Medical treatment, at no cost to the employee for as long as the authorized treating physician relates it to the work-related injury, including Future Medical Benefits after a claim is resolved.  Medical benefits must be ordered by the authorized treating physician and can include medical/surgical treatment and supplies, medicine, crutches, nursing or psychological services, prescription eyeglass/eyewear, hospitalization, and dental work that is made reasonably necessary by the workplace injury.  Employees traveling more than 15 miles one way to and from medical treatment may seek reimbursement from the insurance carrier for their travel expense.

Temporary Disability Benefits paid by the insurance company or self-insured employer and are to replace lost wages.  Disability begins only after the authorized treating physician takes an employee off work and these benefits are begin on the eighth (8th) calendar day of the disability.  If the disability lasts fourteen (14) days or more, benefits will be paid back to the first day of disability.  Temporary disability benefits are usually two-thirds (2/3) of the injured worker’s average weekly wages earned during the 52 weeks prior to the injury.

Payment of Temporary Disability Benefits:  An employee is entitled to 66 2/3% of his/her average weekly wages in temporary total disability (TTD) benefits while taken off work by the authorized treating physician due to the workplace injury, as long as the benefit amount is within the maximum or minimum amounts established by the Tennessee Workers’ Compensation Act.   The employer must submit a Wage Statement (Form C-41) to the insurance adjuster.  This wage statement will list the injured employee’s gross earnings for the fifty-two (52) weeks prior to the date of injury and should show all earnings including overtime and bonuses.  To determine the benefit, gross earnings are totaled and divided by 52 (the number of weeks in a year).  The result is the employee’s average weekly wage.  The average weekly wage is multiplied by .667 to determine the employee’s weekly compensation rate.

During the course of treatment for a work-related injury, the treating physician may determine an injured employee can return to work on “light duty.”  If the authorized treating physician restricts an injured employee’s ability to work, such as limiting the number of hours worked or the type of work performed, it is very important that the physician’s instructions and restrictions are followed at all times.  The employee should get a detailed description of work restrictions from the doctor to provide the employer.  If the employer can provide work within those restrictions, it should do so.  Failure to report for light duty offered by the employer may terminate temporary disability benefits.  If the employee is paid a lesser pay or is restricted to fewer hours because of the light duty, the employee is entitled to “temporary partial disability (TPD) benefits”.  These benefits are figured at 66 2/3% of the difference between the gross light duty wages and the employee’s average weekly wage, subject to the same maximum and minimum workers’ compensation rates described above.

Example:  If an Employee’s average weekly wage were $600.00 per week before being injured, but the same Employee was only able to earn $200.00 per week while on light duty.  The temporary partial disability benefit would be calculated in this manner:

$600.00 minus $200.00 equals $400.00 difference in pay due to the light duty restrictions. 66 2/3% of $400.00 equals $266.68.

Therefore, the Employee will earn $200.00 in wages and would receive $266.68 in workers’ compensation temporary partial disability benefits.  However, if the employer is unable to meet the restrictions provided by the treating physician, the injured employee would remain off work and his/her temporary total disability benefits described above would continue.

Stopping Benefits:  There are several circumstances under which the temporary disability benefits stop.  They include:

• When an injured employee is released by the authorized treating physician to return to work without restrictions.
• If an injured employee refuses to comply with a reasonable request for medical examination or to accept medical treatment, compensation may be stopped for the period of time an employee continues the refusal.
• If the employer or insurance carrier has been paying benefits and discovers those payments were made in error, the insurance carrier can stop benefit payments; but, must file a Notice of Controversy (Form C-27).
• When an injured employee’s treating physician determines the employee has reached maximum medical improvement (MMI), andthecompensability of the injury has not been contested.  Payments must continue until the earlier of the following events:
  • An injured employee accepts or rejects a job offered by the employer at a wage equal to or greater than the employee’s pre-injury wage; or,
  • A Benefit Review Conference is held and a report is filed by the Division.

Permanent Disability Benefits:  When the injury has healed and maximum medical improvement (MMI) is reached, the injured employee will likely be released from the treating physician’s care and may be referred for other additional services such as physical therapy, pain management and possibly work hardening sessions.  The authorized treating physician may assign a permanent impairment rating based on the applicable edition of the American Medical Association Guides to the Evaluation of Permanent Impairment.   The impairment rating, combined with vocational factors, may result in a permanent disability award.  Workers’ Compensation Specialists with the Division conduct, at no cost to the parties, informal Benefit Review Conferences to assist the parties in reaching a final agreement or settlement of the claim. The Benefit Review Conference is discussed below.  Attorney Specialists with the Division may approve settlement agreements with respect to permanent disability and death benefits, including the issues of future medical benefits where provided for by statute.  No settlement will be approved that does not provide that the employee is receiving substantially the benefits to which he/she is entitled.  In cases where there is a dispute between the parties as to whether a claim is compensable or as to the amount of compensation due the Attorney Specialists may approve a settlement on a “doubtful and disputed” basis without regard to whether the employee is receiving substantially the benefits to which he/she is entitled if the settlement is determined to be in the best interest of the employee.

Permanent Partial Disability describes the condition of an employee able to return to a job in the open market, but who retains a permanent disability because of a work-related injury.  That employee may be entitled to Permanent Partial Disability benefits.  The benefit is 66 and two-thirds percent (66 2/3%) of the injured employee’s average weekly wage, subject to limitations depending upon the body part affected by the work-related injury (for injuries before July 1, 2014), and the employee’s ability to return to his/her prior employment.  This benefit continues until he/she becomes eligible for old age retirement under the social security law.

Death Benefits:  When a compensable workplace injury results in the death of a covered employee, benefits are available to the surviving dependents.  Burial expenses for the deceased employee are paid, not to exceed $7,500.  When the deceased employee leaves no dependents, $20,000 shall be paid to his or her estate.  If an employee leaves a surviving spouse and no dependent child, fifty percent (50%) of the average weekly wages shall be paid to the surviving spouse subject to the maximum weekly benefit (400 weeks).  If an employee leaves a surviving spouse and one or more dependent children, sixty-six and two-thirds percent (66 2/3 %) shall be paid to the surviving spouse for the benefit of the surviving spouse and dependent child(ren).

IMPORTANT NOTES:

• If the injured employee has worked for his/her employer for less than 52 weeks at the time of the injury, the weekly compensation rate must be figured by one of the following two methods:
• By counting the number of weeks the injured employee has worked for that employer and calculating gross earnings for those weeks.  The gross earnings are divided by the actual number of weeks employed with that employer; or,
• By calculating the average weekly wage earned by a similar worker employed with the same employer performing the same job as the injured employee during the 52 weeks prior to the injury.
• Temporary disability payments for a compensable work-related injury or illness must be paid by the insurance company and received by the injured employee no later than fifteen (15) days after notice of injury.  All workers’ compensation benefits shall be issued timely to assure the injured employees receive the benefits on or before the date they are due.  Unpaid or untimely paid benefits may be subject to a penalty.

Please note the Tennessee Department of Labor is the author of this content and the original source can be found at http://www.state.tn.us/labor-wfd/wcomp/insurance_adjusters_info.shtml#RESP_ADJUSTER