement has been signed by the parties; and,
The Commissioner of Labor and Workforce Development or a workers' compensation specialist has determined the employee is receiving, substantially, the benefits provided by law or is in the best interest of the employee; and,
The settlement agreement is reviewed by a specialist not associated with the employee's case.
A settlement approved by the Tennessee Department of Labor and Workforce Development shall be entitled to the same standing as a judgment of a court of record.
The designated Discovery Attorney is a statutorily-created position, authorized to:
- Resolve disputes between parties regarding exchange of information in a workers’ compensation claim involved in settlement discussions. The attorney may issue subpoenas where appropriate.
Average of 20-30 referrals per months
Disputes are usually resolved within 10-12 days of receiving the request from the Specialist.
For all Benefit Review Orders issued on or after May 26, 2006 a party may file a Request for an Administrative Review. This review of a Workers’ Compensation Specialist’s Order helps to ensure that a Workers’ Compensation Specialist has made an appropriate decision when applying the Tennessee Workers’ Compensation Law to the facts of a disputed workers’ compensation case pursuant to TCA 50-6-238.
- An Informal Conference must be held within 10 calendar days. The conference is a telephone conference call for the parties to present their arguments to a senior member of the Division.
The Division must produce an Order within 7 calendar days of the Informal Conference.
The parties must comply with the Order within 10 calendar days.