Tennessee Administrative Code

This section provides for peer-to-peer communications. It applies to all treatment requests that have been denied or modified through utilization review. (1) All denials or modifications of requests for treatment shall be made by a utilization review organization in accordance wi…

Each year no later than March 1, utilization review organizations shall send the Bureau an annual report, as described below, for the preceding calendar year. (1) The total number of requested utilization review organization determinations by utilization review organizations as d…

As used in this chapter, the following terms are used as follows: (1) “Administrator” means the administrator of the Tennessee Bureau of Workers’ Compensation. (2) “Bureau” means the Tennessee Bureau of Workers’ Compensation. (3) “Case Management” means medical case management or…

(1) An insurer who provides workers’ compensation insurance regulated by the provisions of T.C.A., Title 50, Chapter 6 or a self-insured employer may provide for a system of case management for catastrophic and/or non-catastrophic injuries involving compensable injuries under T.C…

(1) Catastrophic Injuries. An employer or insurer shall provide case management services in all cases where an employee has suffered a catastrophic injury. The employer or insured should assign a case manager who is currently and actively registered with the Bureau within seven (…

(1) Case management services shall include, but not be limited to, the following elements required in T.C.A. § 50-6-123 [Section 7(b) of Public Chapter 900]: (a) Developing a treatment plan to provide appropriate medical services to an injured or disabled employee; (b) Systematic…

DECISIONS. (1) Any physician, other provider, or an injured employee who is receiving case management services may report instances of inappropriate case management services in writing to the Bureau of Workers’ Compensation Medical Director. The Medical Director shall investigate…

(1) Subject to any applicable requirement of law concerning confidentiality of records, a case manager or a firm providing case management services shall provide the Administrator, or the Administrator’s designee, with any appropriate case management records or permit the Adminis…

(1) The contractor or the employer’s case management provider shall have the right to contact the injured or disabled worker, employer, insurer, third party administrator, legal representative, and all health care providers involved in the case. The contacted parties shall have t…

(1) The provision of case management services to employees who have suffered a workers’ compensation injury is a privilege and no individual may provide case management services in workers’ compensation cases in Tennessee unless the individual provided the Bureau with proof of li…

0800-02-12-.02 Policies 0800-02-12-.09 Employee Protection 0800-02-12-.03 Definitions 0800-02-12-.10 Employer Protection 0800-02-12-.04 Notice to Job Applicants and Employees 0800-02-12-.11 Training Required for Certification 0800-02-12-.05 Types of Testing 0800-02-12-.12 Confide…

(1) A covered employer may establish reasonable work rules related to employee possession, use, sale, or solicitation of drugs or alcohol, including convictions for drug or alcohol-related offenses, and may take action based upon the covered employer’s policies and rules. (2) The…

(1) “49 C.F.R., Part 40” as used in these rules shall refer to the federal regulations pertaining to the testing of drugs or alcohol as promulgated pursuant to the authority of the United States Department of Transportation, compiled at 49 Code of Federal Regulations (C.F.R.), Pa…

(1) A covered employer shall provide at least sixty (60) days’ prior notice to all employees that a drug-free workplace program is being implemented and the effective date of the program. (2) A notice of the covered employer’s drug or alcohol testing policy must also be posted in…

A covered employer that establishes a drug-free workplace program shall conduct the following types of drug tests, alcohol tests, or both, to the extent permitted by law and maintain documentation thereof for at least twelve (12) months: (1) Pre-employment drug tests after a cond…

(1) If an employee or job applicant refuses to submit to a drug or alcohol test, the covered employer may discharge or discipline the employee or may refuse to hire the job applicant. (2) If an injured worker refuses to submit to a post-accident drug or alcohol test, it shall be …

(1) The list of drugs for which a covered employer shall be required to test employees and job applicants is the list on the bureau’s website as posted on the date of the test and which shall be identical to the list of drugs found at 49 C.F.R., Part 40. (2) Tests for all drugs s…

(1) Alcohol testing shall be conducted using either a breathalyzer or a law enforcement obtained blood test. (2) All specimens identified as positive shall be confirmed according to the provisions of 49 C.F.R. Part 40 applicable on the date of testing. (3) The level for a positiv…

(1) A covered employer shall not take disciplinary action against an employee solely upon the employee’s first voluntary request to receive treatment for a drug or alcohol use disorder, if the employee has not previously tested positive for drug or alcohol use, or where employee …

(1) A covered employer who discharges or disciplines an employee or refuses to hire a job applicant in accordance with these rules is considered to have discharged, disciplined, or refused to hire for cause.

(1) A drug-free workplace program must notify all employees that it is a condition of employment for an employee to refrain from reporting to work or working with the presence of drugs or alcohol in the employee’s body; (2) Prior to testing, the employer shall give a written poli…

(1) Information concerning drug or alcohol test results may be shared between representatives of the covered employer, laboratories, medical review officers, employee assistance programs, drug or alcohol rehabilitation programs, and their agents, and utilized by legal counsel rel…

(1) Any employer wishing to participate in the Tennessee Drug-Free Workplace Program shall file with the Tennessee Bureau of Workers’ Compensation a completed Drug-Free Workplace Program application available on the Bureau’s website and shall renew the application each year. Such…

(1) An employee, having timely though unsatisfactorily challenged a positive confirmed test result to the MRO, may contest the result by timely filing a Petition for Benefit Determination (PBD) in accordance with the Rules pertaining to Mediation and Hearing Procedures pursuant t…

