Tennessee Administrative Code

(1) All hearings, except settlement approvals, are recorded for the judge’s use. The court cannot guarantee the quality of the recording. The parties may purchase an audio recording of the hearing from the clerk for twenty-five dollars ($25). The parties may have the audio record…

(1) All parties or their counsel must participate in a scheduling hearing with a judge after a hearing request is filed. (2) After the scheduling hearing is set, the clerk will send a docketing notice to all parties with the case number, time of the scheduling hearing, and judge …

(1) When the parties dispute temporary disability and/or medical benefits, either party may file a hearing request. The hearing request must be accompanied by an affidavit or a T.R.C.P. Rule 72 declaration under penalty of perjury, which must contain a plain, concise statement of…

(1) If requested, a medical provider treating an injured employee must furnish copies of records at a cost allowed by T.C.A. § 50-6-204 for paper records and Rule 0800-02-17-.24 for non- paper records. The medical provider must forward the records within ten (10) business days of…

(1) Parties are encouraged to obtain any necessary discovery informally to avoid undue expense and delay. When these attempts fail or the complexity of the case makes informal discovery impracticable, discovery must be sought in accordance with the Tennessee Rules of Civil Proced…

(1) Except as otherwise provided in these rules, any party may file a dispositive motion in accordance with the Tennessee Rules of Civil Procedure. (a) The moving party must provide any non-moving, self-represented party with a copy of the rule or statute on which the dispositive…

(1) Whenever a judge issues an interlocutory or compensation order and a party fails to comply with that order, the party seeking enforcement of the order may file a motion to compel. Before filing the motion, the moving party must contact the opposing party to inform the party t…

(1) Prehearing briefs for expedited and compensation hearings are encouraged. Unless the scheduling order provides otherwise, prehearing briefs must be filed at least ten (10) business days before the hearing. Briefs submitted by attorneys shall utilize size fourteen (14) Times N…

(1) All parties must participate in alternative dispute resolution after discovery is completed unless the judge determines it unnecessary. (2) Alternative dispute resolution under this section must be conducted as provided by Rule 0800-02-21-.10. (3) If the parties do not reach …

(1) The compensation hearing will be conducted at the time and place specified in the scheduling order. Absent good cause, no motion for a continuance will be considered at the compensation hearing. (2) Ten (10) business days before the date of a compensation hearing or as otherw…

(1) In any case where the parties reach a full settlement, the settlement will not become effective until it has been signed by all parties and approved by a judge. (2) Unless the settlement is of a disputed claim as provided by T.C.A. § 50-6-240, the settlement agreement must co…

(1) A party may move to voluntarily dismiss a petition for benefit determination only once. If an employee has been awarded temporary benefits through an interlocutory order or a motion for summary judgment is pending, a party may not move to voluntarily dismiss the petition. If …

(1) Any party may appeal any order of a workers’ compensation judge to the workers’ compensation appeals board by filing a notice of appeal, on a form approved by the Administrator, with the clerk of the court of workers’ compensation claims. (2) An appeal to the Tennessee Suprem…

An expedited request for investigative report signed and dated by a compliance specialist is a self- authenticating document/government record that is admissible in all court hearings.

The court of workers’ compensation claims has no jurisdiction over a claim for benefits filed against the state by a state employee.

(1) Any party may appeal any order of a workers’ compensation judge by filing a notice of appeal, on a form approved by the Bureau, with the clerk of the court of workers’ compensation claims, in accordance with Chapter 0800-02-21. The notice of appeal must be filed: (a) Within s…

(1) The parties to an appeal have the responsibility to ensure the completeness of the record on appeal. The record on appeal shall consist of: (1) all pleadings, responses to pleadings, Bureau forms, position statements, and orders of the court filed with the clerk of the court …

PROHIBITION OF EX PARTE COMMUNICATIONS; SUSPENSION OF RULES. (1) The appeals board may, in an effort to secure a just and speedy determination of matters on appeal and with the concurrence of all judges, decide an appeal by an abbreviated order or December, 2023 (Revised) 2 WORKE…

(1) Any motion seeking to extend any time limit during the pendency of an appeal must be filed prior to the expiration of the applicable time limit. The motion may be decided per curiam or by one appeals board judge. An order will be issued as soon as practicable after the motion…

(1) A party or parties may have a transcript of any hearing pertinent to the appeal of an interlocutory order prepared by a licensed court reporter and filed with the clerk of the court of workers’ compensation claims within ten (10) business days of the filing of the notice of a…

(1) A party or parties may have a transcript of any hearing pertinent to the appeal of a compensation order prepared by a licensed court reporter and filed with the clerk of the court of workers’ compensation claims within fifteen (15) calendar days of the filing of the notice of…

(1) Briefs shall include a cover page setting forth: (1) the style of the case; (2) the designation “Brief of the Appellant” or “Brief of the Appellee”; and (3) the name and address of the attorney of record or self-represented party filing the brief. (2) Briefs filed in support …

(1) The appeals board shall base its decision on the record on appeal and the arguments of the parties. Oral argument shall be allowed only upon motion of a party and/or by order of the appeals board. Any motion for oral argument filed by a party must state with specificity the r…

OBTAINING CERTIFIED COPIES OF APPEALS BOARD ORDERS AND OPINIONS. (1) Costs on appeal may be assessed as ordered by the appeals board. If an appeal is dismissed, costs shall be taxed against the appellant unless otherwise agreed by the parties or ordered by the appeals board; if a…

