This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are involved with a work-related accident, you should notify your supervisor as soon as possible with all of the details about what happened. You may seek the appropriate medical attention to treat any possible injuries you may have. The treating physician in this circumstance will become your main physician for purposes of receiving compensated medical treatment. Any subsequent physicians you may see must be within the same network as the initial treating physician or must be made upon that physician's referral. Notify the doctor or doctors involved that your injuries or condition have been the result of a work-related accident.
Your employer must submit all forms and information regarding your injury to the insurance provider on the Tennessee Employer's First Report of Injury or Illness (Form C-20) within one (1) working day of knowledge of your injury or illness.
The insurance provider is then expected to contact you and your employer within two (2) working days to get more information regarding the nature of your accident and injury. The insurance provider will use this information to either accept or deny liability for your accident. This determination must be made within fifteen (15) days of notice of your injury.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Your employer may choose to be self-insured or purchase a workers' compensation insurance coverage policy.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
Timeliness in filing requirements and keeping an accurate and detailed record of all filings and medical bills and history are essential to filing a successful claim.
4. What benefits might I be eligible to receive?
You may file for a number of benefits in regards to your injury; however, these benefits may be subject to certain filing requirements and/or conditions to be met that may alter whether or not you will be entitled to receive them. The types of benefits you may be entitled to include the following:
- Medical Benefits: Payments of all reasonable and necessary medical treatment required for the care of your injury.
- Temporary Total Disability Benefits: wage compensation benefits for days you were unable to go to work as a result of your injury. These are payments made to you should your treating physician determine you are unable to return to work for a period of seven (7) or more days. You will receive roughly two-thirds of your average weekly earnings.
- Permanent Disability Benefits: Upon the determination by your treating physician that you have reached maximum medical improvement, your claims adjuster will review your file to determine whether your case warrants the payment of Permanent Disability Benefits.
- Scheduled Injuries: Payment for loss of impairment to a certain body part set for a maximum duration of time.
- Death Benefits: If your injury result in your death, your dependents may be entitled to certain benefits. Your dependents may file a claim as a result of your death by contacting your personnel officer or the State Administrator, Sedgwick (1-800-526-2305) to begin the process.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
You request a Benefit Review Conference with the Department of Labor and Workforce Development within one year of the date or your injury or one year from the date your employer paid your last disability or medical bills. If you are unable to reach a settlement after the Benefit Review Conference has been held, you may choose to file an appeal to the Tennessee Claims Commission. This will lead to a hearings process where each side will be able to present its version of the issue at hand. At this hearing, a commissioner will make a determination regarding the case.
6. If I am not happy with the determination, how do I appeal?
If you remain unsatisfied with the determination of your claim, you may appeal the decision to the Tennessee Supreme Court. All applicable court rules and procedures will apply.