Tennessee Administrative Code

(1) These Rules are required for all medical services and products provided on or after July 1, 2018. For medical services and products provided prior to July 1, 2018, medical billing and processing shall be in accordance with the rules in effect at the time the health care was p…

(1) Purpose: The general purposes of this program are to assure that employees sustaining an injury arising out of and in the scope of employment are treated fairly and to assure that workers’ compensation claims are handled in an appropriate and uniform manner. (2) Scope: This c…

The terms contained within these rules that are not specifically defined within these rules shall have the same definitions as those established by the Workers’ Compensation Law and the case law interpreting it. When any terms that are used in these rules differ from the definiti…

(1) The application fee and renewal fee for adjuster certification and adjusting entity certification shall be posted on the Bureau’s website. The appropriate fee to be submitted with the application shall be the fee in effect on the date of the application.

(1) Prior to being designated as “certified”, an adjuster shall: (a) Make proper application, provide all required documentation and pay all appropriate fees; (b) Complete all required curriculum with a training entity in effect at the time of the application; (c) Achieve a passi…

(1) Prior to becoming re-certified, an adjuster shall have achieved an initial certified adjuster designation and shall complete the curriculum required for re-certification at the time of the renewal application. (2) Re-certification training, including achieving a passing score…

(1) The Administrator may revoke or refuse to renew an adjuster’s previously granted certification permanently or temporarily based upon any of the following grounds: (a) Failure of a certified adjuster to fulfill the requirements for re-certification prior to the end of the term…

(1) Prior to being designated a “certified” adjusting entity an entity shall: (a) Make proper application, provide all required documentation and pay all appropriate fees. (b) Establish and implement a training program that complies with the requirements set forth in these Rules …

(1) Prior to becoming re-certified, an adjusting entity shall have achieved an initial Certified adjusting entity designation, submit a completed renewal application with all appropriate fees and shall meet the requirements of Rule 0800-02-27-.07 above at the time of the renewal …

(1) The Administrator may revoke or refuse to renew an adjusting entity’s previously granted certification permanently or temporarily based upon any of the following grounds: (a) Failure of a certified adjusting entity to fulfill the requirements for re-certification prior to the…

(1) Prior to being recognized as a certified adjusting entity by the Bureau, an adjusting entity shall establish and implement a training program for adjusters that process Tennessee claims and shall provide: (a) Newly-hired medical-only adjusters with at least eight (8) hours of…

In addition to other fees provided by applicable law and regulation, violations of any of these rules shall be subject to enforcement by the Administrator pursuant to T.C.A. § 50-6-419.

The vocational recovery assistance program connects permanently disabled injured workers with public institutions and monetary resources to acquire the knowledge, skills, and abilities they need to return to meaningful employment.

The following definitions are for the purpose of this chapter only: (1) “Administrator” means the chief administrative officer of the Bureau of Workers’ Compensation, with full authority over the Vocational Recovery Assistance Program, or the Administrator’s designee. (2) “Applic…

(1) If any provision of these Rules or the application thereof to any person or circumstance is, for any reason, held to be invalid, the remainder of the Rules and the application of the provisions to other persons or circumstances shall not be affected in any respect whatsoever.…

To be eligible to receive Vocational Recovery Assistance, the applicant shall: (1) Have a permanent impairment rating, as that term is used is T.C.A. § 50-6-204, greater than zero attributable to a compensable work-related injury under the Tennessee Workers’ Compensation Law; and…

To apply for Vocational Recovery Assistance, the applicant must meet the above eligibility requirements and shall: (1) Complete the Form and submit it to the Program. (2) At the Administrator’s discretion, register with the Division of Workforce Services of the Tennessee Departme…

To promote vocational recovery, the program shall: (1) Educate interested parties about the Program, including how to navigate the application process; (2) Assist applicants with accessing resources to define the applicant’s knowledge, skills, abilities, and interests; (3) Inform…

(1) To receive vocational recovery assistance in subsequent fiscal years, any recipient of vocational recovery assistance funds must reapply by submitting to the Program a “Request for Vocational Recovery Assistance Renewal” at least two (2) months prior to the end of the fiscal …

(1) The award amount shall be limited to expenses provided by T.C.A. § 50-6-208(j)(2), including tuition and mandatory fees. (2) Amounts paid to an eligible educational institution shall be applied to the recipient’s student account balance after registration for coursework and a…

(1) The Administrator shall appoint a Fund Allocation Committee comprised of representatives of employees, employers, and the medical and/or vocational rehabilitation communities with knowledge of job opportunities, ability or vocational assessment, or employment training, to ass…

(1) The Program shall notify the applicant and the eligible educational institution of the applicant’s selection as an award recipient. Notice shall be in writing, in a manner prescribed by the Administrator. (2) The Program shall submit payment for covered expenses directly to t…

(1) The following events may cause the immediate discontinuance of payments from the Fund: (a) Failure to meet any eligibility requirement; (b) Failure to timely reapply for benefits; (c) Failure to maintain continuous enrollment absent an approved personal or medical leave of ab…

(1) The Program may grant a recipient a medical or personal leave of absence from continuous enrollment at an eligible educational institution as long as all other applicable eligibility criteria are met. Allowable medical or personal reasons may include illness of the recipient;…

(1) Repayment from the recipient of an award made in error shall not be required if the Bureau determines that the error was through no fault of the recipient. (2) Repayment from the recipient of an award made in error shall be required if the Bureau determines that the recipient…

(1) If a recipient fails to complete a semester for any reason, the eligible educational institution shall apply its refund policy to determine whether a refund may be required. (2) A recipient shall cause any refunded amount to be returned to the Fund. (3) Refunds should be retu…

(1) All time limits referenced in these Rules may be extended by the Administrator unless specifically set by statute.