NOTICE TO THE ATTORNEY GENERAL. (1) The workers’ compensation appeals board is without jurisdiction to consider an appeal of any decision of the claims commission either awarding or denying workers’ compensation benefits to a state employee. (2) When the validity of a statute of …

0800-02-23-.02 Appointing of Members and Composition of 0800-02-23-.04 Meetings Committee 0800-02-23-.05 Committee Leadership and Subcommittees 0800-02-23.-01 PURPOSE AND SCOPE. The administrator’s medical advisory committee serves to provide guidance to the administrator on issu…

(1) The administrator will make appointments to the committee of persons meeting the requirements of Tennessee Workers’ Compensation law and will establish a maximum number of committee members. (2) In addition to representatives of employees, employers and the insurance industry…

(1) Except as provided in subsection (4), the terms of all committee members shall officially begin on January 1 of the year of appointment and expire, four (4) years later, on December 31. (2) Committee members may be reappointed by the administrator upon expiration of a term an…

(1) The medical advisory committee shall meet at the discretion of the administrator. (2) Meetings shall be held in a central location but members shall be allowed to participate by phone or by videoconference with approval of the administrator. (3) Members who participate by pho…

(1) The committee shall have authority to select leadership including a chairperson, co- chairperson, secretary and any other leadership position the committee deems necessary for the transaction of business. (2) The committee shall consult with the administrator in selecting lea…

These rules are intended to ensure the effective and expedient resolution of workers’ compensation claims within the adjudication process provided through the court of workers’ compensation claims and the attendant mediation process. These rules govern only the procedures for the…

(1) Whenever a judge has issued an interlocutory or final order in a workers’ compensation claim and a party has failed to comply with that order, the party seeking enforcement of the order may file a motion to compel with the court requesting that the court enforce the order. Be…

In addition to referrals made by a workers’ compensation judge, any Bureau employee may refer any person or entity to the penalty program for the assessment of a civil penalty whenever the referring employee believes that there may have been a violation of the Bureau’s rules or t…

(1) Upon receipt of a referral, the referral shall be assigned to an employee of the penalty program who shall attempt to collect all information necessary to determine whether a civil penalty should be assessed. (2) In investigating a referral, the investigating employee may con…

(1) The investigating employee may assess a civil penalty for each action of not less than fifty dollars ($50) but no more than five thousand dollars ($5,000) against the person or entity that is the subject of the referral for the following acts: (a) Failed to attend a scheduled…

(1) All requests for a contested case hearing must be made in writing, received by the Bureau, and must include a copy of the penalty assessment. (2) A request for a contested case hearing shall not be timely unless the request is received by the Bureau before the close of busine…

(1) Unless otherwise provided by law, penalties shall be made payable to the Bureau of Workers’ Compensation. Payment may be made by check or credit card and, if made by check, must be mailed to the Bureau at the address provided on the penalty assessment notice. (2) All penaltie…

0800-02-25-.02 Definitions 0800-02-25-.04 Drug Formulary 0800-02-25.01 PURPOSE AND SCOPE. (1) Purpose: To provide guidelines for the diagnosis and treatment of commonly occurring workers’ compensation injuries. (2) Scope: To include guidelines for diagnostic and treatment request…

(1) “Act” means the applicable Workers’ Compensation Law in effect. (2) “Administrator” means the chief administrative officer of the Tennessee Bureau of Workers’ Compensation, or the Administrator’s designee. (3) “Authorized Treating Physician" means the practitioner chosen from…

(1) Effective January 1, 2016, the Tennessee Bureau of Workers’ Compensation adopts the current edition, and any future published updates, of the Work Loss Data Institute ODG Guidelines as published by the Work Loss Data Institute, the Chronic Pain Guidelines of the State of Tenn…

(1) The purpose of the drug formulary is to facilitate the safe and appropriate use of medications for injured workers, and is a specific part of the Treatment Guidelines set forth in subsection .03 of this rule. (2) The Bureau adopts the ODG Drug Formulary as found in Drug Appen…

(1) The purpose of this rule is to provide a legal framework for electronic billing, processing, and payment of medical services and products provided to an injured employee and data reporting subject to Tennessee Code Annotated § 50-6-202.

(1) “Business day” means Monday through Friday, excluding days on which a holiday is observed by this jurisdiction. (2) “CAQH CORE” Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange is a national standards organization that develops o…

(1) For electronic transactions, the most current version of the following electronic medical bill processing standards shall be used: (a) Billing: 1. Professional Billing – the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, Health Care Claim: Professi…

Billing codes and modifier systems identified below are valid codes for the specified workers’ compensation transactions, in addition to any code sets defined by the standards adopted in 0800-02-26- .04. (1) “CDT-4 Codes” – codes and nomenclature prescribed by the American Dental…

(1) Applicability (a) This section outlines the exclusive process for the initial exchange of electronic medical bill and related payment processing data for professional, institutional/hospital, pharmacy, and dental services. September, 2021 (Revised) 5 ELECTRONIC MEDICAL BILLIN…

AGENTS’ RECEIPT OF MEDICAL BILLS FROM HEALTH CARE PROVIDERS. (1) Upon receipt of medical bills submitted in accordance with 0800-02-26-.03, 0800-02-26-.04, and 0800-02-26-.05, a payer shall evaluate each bill’s conformance with the criteria of a complete electronic medical bill. …