Workers’ Compensation Mileage Reimbursement Rates

Reimbursement for mileage to and from medical treatment may be requested if travel exceeds 15 miles.

Please note that regardless of the date of injury, mileage reimbursement is for the date of the office visit. See Tennessee Code Annotated 50-6-204 (a)(6)(A) & (B).

Effective Date Mileage Rate

August 1, 1998 = $0.26

August 1, 1999 = $0.28

March 1, 2000 = $0.32

May 1, 2004 = $0.35

January 1, 2005 = $0.38

September 19, 2005 = $0.46

January 1, 2006 = $0.42

January 15, 2007 = $0.46

October 1, 2008 = $0.54

July 1, 2009 = $0.51

January 1, 2010 = $0.46

August 1, 2011 = $0.47

Employees who have suffered a compensable workplace injury are entitled to the following benefits:

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:

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

The Tennessee Department of Labor announces the appointment of first workers’ compensation judges

The Tennessee Department of Labor’s Division of Workers’ Compensation announced the appointment of their first eight workers’ compensation judges.

The Tennessee Legislature passed comprehensive Workers’ Compensation reform legislation last year. The reform created a new, administrative Workers’ Compensation Court within the Workers’ Compensation Division. The new judges will begin work prior to July 1, 2014, when the new law goes into effect.

“Workers’ Comp reform will result in a system that is fair to both employees and employers and will speed up the settlement of injury claims,” said Labor Commissioner Burns Phillips. “This should result in more predictable outcomes.”

The appointees are as follows:

• Brian Addington, Kingsport, Attorney with the Division of Workers’ Compensation

• Joshua Baker, Nashville, Administrative Attorney and Legislative Liaison with the Division of Workers’ Compensation

• Lisa Knott, Knoxville, Attorney with the Division of Workers’ Compensation

• Pamela Johnson, Knoxville, of Counsel with the Leitner, Williams, Dooley and Napolitan law firm in Knoxville.

• Allen Phillips, Jackson, partner with Waldrop & Hall in Jackson.

• Jim Umsted, Memphis, Attorney with the Division of Workers’ Compensation

• Thomas Wyatt, Chattanooga, partner with Summers & Wyatt

• Ken Switzer will be the Chief Judge. He is an associate with the Howard Tate law firm.

The appointments were made by the Workers’ Compensation Division Administrator, Abbie Hudgens, and were selected from recommendations from the Workers’ Compensation Interview Committee, which was composed of representatives of employees, employers, and the legal community from all three grand divisions of the state.

Please note that this is an official announcement from the Tennessee Department of Labor and the original content can be found at https://news.tn.gov/node/12397

The Tennessee Department of Labor’s Fee Notice regarding a Utilization Review Appeal

Public Chapter 289 (2013) and Tennessee Code Annotated § 50-6-204 (j)(5)authorize an employer to use utilization review to determine the medical necessity of a treatment recommended by an authorized treating physician, and, in instances required by the workers’ compensation statutes or the medical fee schedule.

Utilization review is required in the form of pre-admission review for all inpatient hospital admissions, and concurrent review should be done after discharge. Emergency admissions require utilization review within one business day of the admission. Utilization review is required on chiropractic, physical and occupational services after twelve visits. In order to facilitate expedited utilization review, whenever a physician orders physical therapy or occupational therapy the physician should include the diagnosis on the prescription for physical therapy or occupational therapy. Utilization review is required for psychological treatment services in excess of fifteen (15) visits.

Pursuant to Tennessee Code Annotated § 50-6-204(j)(5) and Rule 0800-02-06-.07 (2) (c), the Division is authorized to impose a fee for the administration of the utilization review appeal process. Accordingly, the Workers’ Compensation Division, or their contractor, Eckman/Freeman & Associates, will collect a fee not to exceed $250 for each review conducted. After the utilization review appeal is completed, an invoice will be submitted to the employer, or their workers’ compensation insurance carrier, for payment. The fee shall be paid by the employer, or their workers’ compensation insurance carrier, within thirty (30) calendar days of the completion of the utilization review appeal. If the fee is not paid within the time frame, then a 10% interest payment shall accrue for every thirty (30) calendar days that the fee remains unpaid.

The Workers’ Compensation Division, or their contractor, Eckman/Freeman & Associates, will provide notice to the employer’s workers’ compensation insurance carrier’s adjuster whenever it receives an appeal of a utilization review decision rendered pursuant to the statute. If the carrier decides to rescind the original utilization review decision, the carrier must inform the Workers’ Compensation Division, or their contractor, Eckman/Freeman & Associates, of its decision within two (2) business days of the date the Division, or their contractor, notified the carrier of the utilization review appeal to avoid assessment of the fee. In order to avoid the fee, information that the utilization review decision has been rescinded must be provided to the entity– meaning either the Division or Eckman-Freeman–that sent the carrier notice of the utilization review appeal.