(1) In the event the Administrator denies an application for vocational recovery assistance that was submitted within the time limitation set forth by T.C.A. § 50-6-208(j)(1)(B), the applicant may re-file an application to be reconsidered for a future award. For purposes of the a…

(1) Pursuant to Tenn. Code Ann. § 10-7-503(g), the following rules regarding public records for the Bureau of Workers’ Compensation are adopted to provide economical and efficient access to public records as provided under the Tennessee Public Records Act (“TPRA”) in Tenn. Code A…

(1) “Administrator” means the chief administrative officer of the Bureau of Workers’ Compensation or the Administrator’s designee. (2) “Bureau” means the State of Tennessee, Bureau of Workers’ Compensation. (3) “Office of Open Records Counsel” or “OORC” means the Office of Open R…

(1) Public record requests shall be made to the Records Custodian or his/her designee in order to ensure public record requests are routed to the appropriate records custodian and fulfilled in a timely manner. (2) Public record requests for copies, or requests for inspection and …

(1) The Records Custodian shall review public record requests and make an initial determination of the following: (a) If the requestor provided evidence of Tennessee citizenship; (b) If the records requested are described with sufficient specificity to identify them; and (c) If t…

(1) There shall be no charge for inspection of open public records. (2) The location for inspection of records within the offices of the Bureau of Workers’ Compensation should be determined by the records custodian. (3) The records custodian may require an appointment for inspect…

(1) A records custodian shall respond to a public record request for copies in the most economic and efficient manner practicable. (2) Copies will be available for pickup at a location specified by the records custodian or may be delivered to the mailing address specified by the …

(1) Fees and charges for copies of public records should not be used to hinder access to the inspection of public records. (2) Pursuant to Tenn. Code Ann. § 10-7-503(a)(7)(C)(i), upon a request for copies of Public Records, the Bureau shall assess fees for copying and labor based…

(1) The following records are exempted from the open record rule: (a) First Reports of Injury, pursuant to § 50-3-702(b), unless the Bureau has a properly executed authorization. (b) Workers’ compensation medical records, pursuant to § 50-6-131, shall remain confidential and shal…

(1) Mediation Records (a) The Bureau adopts Tennessee Supreme Court Rule 31 pertaining to confidentiality of all information created or obtained during mediation proceedings except as otherwise required by law. (b) Mediation records consists of all documents and information prese…

(1) The purpose of these rules is to establish the processes and procedures for administering the Uninsured Employers Fund in T.C.A. §§ 50-6-801 et seq. and for paying appropriate benefits from the Fund while fulfilling the obligation of the Bureau to protect the integrity of the…

(1) “Act”: Tennessee Code Annotated, Title 50, Chapter 6. (2) “Administrator”: The chief administrative officer of the Bureau of Workers’ Compensation or the Administrator’s designee. (3) “Bureau”: The Tennessee Bureau of Workers’ Compensation as defined in T.C.A. § 50-6- 102, an…

An employee may be eligible for benefits from the Fund, subject to approval by the Bureau of Workers’ Compensation Administrator, within the meaning provided by this section if: (1) The employee was employed by an uninsured employer; (2) The employee suffered an injury on or afte…

(1) The following benefits may be provided to an eligible employee: temporary disability benefits up to $20,000.00; and medical benefits up to $20,000.00, to include a medical causation evaluation, mileage reimbursement, and attorney’s fees, if applicable. (2) The maximum benefit…

(1) An Expedited Request for Investigation form may be admissible in the Court of Workers’ Compensation Claims under the Court’s rules as evidence of potential eligibility for benefits from the Uninsured Employers Fund. (2) Notice to the Uninsured Employer must be included in the…

(1) If the Bureau receives information about a work injury involving an uninsured employer, an Expedited Request for Investigation is required. (2) The Bureau employee notified about the work injury and lack of insurance coverage will submit a completed Expedited Request for Inve…

(1) Upon the filing of a petition for benefit determination (PBD, or Form LB 1095) for an Uninsured Employers Fund claim, the matter shall be mediated under T.C.A. § 50-6-236. (2) The mediator shall notify the Uninsured Employers Fund benefit coordinator of the PBD filing, who wi…

(1) The Court of Workers’ Compensation Claims will follow statutory guidelines, existing hearing procedures and protocol for expedited hearings and compensation hearings. (2) The Court of Workers’ Compensation Claims may consider the investigator’s report and if applicable the me…

(1) Annually the Bureau shall contract with a Third-Party Claim Administrator to administer UEF claims. The Third-Party Claim Administrator shall request, receive, and review medical records and medical bills and shall submit recommendations to pay temporary disability benefits a…

(1) The Bureau Administrator may pay from the Fund reasonable expenses of collection and enforcement, including filing fees and collection expenses incurred by the Bureau. The Administrator may recover these fees and expenses from employer. (2) The Bureau shall assume the rights …