An injured employee should immediately report any work-related accident, injury or illness to their employer.  Employer notification, preferably in writing, is required within thirty (30) calendar days of the date of injury or the date when a physician first tells the employee that his/her injury is work-related. If you are an employee of the State of Tennessee, there are a few differences in the way that your claim is handled. Please check here for information regarding the responsibilities of a state employee. Upon the report of a workplace injury, an employer should provide the employee, in writing on An Agreement Between Employer/Employee Choice of Physician (Form C-42) a list of:

• At least three physicians;
• Not associated together in practice together; and
• Within the community of the injured employee, if available.
• If the injury involves the employee’s back, the number of named physicians listed must be expanded to at least four (4) names, one of whom must be a chiropractor.

The employee has the right to choose a physician from the list.  The physician selected by the employee becomes the “authorized treating physician” and the employee is then required to accept treatment from that physician and should not seek treatment from any other medical provider unless the authorized treating physician makes a referral.

• The C-42 form must indicate the name of the physician chosen by the injured employee, be signed by the employee with a copy given to the employee, and the original kept on file with the employer.  Employees may also be asked to sign a Medical Waiver and Consent Form (Form C-31) to allow the employer and/or insurance adjuster to receive copies of medical notes and reports from the chosen physician.

• The employer should also have a Tennessee Workers’ Compensation Insurance Notice posted so the injured employee can see the name of the insurance carrier.  If the notice is not posted, the employer should tell the injured employee who the insurance carrier is and how to reach them.

If there are not enough physicians available within the community of the injured worker, names of physicians from outside the community should be added.  Employees traveling more than 15 miles one way to or from medical treatment may seek reimbursement from the insurance carrier for their travel expense. For additional information about this topic, please call the Tennessee Department of Labor at 615-532-4812 or 1-800-332-2667.

IMPORTANT NOTES:

• If a dispute regarding medical treatment or other benefits occurs, an injured employee may seek help resolving the dispute from the Division.  The employee must complete a Request for Assistance Form (C40A) (*Click here for Spanish version) and mail, fax or E-mail to the proper office indicated on the form.
• To protect his/her rights to benefits, an injured worker must timely submit a completed Request for Benefit Review Conference (Form C-40B) 
• The right to receive workers’ compensation benefits does not stay open forever.  In most cases, the deadline to request the benefit review conference is one (1) year from: Employers are not required to pay employees for time spent attending doctor appointments, unless the company has a policy to pay for such time.
  • The date the injury occurred; or,
  • The date the last temporary disability benefits were paid or medical benefits were provided for the injury, whichever is latest.
• Employers or adjusters are generally not required to offer a second panel of physicians or a second opinion.  If requested by the injured employee, however, the insurer or employer MAY agree to provide a second panel.  An employee may always seek a second opinion or obtain treatment with any physician at his/her own expense.
• Injured employees must comply with all medical treatment prescribed by the authorized treating physician at all times.  Benefits may be suspended if the injured employee fails to comply with a reasonable request.

PLEASE NOTE: THIS INFORMATION IS PROVIDED BY THE TENNESSEE DEPARTMENT OF LABOR AND IS INSERTED HERE ONLY AS A MATTER OF CONVENIENCE.  THE ORIGINAL INFORMATION CAN BE FOUND HERE.