The Notice of Appeal Rights for a Utilization Review Denial (Form-C35A) was updated in December of 2010. Please note that any older versions of the Form-C35A will not be accepted and will be returned to the carrier and/or their utilization review company as invalid. The carrier and/or their utilization review company will be required to resubmit the correct version of the form.

This information was generated by the Tennessee Department of Labor and the original source can be found here http://www.tn.gov/labor-wfd/wcomp/forms/UR%20Appeal%20Fee%20Notice.pdf

Tennessee Targets Workers’ Comp Fraud in Construction Industry

The Tennessee Department of Labor has been expanding efforts to uncover employer fraud within the construction industry.

The efforts, aided by recent legislation, will help identify employers who are paying workers under the table, intentionally misclassifying workers as independent contractors, and who are failing to report all wages paid.

The state Department of Labor & Workforce Development said a Nashville drywall firm accused of lying to an insurance company about how many employees were on its payroll was first to pay $300,000 in a settlement.

Officials said the fraud is typically used to avoid paying workers’ compensation and unemployment insurance tax premiums. It also gives deceptive employers an unfair competitive advantage over law-abiding firms, they said.

Part of the effort includes the hiring of additional investigators to detect the fraud. Since legislation went into effect in July 2013, three investigators have been hired.

The agency is also buying new fraud detection software and plans a public awareness campaign that will include a website and a phone line at 1-800-332-2667 for citizens to report a business suspected of misclassifying its workers.

This information was produced by the Insurance Journal and the original source of the information can be found here http://www.insurancejournal.com/news/southeast/2014/06/06/331240.htm

The Tennessee Department of Labor’s Administrative Review Program

The Administrative Review Program provides an independent review of a Benefit Review Order. If the injured employee, employer or insurance adjuster disagrees with an Order issued by a Benefit Review Attorney Specialist, he/she may request an Administrative Review of the Order. Once requested, an Administrator’s Designee will review all of the information and documentation in a case file and conduct an informal conference before making a decision and issuing a new order. The Program’s goals are to assure that Orders, whether awarding or denying benefits, are in accordance with the applicable Workers’ Compensation Law, rules and regulations, policies and procedures, as well as case law to provide a more informal and cost-effective appeal process than through the state’s Court system. The administrative review is conducted by a Workers’ Compensation Attorney Specialist, known as an Administrator’s Designee, in an expedited and efficient Informal Conference over the telephone in which each party is able to explain the facts and issues involved in their workers’ compensation matter. Either party may request the review by submitting a Request for Administrative Review Form C-44 within seven (7) calendar days of his/her receipt of the Benefit Review Order.

IMPORTANT NOTES:
•An Informal Conference is conducted within ten (10) calendar days from the date the Division receives the Request for Administrative Review Form C-44 unless otherwise agreed by both parties. The conference is a telephone conference call for the parties to explain the facts and issues of their workers’ compensation matter to a senior member of the Division.
•General information that was available and could have reasonably been obtained and provided by a Party to the Benefit Review Specialists before the Benefit Review Order was issued will not be considered by Administrative Review except in very limited circumstances.
•The Division must produce a new Order within seven (7) calendar days of the Informal Conference.
•The parties must comply with the new Order within ten (10) calendar days of the receipt of the decision.

Please note the previous information came from http://www.tn.gov/labor-wfd/wcomp/employers_info.shtml#ADMIN_REV

Going to and from work and the traveling employee

An employee, who travels on business for the employer, or at the request of the employer, is in the course of employment while traveling. Employees on business trips are generally considered to be continuously in the scope of employment during the entire duration of the business trip, unless the employee makes a distinct departure on a personal errand. However, this requires a substantial and unauthorized deviation or detour for personal purpose to remove the travel from being considered to be in the course of employment during the period of deviation. Issues regarding traveling employees generally go to whether an injury, which occurs while traveling, meets the “in the course of” requirement of the workers’ compensation statute. Typically, there is no coverage for an employee while traveling to the office or while traveling home. However, there are several key questions in determining whether or not a traveling employee will be entitled to benefits. The nature of the activity in which the employee was involved while traveling, resulting in the injury must be determined. Typically, if a trip involves both business, as well as personal purposes, then the trip will be deemed to be one in which coverage is provided. However, claims in which the employer provides a vehicle also results in compensable claims, even though an employee may be traveling to their home. This rule has been extended to provide coverage if an injury occurs on the employee’s premises, even during a break or while off the clock, or while involved in a recreational activity, which is provided by the employer.

What is the definition of injury by accident?

