Learn what to do if you suffer an on-the-job injury or illness in the Volunteer State
All 50 states require certain employers to carry workers' compensation insurance for the purpose of providing benefits to employees who are injured on the job.
The first state to pass such a law was Wisconsin in 1911. Tennessee soon followed by passing the Tennessee Workers' Compensation Act in 1919. Before the Act was passed, workers in Tennessee rarely recovered damages for injuries they sustained at work because injury claims were met with strong defenses like assumption of the risk and fellow-servant rules.
The Act served as a compromise between employees (who could receive benefits without having to prove fault) and employers (who only had to pay the benefits set forth in the Act).
The Act has grown over the years and the language can be confusing. In this article, we'll provide a straightforward overview of worker's compensation in the Volunteer State by answering some of the most common questions.
What is workers' compensation insurance?
Workers' compensation is a form of insurance that pays benefits to injured workers.
One of the most important aspects of workers' compensation is that it is a no-fault insurance. This means employees receive benefits for eligible injuries without having to prove that anyone was at fault for the injury.
Another important aspect of workers' compensation is that it's an exclusive remedy. This means covered employees must file a workers' compensation claim instead of filing a personal injury lawsuit against their employer or colleague. Employees may, in certain situations, be able to file a third-party lawsuit in addition to a workers' compensation claim if someone other than their employer or colleague is at fault for their injury.
Does your employer have workers' compensation insurance?
Every employer with 5 or more full-time or part-time employees is required by Tennessee law to carry workers' compensation insurance. In the construction and mining industries, employers must provide coverage even if they only have 1 employee.
Is your injury covered by workers' compensation insurance?
All injuries and illnesses (other than those that are self-inflicted) are covered by workers' compensation insurance so long as the injury arose primarily out of and in the course and scope of your employment.
An injury or illness arose out of and in the course and scope of your employment if:
- The injury happened while you were performing a work task, and
- The injury was caused by a work-related incident (in other words, the injury wouldn't have happened if you were just sitting at home).
This concept can be a little confusing, so let's take a look at a couple of examples:
Ryan works for a construction company in Knoxville. While demolishing a building, he is struck in the head by a piece of falling concrete.
In this example, Ryan would likely be able to receive workers' compensation benefits because the injury occurred while he was performing a work task (demolishing a building) and the injury wouldn't have occurred if he was sitting at home.
Bill works as a janitor for a nursing home in Oak Ridge. While emptying the trash one morning, he suffers a heart attack. Bill had been into the doctor a week earlier and was told that he suffered from high cholesterol and was at risk for a heart attack.
In this example, Bill probably wouldn't receive workers' compensation benefits. Even though the injury occurred while he was performing a work task (emptying the trash), the injury wasn't necessarily caused by his job and would have still occurred if he was sitting at home.
Workers' compensation covers both traumatic work injuries and occupational work injuries:
- Traumatic work injuries are those that result from a one-time accident at work (e.g., a severed finger)
- Occupational injuries occur over a period of time (e.g., repetitive movement injuries)
What's more, employees can receive compensation for pre-existing injuries so long as a work-related accident temporarily or permanently aggravated the pre-existing injury.
How do you file a workers' compensation claim?
There are 3 steps involved in filing a workers' compensation claim in Tennessee:
- The injured worker must report their work-related injury to their supervisor within 15 days of the date of the injury.
- The supervisor must complete the First Report of Injury Form (Form C-20) and submit the form to their workers' compensation insurance company within 1 day of being notified of the injury.
- The workers' compensation insurance company must accept or deny the claim within 15 days of receiving the form.
It's important to keep in mind a couple of legal rights you have during this process.
First, your supervisor has a legal obligation to file your claim whether or not they believe your injury was work-related.
Second, it's illegal for your employer to fire you or otherwise punish you for filing a workers' compensation claim.
What benefits are provided to injured workers in Tennessee?
Workers' compensation benefits are supposed to return injured workers to their pre-injury health and their pre-injury financial status as soon as possible. To accomplish this, injured workers in Tennessee can receive the following benefits:
- Reasonable and necessary medical expenses (e.g., doctors visits, hospital bills, prescriptions)
- Related travel expenses (e.g., driving to doctors' appointments)
- Partial wage replacement for employees who are unable to work or continue to work but earn less pay while recovering from their injuries
Partial wage replacement benefits are determined based on the nature of the injury and fall into 1 of 4 categories:
TPD benefits apply if the injured employee can still work but is restricted to working fewer hours than normal by their treating physician.
TTD benefits apply if the injured worker is forced to stop working completely for a non-permanent period of time.
PPD benefits apply if the injured worker is permanently disabled because of a work-related injury but is able to return to some type of work.
PTD benefits apply if the injured worker is permanently disabled and unable to return to any type of work.
Certain family members can receive financial benefits if a loved one is killed in a work-related accident. More specifically, family members can receive:
- Wage replacement benefits. When the deceased leaves no dependent, $20,000 is paid to their estate. If the deceased leaves a surviving spouse and no dependents, 50% of the worker's average weekly wage is paid to the surviving spouse (subject to a state maximum). If the deceased employee leaves a surviving spouse and 1 or more dependent children, 66.6 % is paid to the surviving spouse for the benefit of the spouse and the children.
- Burial expenses. Burial expenses up to $10,000 are paid by workers' compensation insurance.
What happens if your claim is denied?
Workers' compensation claims get denied for lots of reasons. Here are the steps you should consider taking if your claim is denied:
- Talk to your employer's insurer to find out why your claim was denied or why you didn't receive the benefits you thought you should receive. Mistakes happen and you might be able to resolve the issue easily with a telephone call.
- File a Petition for a Benefits Determination with the Tennessee Bureau of Workers' Compensation. This petition must be filed within 1 year from the date of your injury. Once this form is filed, your case will be assigned to a mediator who will work with you and your employer to reach an agreement without having a hearing before a judge.
- If you're unable to reach an agreement with the mediator, the mediator will issue a Dispute Certification Notice (DCN). You have 5 business days to request that the mediator add information to the DCN.
- After 5 business days, the mediator will file the DCN with the Tennessee Workers' Compensation Court. You then have 60 days to request a hearing before a judge (called a "Compensation Hearing").
- At the Compensation Hearing (which may be expedited or regular depending on what you choose), the judge will issue a decision.
- If you're not satisfied with the decision, you can appeal the decision to the Workers' Compensation Appeals Board within 30 days (or 7 days if your hearing was expedited) or appeal directly to the Tennessee Supreme Court.
- Tennessee Workers' Compensation: Understanding the Law and the Claims Process
The basis for personal injury law is fairly straightforward:
If you're injured because of someone's negligence, then you're entitled to recover for your financial losses related to the injury.
The premise for the workers' compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you're injured at work.