Workers' Compensation (Workers' Comp)
In the interest of protecting workers injured on the job, state legislatures have enacted Workers' Compensation laws (Workers' Comp). Congress enacted similar laws to provide for federal employees. Employees are often quite familiar with the concept of Workers' Comp but understand little about how it works. This lack of understanding is hardly surprising given the complex nature of the Workers' Comp system and law. Below is an overview of Workers' Comp law in Tennessee. The subject is far too complex to permit much detail here; we suggest that you contact an attorney for guidance if you have a specific question.
- Tennessee Law
- Every employer subject to the Workers' Compensation Law shall pay compensation for personal injury or death by accident arising out of and in the course of employment without regard to fault as a cause of the injury or death.
- Employees are obligated to accept such payment under the law.
- Employers are subject to Workers' Comp law if the business employs 5 or more people.
- Benefits are of four types and are paid according to the Schedule of Compensation.
- Injuries are of two types: Partial and Total.
- There are three types of Coverage for employers to choose from:
- Insurance Policy.
- Self-Insured Trust.
- There are four different types of Benefits an employee can receive under Workers' Compensation.
- Disability benefits - weekly benefits paid if a doctor finds that the employee is unable to work. The injured employee is not paid for the first seven days after the injury. Compensation may begin on the eighth day and must begin no later than fifteen days after the injury.
- Medical benefits - each employee should have the option of choosing free treatment from a panel of three physicians provided by the employer.
- Permanent disability and final settlement - if the employee will never recover from the work-related injury, then a settlement must be determined based on the schedule of compensation. The treating physician will provide a percentage of disability, and a Workers' Comp representative will assist in determining the correct amount of the settlement.
- Death benefits - when a job-related accident results in the death of a covered employee, the widow or dependent orphan are entitled to receive fifty percent (50%) of the deceased employee's average weekly income. If the deceased worker leaves both a surviving spouse and dependent children, they will be compensated at sixty-six percent (66%) of the deceased employee's average weekly income.
- The Schedule of Compensation is a complex set of rules for determining the amount of damages due to the injured worker. The schedule relies on a variety of factors. including percent of disability and part of the body injured.
- When an employee is injured, the employer should take the following steps:
- Fill out a First Report of Work Injury (or C-20) form.
- File the C-20 along with a statement of the employee's wages with the insurance carrier within one (1) working day of the injury.
- Offer the employee a panel of three physicians. The list of doctors should also be posted so that employees know where to go when they are injured.
- Inform the injured employee of the name and number of the insurance carrier.
Responsibilities of Others:
- Insurance Carriers
- Contact the employer and injured employee within two (2) working days after receiving the C-20 in order to gather additional information.
- Contact the treating physician within seventy-two (72) hours of treatment to confirm injury or illness and make a preliminary determination on cost of treatment.
- Accept or deny the claim within fifteen (15) days, and inform the employer and employee of the decision.
- Issue a compensation payment to the injured employee no more than fifteen (15) days after the C-20 was filed.
- Send a copy of the C-20 form and the notice of first payment or notice of denial to the Division of Workers' Compensation no later than fourteen (14) days after notice of injury.
- Pay all medical costs within forty-five (45) days after receiving the bill.
- Medical Case Management - a case manager must be assigned to any claim:
- In which an employee requires hospitalization.
- In which the injury costs more than 10,000 dollars.
- In which the employee missed more than eight (8) weeks of full-time work.
- Case Management Services include:
- A face-to-face visit with the injured employee within fourteen (14) days of the injury.
- Monitoring of treatment and the healing process.
- Decisions about whether medical treatment is cost effective and appropriate.
- Determining an appropriate plan for return to work.
Filing Requirements and Limitations:
- Workers' Compensation claims must be brought within one year after the injury occurred or after the injured employee finds out that the injury is permanent and was caused by work.
- Injuries must be reported in writing to the employer within 30 days of the injury.
- The Department of Labor's Office of Workers' Compensation Programs (OWCP) oversees the regulations and laws that are put in place to cover federal employees who are injured at work or get sick because of work.
- The Tennessee Department of Labor and Workforce Development regulates Workers' Compensation for employees who work for private companies and state and local agencies.
Remedies and Damages:
- You may file your claim in court if it is not settled.