Top tips for navigating Tennessee's workers' comp system
If you've been hurt on the job in Tennessee, you may soon find yourself in a state workers' compensation system that can be confusing and sometimes hostile.
But you can improve your chances of a good outcome by understanding how the system works.
Here are top tips on how to navigate the system, compiled from Tennessee Bureau of Workers' Compensation publications and Memphis workers' comp lawyer Jonathan May of the firm Morgan & Morgan.
What is workers' compensation?
Workers' compensation is a system that provides medical care to people who have been hurt on the job. If necessary, the system also provides disability payments or death payments.
In Tennessee, the system is governed by the Tennessee Bureau of Workers' Compensation.
Basic information on the system is available online at https://www.tn.gov/workforce/injuries-at-work.html.
The state has produced a series of videos that explain the system — they're helpful and they're available on this page.
First, if you're hurt on the job, report it
If you are hurt on the job, report it to your company as soon as possible. You should tell your supervisor or someone else in your company who handles worker injuries.
Make sure to state clearly that it was an on-the-job injury and that you need medical care.
If you don't report the injury in time, your employer could argue that your injury wasn't work-related and isn't eligible for coverage.
According to the state, the law says you must tell your employer about the injury — and your need for medical care — within 15 days of the date of the accident.
The law makes an exception for workers exposed to bad air, chemicals or repetitive trauma. These workers may not know they have a work injury until they have seen a doctor much later. The law says these workers have to report the injury within 15 days of when they know they have a work injury.
Some on-the-job injuries appear minor at first, but later turn out to be serious. For instance, a small pop in your back might be the first sign of a big back injury. So when in doubt, report your injury right away.
Under Tennessee law, you might still be eligible for coverage even if your report your injury late. Still, it's easiest to report it on time.
Your employer is supposed to make a record of you reporting the injury.
Your employer should complete Tennessee form C-20, called "Employer's First Report of Work Injury or Illness." You can find the form online at this link.
You can also create a record on your own. Send your employer a text message, an email or a Facebook message that says you were injured at work, and when, where and how the injury happened, May said.
"Just create your own paper trail if you are not sure that they have done so," he said.
The Tennessee Bureau of Workers' Compensation has created an instructional video about reporting work injuries, which you can watch at this link.
Firing an employee for reporting an injury is illegal
The state says firing you for reporting an injury is illegal.
"It is illegal for an employer to fire an employee for reporting a work injury," the state says in a publication. "If you are fired and believe it was for reporting a work injury, you may wish to consult an attorney. The Bureau of Workers’ Compensation does not have authority to resolve wrongful termination claims."
May, the attorney, says most employers won't retaliate against workers who report a work injury. Most injured workers eventually go back to their jobs — or if they don't, it's because they choose not to, he said.
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Your company should give you a panel of three doctors to choose from
You can pick from one of three doctors provided by your company. The doctor you choose will treat your injury and make decisions about your care.
Some injured workers complain that they believe the treating doctor is working for the company, rather than for them. Other people report a good relationship with their treating doctor and see their physician as an advocate.
You can improve the odds of a good match by researching the three doctors in advance.
Web sites such as Healthgrades.com and Vitals.com provide the physicians' backgrounds and reviews from patients.
Companies are legally required to give injured workers a panel of three physicians, but they don't always do it. If your company does not provide a panel of three doctors, request one.
You may receive temporary disability payments
If you've been injured on the job and you are unable to work normally, you may be eligible for temporary payments.
There are two types: temporary partial disability benefits are paid if you're on "light duty" or restricted to limited hours.
Temporary total disability payments are paid if you can't work at all — or if your employer declines to accommodate your restrictions.
For more details on how these benefits are calculated, visit this state web page or watch this video.
If you're severely injured, you may be eligible for permanent benefits
The best outcome for you is a quick recovery from your injury and a fast return to work.
However, if you are severely injured and won't fully recover, you may be eligible for permanent benefits.
The first type, permanent partial disability benefits, is for those workers who have a permanent physical impairment.
Permanent total disability benefits are for those workers who can never return to any work: for instance, a person who suffered paralysis, a severe limb amputation, or a traumatic brain injury.
Permanent partial disability cases are much more common than total disability cases.
You may hear the term "maximum medical improvement."
That's when your treating physician concludes that you're unlikely to improve further. The doctor assigns an impairment rating.
For instance, the doctor might conclude one worker is 5% disabled, while another worker is 50% disabled.
That rating and your pay are used to calculate your benefits.
These benefits are usually paid as a lump sum.
For more details on permanent benefits, visit this state web page or watch this video.
As your case progresses, show up to every medical appointment
May, the workers' compensation attorney, urges people to come to every appointment. That means doctor visits and other appointments, including imaging and physical therapy.
"Your job is to be at every appointment," he said. "Missing appointments can really, really mess up people's claims."
Missing appointments can cause you to be declared medically noncompliant and lose your benefits.
If your injury causes a permanent disability, your doctor may have to testify in court. "We want that doctor to be able to say 'Mr. Smith was invested in his recovery. He did everything that we asked of him. And unfortunately this is as well as he was able to get.'"
