WC 101
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What is Workers Compensation Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment.
The Purpose of Workers Compensation The purpose of workers compensation laws is to provide: Coverage of medical expenses for treatment of injuries or occupational illness. Income protection for those who must be absent from work because of occupational illness or injury. Limited compensation for serious permanent injuries such as loss of limb or loss of life.
The Purpose of Workers Compensation Benefits for the Employee Coverage is provided without direct cost to the employee Prompt payment of claims following an injury Medical expenses are compensated Payments are based on the employee s current earnings Payments are made to an employee s spouse or dependent children in the event of death
The Purpose of Workers Compensation Benefits for the employer It establishes an orderly process to follow for all work-related injuries; It is the exclusive remedy for employees hurt at work; this means that, in exchange for the defined benefits they receive under workers compensation, injured employees give up the right to sue their employers in regular court.
Who is Covered? All employers with five or more full- or part-time employees are required to carry workers compensation insurance on those employees. Any person engaged in the construction industry is required to carry workers compensation insurance on his or her employees, even if there are fewer than five employees.
WC Applicability An injury is compensable if it arose primarily in the course and scope of work when all other possible causes are considered An injury arises primarily out of the employment if the employee can show that it contributed more than fifty percent (50%) in causing the injury, considering all causes.
WC Applicability Treating physician must state that work primarily caused the injury to a reasonable degree of medical certainty. Reasonable degree of medical certainty means, in the opinion of the physician, it is more likely than not considering all causes, as opposed to speculation or possibility. T.C.A. 50-6- 102(12)(D)
WC Claims Employees should immediately notify their employers of any work related incident. The law requires them to give their employers notice within 30 days of the date of injury or when a physician first tells them that the injury or illness is work-related. Employers must report all known injuries to their insurance carriers on a form called Employer s First Report of Work Injury or Illness (Form C-20). Carrier has 14 Days to file report with state. Report Promptly All Claims Costs increase as time goes on TCG has claims specialists to assist you.
MOD Rate Also EMR, E-MOD, etc. Affects premium Based on three years of losses. Basically determined by comparing actual losses with expected losses in given industry.
Physician Panel Employers required to provide employees with panel of three or more physicians. employer can select any independent, reputable physician in the employee s community. If not enough physicians in the employee s community the employer must provide a list of three physicians within a 100-mile radius. more than 15 miles one way for treatment requires mileage reimbursement
Physician Communication Tenn. Code Ann. 50-6-204(a) states: Any medical provider who is authorized by the employer and has treated or provided medical care to an injured employee may communicate, orally or in writing, with the employer, or the employer s attorney Employee shall sign a DOL-prescribed medical authorization form and the medical provider must honor any request by the employer for medical information, records, and opinions Employer shall provide to Employee copies of all materials provided to the physician or received from the physician at least 10 days prior to deposition.
Return to Work / Light Duty Focus on bringing employees back to work as soon as they are medically able. Can potentially reduce WC related costs. Often gets employees back to full work status more quickly.
TN Drug Free Benefits: A shift in the burden of proof in workers compensation claims involving a positive alcohol or drug test. Discounted workers compensation insurance premiums (by 5%). Denial of unemployment benefits to an employee terminated because of a positive alcohol or drug test.
Division of Workers Compensation Offices 1-800-332-2667 Website: www.state.tn.us/labor-wfd/wcomp Clay Pickett Montgomery Robertson Claiborne Hancock Stewart Sumner Fentress Scott Hawkins Lake Obion Trousdale Campbell Henry Cheatham Macon Jackson Overton Weakley Houston Grainger Davidson Smith Union Wilson Hamblen Greene Dickson Morgan Dyer Gibson Carroll Putnam Anderson Benton Humphreys Knox Jefferson De Kalb White Cumberland Williamson Cocke Rutherford Roane Lauderdale Crockett Hickman Cannon Loudon Blount Sevier Henderson Haywood Madison Decatur Perry Warren Van Buren Rhea Maury Lewis Bedford Bledsoe Tipton Coffee Meigs Chester McMinn Monroe Sequatchie Marshall Grundy Moore Shelby Fayette Hardeman Hardin Wayne Giles McNairy Lawrence Lincoln Franklin Hamilton Bradley Marion Fayetteville Polk Sullivan Johnson Washington Carter Unicoi Memphis Nashville--Metro Center Cookeville Knoxville 170 N. Main Street, 11 th Fl Memphis, TN 38103-1820 Telephone: 901-543-6077 Fax: 901-543-6039 2222 Rosa L. Parks Blvd. Nashville, TN 37228 Telephone: 615-741-1383 Fax: 615-253-2480 444-A Neal Street Cookeville, TN 38501-4027 Telephone: 931-520-4290 Fax: 931-520-4316 1525University Avenue Knoxville, TN 37921-6741 Telephone: 865-594-5177 Fax: 865-594-5172 Jackson Murfreesboro Chattanooga Kingsport 225 Dr. MLK Drive, 1 st Fl Jackson, TN 38301-6985 Telephone: 731-423-5646 Fax: 731-265-7022 845 Esther Lane Murfreesboro, TN 37219 Telephone: 615-848-6743 Fax: 615-217-9378 540 McCallie Ave, Ste W600 Chattanooga, TN 37402 Telephone: 423-634-6422 Fax: 423-634-3115 1908 Bowater Drive Kingsport, TN 37660-4136 Telephone: 423-224-2057 Fax: 423-224-2056
TN WC Court Judicial function moved from courts to the Division of Workers Compensation Judges appointed by Administrator Licensed attorneys at least 30 years old Must have at least 5 years appropriate experience Will serve a 6 year term; maximum of 3 terms There will be one Chief Judge Selection process
Uninsured Employers Fund Responsible for the enforcement of insurance coverage requirements Ensures that all employers comply with insurance coverage provisions of the WC Law. Penalize those employers who fail to comply with the law and fail to provide WC protection for their employees. Assesses penalties equal up to a total of 2 ½ times the estimated annual workers compensation insurance premium. Violators 1-800-332-2667 or online form.
Employee Misclassification Education and Enforcement Fund Identifies and penalizes employers when a worker who is actually an employee is treated as selfemployed or an independent contracted. Misclassification causes disadvantages to employers that comply with the law. List provided on tn.gov website to determine if someone is an independent contractor or employee. Violators can be reported to same phone number.
Prevention / Safety Best way to reduce WC costs is through injury prevention Injuries affect MOD rate Look for trends Leading WC related hazards for roofers Falls Material Handling
WC and Subcontractor Use Use only insured subcontractors Obtain COI Preferably from Agent / Carrier Subcontractor Agreement Additional insured clause as part of the subcontractor agreement, requiring a written notification of any policy cancellations from the insurance provider.
Employee should Immediately notify his/her employer and complete a First Report of Injury. If medical care is required, choose a physician from a panel of physicians that is provided by the employer. Sign the form to acknowledge. Sign a medical waiver. Follow the advice of the physician. Stay in contact with the employer and insurance adjuster.
Employer Should Have the employee complete a First Report of Injury and file it with their insurance carrier Provide the injured employee an appropriate panel of physicians Have the injured employee sign a medical waiver Give the injured employee the name & phone number of the insurance carrier/adjuster Provide a wage statement to the adjuster
CONTACT US. The Crichton Group 3011 Armory Drive Suite 250 Nashville, TN 37204 P 615-383-9761 F 615-383-4628 info@thecrichtongroup.com