New TN Work Comp Claim Handling Standards

Revisions to Tennessee's workers' compensation claims handling standards are coming beginning on August 2, 2018. 

Revisions include adjusting entities to designate a liaison to the Bureau to serve as a primary point of contact; clarification on the steps to file claims if the Social Security number is missing or unknown; deletion of the former requirement to have a claims office in the state, and new requirements for making contact with the injured employee.

In summary:

  • Workers must now be notified within two (2) business days of a new claim adjuster or insurance carrier.
  • Large claim migrations from one carrier to another require seven (7) days’ notice.
  • Claims managers must designate a central point of contact for workers and the bureau.
  • A “Beginners Guide to Tennessee Workers’ Compensation” brochure must be sent to injured workers within two (2) business days of notification of injury.  This must be sent by US Mail.  There are no provisions for sending via Email.
  • Contact with the injured worker must be made within two (2) days after the worker receives the brochure. For medical only claims, the adjuster may satisfy the requirement by mailing a notice of reported injury with contact information & Email address. 
  • Twice a year, each adjusting entity will provide the bureau a list of all claim adjusters and their contact information.
  • If electronic data submissions do not receive an 85% acceptance rate per month, then penalties may apply.
  • Social security numbers – if injured workers’ do not have a SS# for claims documentation, then Tennessee requires a number starting with nine (9), followed by the injured worker’s date of birth.  If a SS# is later found, then the bureau must be immediately notified with a first report of injury change notice.
  • All electronic submissions and Email to the bureau must be scanned by antivirus before hitting the send button.
  • If an adjusting entity contracts with a trading partner to electronically file transactions with the Bureau on the entity’s behalf or uses a trading partner software product to electronically send  transactions to the Bureau, a “Trading Partner Agreement” form provided by the bureau must be fully completed and submitted to the bureau.

See the following link for all changes: http://publications.tnsosfiles.com/rules_filings/05-07-18.pdf

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