Workplace injuries and illnesses can happen at any time. Even in an office environment someone can slip and fall over and break a leg or arm. Like nearly every other state in the U.S., most employers in Tennessee must have workers’ compensation insurance to protect their employees in the event that they are hurt or become sick at work. Workers’ comp. is meant to protect both employees and employers. Employees can obtain help with medical expenses and lost earnings while employers gain by not being sued by their employees. Not every claim leads to a satisfactory compensation payment. Some are denied altogether or the payment is far less than that expected. An appeal can help to overturn a claim denial. Workers’ Comp. Law in Tennessee Workers’ compensation in Tennessee is controlled by the Tennessee Bureau of Workers’ Compensation. The Bureau ensures that employers that are required to have workers’ comp. insurance are compliant as well as providing a structure for appeals. Most employers in the state take out insurance cover with a private insurer. A few larger businesses are able to self-insure. Employees who are injured or become sick while at work are advised to formally let their employer know the details of their injury or illness within a specified time period. This is within 30 days in the first half of the year, and within 15 days in the second half of the year. Employees are given a choice of physicians and medical institutions to use to assess and treat their injuries or illnesses. Workers’ comp. claims in Tennessee are no-fault, meaning there is no need to prove that the employer was at fault to make a claim. Why a Workers’ Comp. May be Denied Tennessee workers’ comp. claims are not always honored by insurers. Quite a lot are denied outright, sometimes on technicalities, such as not reporting the injury or illness within the required time period, not filling in a claim form on time or leaving out information. Occasionally there are genuine mistakes that are made by employers that seem to indicate that an employee may not have been at work when claimed. That’s why it is useful to report the injury or illness on paper rather than orally. The date and time of the incident will not then be in doubt. Insurers may also deny a claim because: the employee caused the accident to happen deliberately; refused to use provided safety equipment or follow established rules; the employee was drunk or had taken drugs; the employee’s injury or illness did not happen at work or was pre-existing. How the Workers’ Comp. Appeals Process Works in Tennessee If your claim has been denied you have the right to appeal the decision. This can be quite long winded and it can sometimes involve several levels of appeal before a successful resolution. You are strongly advised to have a workers’ comp. attorney advise you of the process and help represent you if necessary. The first step in the appeals process is mediation. A mediator is appointed by the Board who will listen to your side of the claim and examine any evidence you have available. The insurer will also be represented. The idea of mediation is to try to seek a resolution of the dispute without having it go to court. If mediation fails, the next step is to file a petition for your case to be heard by the Court of Workers’ Compensation Claims. This has to be done within 60 days of the denial decision. There will be a judge presiding at the hearing, who will examine all the evidence available and make a decision. If you are unsatisfied with the judge’s decision there are still two levels of appeal left to use. There is the Tennessee Workers’ Compensation Appeals Board and failing that, the Tennessee Supreme Court. Why You Should Hire a Workers' Comp. Attorney As can be seen from the description above, an appeal against a workers’ comp. claim denial can be a complicated and lengthy process. The insurer who denies your claim will be sure to use a competent attorney to help them when it comes to an appeal, so if you do not have effective legal representation yourself, then it will be less likely that you will get a satisfactory result. Talk to an experienced workers’ comp. attorney before going ahead with your appeal.
