FREQUENTLY ASKED QUESTIONS IN REFERENCE TO TENNESSEE
WORKERS’ COMPENSATION

The information provided herein is not interned to serve as a complete statement of the law nor should it be considered to constitute legal advice. The questions addressed are general in nature. Each employee’s injury or disease is unique and different and has unique legal implications. Time is often of the essence in any work related injury or disease circumstance and it is always advisable to consult an attorney for advice specific to your circumstance as soon as practicable.


What is workers’ compensation and where does it apply in Tennessee?
Employers in Tennessee are generally required to provide workers’ compensation insurance coverage for their employees or be self-insured for workers’ compensation. All employers with five (5) or more employees) and all constructions employers must certify to the Tennessee Department of Labor and Workforce Development as well as the Tennessee Department of Insurance that they have met this requirement.

What types of injuries are covered under workers’ compensation?
The Tennessee Workers’ Compensation statute applies to on-the-job injuries as well as occupational diseases. Examples of on-the-job injuries would include back or neck injuries, knee injuries, etc. Examples of occupationally related disease conditions would include asbestosis related lung disease, cancers causes by exposure to toxins in the work place, etc. Occupational conditions can also involve conditions which develop gradually over time such as carpal tunnel syndrome caused by repetitive job activities or hearing loss caused exposure to noise on the job.

Can an employer deny payment of a claim because the injury was the fault of the worker?
No. Workers compensation benefits cannot be denied by an employer based on the worker’s negligence. However, if the employee is injured because of his/her willful misconduct or because the worker intentionally injured himself/herself the employer does not have to provide benefits.


Are gradual injuries covered under Tennessee workers compensation?
Yes. As indicated above, Tennessee state law recognizes occupational conditions that develop gradually over time. These types of injuries can include aggravation of per-existing degenerative disc disease involving the neck or back, carpal tunnel syndrome caused by repetitive job activities or hearing loss caused exposure to noise on the job.


Are diseases covered under Tennessee workers compensation?
Yes. As indicated above, Tennessee state law recognizes disease conditions that are caused or aggravated by occupational exposures. The Tennessee workers compensation statute provides specifically for recovery for “occupational diseases.” These conditions may develop years after the worker has left the employment where the toxic exposure occurred. Examples of diseases that can be caused by occupational exposures include asbestos related lung disease, asthma, chronic beryllium disease, cancers caused by toxic exposures, etc.


How and when does an employee report an on-the-job injury or occupational disease?
The injured worker should report the injury in writing to the employer immediately, but no later than thirty (30) days after the injury. The employee should immediately notify their direct supervisor or other management personnel and request that he/she be provided prompt medical evaluation and/or treatment for the injury or condition.

Where an injury develops gradually or in the occupational disease context, it is important that the employee provide notification to his/her employer as soon as the worker is aware of the injury or disease.


Who determines if the injury or illness will be accepted as work related?
The employer is required to report the injury or illness to its workers’ compensation insurance carrier even if the employer questions the validity of the claim. The insurance company usually has the obligation to decide if the claim will be accepted as work related or not.


What are the obligations of an injured worker in reference to the employers’ or insurance company’s investigation of the injury?
An employee should cooperate with his/her employer or the insurance company in the reasonable investigation of the injury. However, prior to giving any statement to the representative of the insurance carrier, it is advisable that the injured employee consult an attorney and consider having the attorney present when the statement is given.


What benefits are injured workers entitled to in Tennessee?
A. Time off work: The workers' compensation insurance carrier generally is responsible for making payments to the injured employee. The first payment is due within fifteen (15) days of knowledge of injury and benefits should be paid at least semi-monthly. The Tennessee Department of Labor Regulations require that, "all workers' compensation benefits shall be issued timely to assure the injured employee receives the benefits on or before the date they are due."

The injured employee must have a doctor's statement for time out from work. Count every calendar day covered by the doctor's off work statement. Do not count the date of injury. The days do not have to be consecutive. If the employee is returned to work and then has to miss additional days, count every day covered by the doctor's excuses.

An injured employee is not paid for the first seven (7) days of disability. On the eighth (8th) day, the employee is eligible for one day's benefits; on the ninth (9th) day, the employee is eligible for two days' benefits, and so on. If the employee continues to lose time from work through the fourteenth (14th) day, the seven-day waiting period will be picked up and the employee will be due benefits for all fourteen (14) days.

An employee is generally entitled to 66 2/3% of his/her average weekly income, subject to the state maximum and minimum. The employer should submit a wage statement to the insurance carrier with gross earnings for the past fifty-two (52) weeks prior to the date of injury. The payment to the employee is based on an average pay for the 52 week period prior to the injury. These benefits are called temporary total disability benefits and are paid during the period of time the employee is off work and under a physician’s care.