(1) Subject to any superseding federal or state law, these rules shall govern contested case proceedings before the Bureau of Workers’ Compensation, and will be relied upon by administrative judges in all contested cases utilizing administrative judges appointed under T.C.A. §§ 5…

The following definitions apply to this Chapter and the procedure for seeking a contested case hearing within the Tennessee Bureau of Workers’ Compensation. (1) “Administrative Hearing Clerk” means the Administrative Hearing Clerk of the Bureau of Workers’ Compensation, 220 Frenc…

(1) A Bureau Employee may accept information concerning possible non-compliance or a possible violation of the Workers’ Compensation Law or Bureau Rules from another Bureau Employee, from within the Bureau, from within the Department, from other governmental entities or agencies,…

(1) When the records of the Bureau reasonably indicate that an Employer, Employee, or other person or entity subject to the Workers’ Compensation Law has or may have violated or failed to comply with the requirements of the Workers’ Compensation Law or Bureau Rules and the Admini…

(1) In accordance with applicable statutes and as warranted by the facts and circumstances found during the investigation or inspection or the response to the notice, the Administrator or Administrator’s Designee may dismiss the matter and/or enter into a settlement agreement res…

(1) If an Employer, Employee, or other person or entity subject to the Workers’ Compensation Law or Bureau Rules fails to timely respond to a certified letter or other appropriate notification or fails to demonstrate to the satisfaction of the Administrator or Administrator’s Des…

(1) All pleadings, requests for contested case hearings, requests for pre-hearing conference, and any other materials are required to be filed with the Administrative Hearing Clerk by a time certain as set by these rules and shall be filed by delivering such materials in person o…

(1) In computing any period of time prescribed or allowed by statute, rule, or order, the date of the act, event or default after which the designated period of time begins to run is not to be included. The last day of the period so computed is to be included unless it is a Satur…

(1) Any affected person may appeal an Initial Agency Decision by filing a Request for Contested Case Hearing. (2) The Appeal of an Initial Agency Decision shall be filed in writing with the Administrative Hearing Clerk within fifteen (15) days of receipt of the initial Agency Dec…

(1) Commencement of Action. A contested case proceeding in the Bureau may be commenced by filing a Reques t for Contes ted Cas e Hear ing to appeal an Initial Agency Decision by an affected person. (2) Notice of Hearing. In every contested case, a notice of hearing shall be issue…

(1) In any case in which a party has requested a contested case hearing from the Bureau and provided the Bureau with an address, a copy of the notice of hearing shall, within a reasonable time before the hearing, be delivered to the party to be affected at the address provided, b…

(1) Any party to a contested case hearing may be advised and represented, at the party’s own expense, by a licensed attorney. June, 2017 (Revised) 8 PROCEDURES FOR PENALTY ASSESSMENTS AND HEARING CHAPTER 0800-02-13 CONTESTED CASES (Rule 0800-02-13-.12, continued) (2) Any party to…

(1) Scope - This rule applies to all motions made prior to a hearing on the merits of a contested case, except that discovery-related motions shall not be subject to Interlocutory Review. This rule does not preclude the administrative judge from convening a hearing or converting …

(1) Continuances may be granted upon good cause shown in any stage of the proceeding. The need for a continuance shall be brought to the attention of the administrative judge as soon as practicable. (2) Any case may be continued by mutual consent of the parties when approved by t…

(1) Parties are encouraged where practicable to attempt to achieve any necessary discovery informally, in order to avoid undue expense and delay in the resolution of the matter at hand. When such attempts have failed, or where the complexity of the case is such that informal disc…

(1) All petitions for leave to intervene in a pending contested case shall be filed in accordance with T.C.A. § 4-5-310, and shall state any and all facts and legal theories under which the petitioner claims to be qualified as an intervenor. (2) In deciding whether to grant a pet…

The administrative judge at the request of any party shall issue signed subpoenas in blank in accordance with the Tennessee Rules of Civil Procedure, except that service in contested cases may be by certified return receipt mail in addition to means of service provided by the Ten…

(1) Default. (a) The failure of a party to attend or participate in a prehearing conference, hearing or other stage of contested case proceedings after due notice thereof is cause for holding such party in default pursuant to T.C.A. § 4-5-309. Failure to comply with any lawful or…

In all Bureau hearings, the testimony of witnesses shall be taken in open hearings, except as otherwise provided by these rules. In the discretion of the administrative law judge, or at the motion of any party, witnesses may be excluded prior to their testimony. The standard for …

Prior to any judicial review being perfected by either party to Chancery Court, clerical mistakes in orders or other parts of the record, and errors therein arising from oversight or omissions may be corrected by the administrative judge at any time on the initiative of the admin…

Unless otherwise provided by law or clearly inapplicable in context, the Tennessee Code of Judicial Conduct, Rule 10, Canons 1 through 4, of the Rules of the Tennessee Supreme Court, and any subsequent amendments thereto, shall apply to all administrative judges and hearing offic…

The provisions of this chapter shall apply to all employers, adjusting entities and providers of services related to workers’ compensation claims in the State of Tennessee subject to provisions of the Workers’ Compensation Law.

(1) “Adjusting Entity” means a trade or professional association, managing general agency, pool, third party administrator and/or insurance company licensed to write workers’ compensation insurance in Tennessee and shall also mean a self-insured Employer or group self-insured Emp…