If your employer isn't providing you the medical care or payments you believe you deserve, here's what to do
If your employer isn't providing you the medical care or payments you believe you deserve, you can file a claim.
The formal name for this is a Petition for Benefit Determination.
In most cases, the deadline to file the Petition for Benefit Determination is one year from: A) The date the injury occurred or, B) The date the last temporary disability benefits were paid or medical benefits were provided for the injury, whichever is latest.
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You can download the form from the state web site here. Fill out the form and email it to the state.
You can also fill out the form by visiting the web site Workerschampion.org. It's a program of Tennessee Alliance for Legal Services and will walk you through the process.
What happens if you file a Petition for Benefit Determination
Once you file your form, the state assigns your case to a state mediator.
The mediator sets up a meeting between you and a representative of your company. This is usually done by phone call.
You get on the phone and discuss the issue. The phone call may fix your problem.
If the phone call doesn't fix the problem, the mediator will file a dispute certification notice. You then have 60 days to file a petition to the Court of Workers’ Compensation Claims.
The court will then schedule a hearing on your case.
The courts are located around Tennessee.
If a case involving a worker with limited English goes to court, an employer is required to pay for a certified interpreter.
May, the lawyer, says you should probably try to resolve the dispute during the mediation phone call if possible, because a court hearing and a ruling could take several months.
How to find a lawyer
The state government allows you to file workers compensation claims by yourself, without a lawyer.
However, depending on your circumstances, you may want to hire an attorney.
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To find attorneys that handle workers compensation cases, use Google, talk with coworkers who've been injured, or contact the bar association in your area for a list of lawyers.
You can check an attorney's background and license status by searching the state Board of Professional Responsibility database at this link.
The state ombudsman's office also provides advice
Only a few lawyers still handle workers compensation cases in Tennessee and you may have a hard time finding an attorney.
The state ombudsman's office offers advice to injured workers who don't have lawyers.
Call 1-800-332-2667.
You may face a long hold time.
If your health care is denied through utilization review, file a state appeal. There's a good chance you will win.
In Tennessee, companies that represent your employer can block your treatments, including medications, physical therapy and surgeries.
This often happens through a process called utilization review. Utilization review is when the company sends your medical records to another doctor.
The other doctors often decide that your treatment isn't needed.
If the other doctor blocks your treatment, you should receive a notification in the mail.
When injured workers challenge these denials by filing appeals to the state medical director's office, they often win.
May, the lawyer, urges people to file appeals.
"You got 30 days from the day that's on the top of that letter. It costs you nothing to challenge it," May said. "And given what we know about the percentage of these things that's overturned, it would be silly not to challenge it."
If you have a lawyer, you can ask your lawyer to file the appeal.
If you don't have a lawyer, ask your doctor's office if they can file an appeal for you.
If no one else can file the appeal for you, you can do it yourself.
You do not need to include additional documentation to support your appeal.
You don't have to include your medical records. Your employer is responsible for submitting your medical records in response to your appeal.
The appeal form is C-35A. It is available on the state web site, and it's also supposed to be mailed to you.
If your treatment has been denied through utilization review, and the state medical director's office also rules against you, you have seven days to file a Petition for Benefits Determination to put your case before the Court of Workers’ Compensation Claims.
See the information above about how to file a Petition for Benefits Determination.
You can appeal beyond the Court of Workers' Compensation Claims
If you lose your case at the Court of Workers' Compensation Claims, you can keep appealing to higher levels, including the Board of Workers' Compensation Appeals.
The state government has prepared a video on how to handle this appeals process. You can watch that video here.
Do not quit your job
If you're badly hurt, you may be away from work for a while. May, the attorney, says you shouldn't quit.
“If they’re not going to bring you back after your injury, make them not bring you back. Don’t give them an easy out by quitting,” he said.
He says if your injury leads to a permanent disability, quitting your job can hurt you.
"Permanent benefits come in two stages," he said. "There's an initial award that anyone with an impairment rating is owed, regardless of their work status.
"Then, there's a secondary award that some people might be owed, if they're unable to return to any employment earning at least the same or greater wage as they were before the injury."
"However, if they voluntarily resign, or retire or are terminated for cause from the job, they're stripped of that potential secondary award."
Be honest about your injury
Injured workers sometimes exaggerate their injury and claim greater disabilities than they really have.
May, the workers' comp attorney, describes rare cases in which a company sets up video surveillance outside a worker's home and catches them doing things that they're supposedly too injured to accomplish.
"Like someone who's told the doctor that they can't really lift anything. And then someone sends me a video of them, like literally, he-man carrying a loveseat over their head to help the garbageman put it in the truck."
If you're caught lying about your injury, there's little that any advocate can do to help you. Be honest about your injury and about the extent of your disability.
Investigative reporter Daniel Connolly welcomes tips and comments from the public. Reach him at 529-5296, daniel.connolly@commercialappeal.com, or on Twitter at @danielconnolly.
This article originally appeared on Memphis Commercial Appeal: Injured at work? Guide to Tennessee's workers' compensation system