The Tennessee Workers’ Compensation Law is applicable in situations where an Employee sustains an injury by accident arising out of and during the course and cope of his/her employment. Tenn. Code Ann. § 50-6-102 defines “Injury” and “personal injury” as an injury which is caused by an accident that arises out of and during the course and scope of Employee’s employment which causes the Employee to suffer either disablement or death of the employee. The statute also includes occupational diseases and mental injuries within the definition of “injury”.

For injuries that occur on or after June 6, 2011, The Tennessee Workers’ Compensation Statute defines “Injury” and “personal injury” as an injury by accident arising out of and in the course of employment that causes either disablement or death of the employee. “Injury” and “personal injury” shall not include a disease in any form, except when it arises out of and in the course and scope of employment. “Injury” and “personal injury” include a mental injury arising out of and in the course of employment. An injury is “accidental” only if it is caused by a specific incident (or incidents) arising out of and in the course of employment and is identifiable by time and place of occurrence.

After June 6, 2011, cumulative trauma conditions, hearing loss, carpal tunnel syndrome, and all other repetitive motion conditions shall not be considered an “Injury” and “personal injury” unless such conditions arose primarily out of and in the course and scope of employment. Also, the revised statute now provides that the authorized treating physician’s opinion on causation is presumed to be correct. Thus, the panel chosen physician’s opinion on causation is presumed to be correct, and can only be defeated by a preponderance of the evidence. Considering the new limitations on gradual injuries, the authorized physician’s opinion on causation is even more important and it makes it more difficult for the Plaintiff to rebut causation by an independent medical examiner’s opinion.

The Medical Impairment Rating Registry

The Medical Impairment Rating (MIR) Registry is a Division of Workers’ Compensation-maintained listing of qualified and approved physicians who are specially trained to conduct impairment rating medical evaluations and who have applied to serve on the Registry. The program is designed to assist parties in settling a workers’ compensation claim when the only item being disputed is the impairment rating. The program provides the names of physicians, listed on the Registry, who are specifically trained in the techniques of performing impairment rating evaluations on the body part(s) involved in the workers’ compensation claim. The physicians whose names are provided will be objective and impartial since they will not have been involved in the claim whatsoever. The rating produced by the physician selected by the parties is utilized to help determine any Permanent Disability Benefits due in the matter. Before the parties can request a MIR evaluation, there must be a dispute about the impairment rating. A dispute occurs when:

There are competing impairment ratings issued by different physicians, and the parties disagree as to which rating is correct (dueling doctors), or
The treating physician has placed permanent restrictions on the claimant, but has issued a rating of “zero,” or states that there is “no permanent impairment.”
To request the MIR evaluation, one of the parties must submit the Application for a Medical Impairment Rating (MIR) form to the division.

The Program is designed to increase the number of cases being settled outside the courts. It is quicker, less expensive and adds consistency and predictability to the system when compared to having the issue resolved in court. For additional information about this topic, please call the Tennessee Department of Labor at 615-532-4812 or 1-800-332-2667. IMPORTANT NOTES:

The program is available only for dates of injuries on/after July 1, 2005.
An MIR evaluation may be requested by either party. Regardless of which party requests it, the cost of the evaluation is borne by the employer.
To help eliminate some of the unproductive negotiations and unnecessary lawsuits, opinions that physicians issue in MIR evaluations are considered, by statute, to be “accurate” and can be overcome only by clear and convincing evidence to the contrary.
The report provided by the MIR physician will provide only the impairment rating. It will not address causation, apportionment, job restrictions or modifications, or the appropriateness of treatment.
Injuries occurring on or after January 1, 2008 must be rated by The AMA Guides to the Evaluation of Permanent Impairment, 6th Edition.
Injuries occurring prior to January 1, 2008 must be rated by the applicable version of the AMA Guides, as determined by the Tennessee Workers’ Compensation Act.

The Tennessee Department of Labor’s Penalty Program

The Penalty Program investigates and assesses penalties for violations of the Tennessee Workers’ Compensation Act other than those covered by the Uninsured Employers Fund (UEF) and the Employee Misclassification Education and Enforcement Fund (EMEEF). The Program enforces several penalties, including:

A 25% penalty for failure to pay or to timely pay temporary disability benefits; (If assessed, this penalty goes to the injured employee not to the Division.)
A $10,000+ penalty for failure to timely comply with a Specialist’s or Administrator’s Designee’s order; and
A penalty for an insurance company’s or self-insured employer’s failure to timely file claims forms; (Timely claims forms are important to the Division as the forms supply important claims information to the legislature for its consideration regarding changes to the Workers’ Compensation Act.)
Other various penalties.

Click here for a summary of workers’ compensation penalties.

For additional information about this topic, please call the Tennessee Department of Labor at 615-532-4812 or 1-800-332-2667.