B. Medical expenses: Generally, the employer is responsible for providing the injured worker with all required medical treatment for the work injury. These benefits can include the cost of doctor’s visits, prescription medication, surgery costs, physical therapy, etc. The employer or its insurance carrier is responsible for designating an authorized health care provider and the employee must seeking medical treatment through the authorized providers. Out of pocket expenses paid by an employee for prescription medications or, in some cases, mileage to and from medical care can be reimbursed to the employee.
Medical treatment extends for as long as required by the authorized treating physician. If appropriate, this physician will provide the employee with off-work excuses and light or restricted duty limitations. It is very important that the authorized physician's instructions and restrictions be followed at all times.

C. Permanent disability benefits: Permanent disability benefits may be due to an employee when the injured employee does not completely recover from the work-related injury and/or a physician indicates that the employee will not fully recover from the injury. The physician will give a percentage of medical impairment and state the part of the body involved. An employee is entitled to the amount of “disability” attributable to the work injury, even if the employee has been able to return to his/her previous job. There are many variables in the computation of a disability award or settlement.

D. Death Benefits: When an injury or occupational disease results in the death of a covered employee, the widow or widower or dependent orphan is entitled to 50% of the deceased employee's average weekly wage, not to exceed the maximum per week. If the deceased employee leaves a widow/widower and one or more dependent children, 66 2/3% of the deceased employee's average weekly wages, not to exceed the maximum per week, is due. If a deceased employee leaves other relatives dependent on the employee for support, compensation may also be payable to those dependents. When the deceased employee leaves no dependents, $20,000 is paid by the employer to the estate of the worker. The Law also provides for partial reimbursement of burial expenses subject to the statutory maximum.


Can the employer require the employee to file work related medical bills with the employee’s health insurance company?
No. Tennessee State law requires that the employer or its workers compensation insurance carrier assume responsibility for medical treatment related to the occupational injury or disease. An employer is specifically prohibited from instructing an employee to file such bills with his/her health insurance company.


When do temporary workers' compensation benefits stop?
When the injured employee is released to return to work or when the treating physician determines that the employee has reached maximum medical improvement (even if the employee is unable to return to work).

If the injured employee refuses to comply with any reasonable request for medical examination or to accept medical treatment, compensation may be stopped for as long as the employee continues the refusal.


What happens if the injured employee is released to return to work on light duty, but light duty is not available?
The employee should get a detailed description of work restrictions from the doctor. If the employer can provide work within those restrictions, they should do so. However, if the employer is unable to meet those guidelines, the injured employee may be entitled to remain off work and his/her lost time pay would continue. If the employer pays the employee less while working light duty, the employee is entitled to "temporary partial disability" benefits.


Can an employee apply for and receive workers compensation benefits for hearing loss?
Yes. If noise exposure in the workplace has resulted in permanent hearing loss or has aggravated a preexisting hearing condition, the Tennessee workers compensation statute may provide for compensation to the worker for the permanent injury as well as medical treatment expenses such as hearing aids.


Can an employee apply for and receive workers compensation benefits for a condition that is aggravated by his/her work?
Yes. If an employee has a preexisting condition that is aggravated by his/her work, the employer may be responsible for benefits. For example, an employee’s “bad back” condition that is made worse by work duties may submit a claim for benefits.


If an employee is retired can he/she pursue a workers compensation claim?
Yes. Many conditions, such as occupational diseases, may not appear until many years after the employee has left his/her employment. Although these types of occupational claims present unique challenges, a successful claim can often be pursued. It is important that you discuss the specifics of your possible toxic work exposures with your doctor in reference to your diagnosis.


What are the types of disputes that are generally involved in a workers compensation claim?
Many times there are disputes between an employee and his/her employer as to whether or not the injury or disease is work related. Disputes concerning medical treatment and the employee’s opportunity to seek another medical opinion are commonplace. If an acceptable settlement of the disability portion of the claim cannot be reached, an employee can request mediation through the Tennessee Department of Labor. If these efforts are unsuccessful, an employee is entitled to have a Judge determine the amount of benefits to which the employee is entitled.


What factors are considered in determining the amount of permanent disability benefits to which an injured employee may be entitled?
Tennessee workers compensation law specifies that the Judge should consider a number of factors. These factors include testimony from the employee and his/her doctors about his/her injury and the amount of permanent medical impairment; the employee’s age; the educational, training and work background of the employee; the availability of jobs in the local market and the employee’s ability to work with any restrictions that result form the injury.

What is the cost of hiring an attorney to advise an employee in reference to his/her workers compensation case?
Tennessee state law limits attorneys to a contingent fee of twenty percent (20%) of any recovery. Under most contingency agreements, the attorney only charges a fee if there is a recovery from the employer or its insurance company. Many attorneys will provide an initial consultation and evaluation of the employee’s case free of charge.