New Claims Handling Standards in Tennessee

Written by: Byron Lindberg

Several revisions to the Claims Handling Standards (0800-2-14) went into effect, on August 2, 2018, with new rules ranging from a requirement that adjusting entities designate a liaison between the entity and the Bureau of Workers’ Compensation to new regulations governing contact/interaction with injured employees. Some of the revisions to be especially aware of include:

Each adjuster agency must designate at least one liaison between the entity and the Bureau. The liaison must possess the means to provide the Bureau with information/data pertaining to claims assignments, payment status, and contact information for the entity’s adjuster and primary EDI contact. Each January and July, the liaison must file Form LB-3263 (or a similar form containing the requisite information) notifying the Bureau of the names and contact information of each adjuster processing or supervising claims in Tennessee. Additionally, in January of each year (and/or within 15 calendar days of any change) the adjusting entity must provide the Bureau with their designated liaison’s contact information. Failure to comply with the requisite notifications subjects the entity to civil penalties.

The Bureau will monitor adjusting entities’ EDI/electronic form filings for completeness and accuracy. An adjusting entity that fails to successfully transmit documents with at least an 85% acceptance rate for any calendar month will be subject to a civil penalty.

Within 2 business days of receipt of notice of an injury from an employer, the adjusting entity must send, by U.S. Mail, a Notice of Reported Work Injury and the Beginner’s Guide to Tennessee Workers’ Compensation to the employee’s last known address. The prescribed forms can be found on the Bureau’s web site.

Decision on compensability must be made within 15 calendar days of notice of injury. If the claim is denied, the adjusting entity must notify the Bureau within 5 business days of the decision to deny by filing a Notice of Denial of Claim for Compensation. The adjusting entity must also provide a non-EDI version of the Notice of Denial simultaneously to the employee or the employee’s agent/attorney.

In all claims involving lost time, the adjuster shall make verbal or written contact with the employee within 2 business days of notice of injury, providing the adjuster’s name and direct contact information and investigating the facts of the claim. For “medical only” claims, only, the contact requirement is satisfied by mailing the Notice of Reported Work Injury.

Within 2 business days of there being a change in the adjuster assigned to a claim, the new adjuster shall make verbal or written contact with the employee to provide their name and direct contact information.

The new Claims Handling Standards also removed the requirement that insurers providing workers’ compensation insurance must maintain a claims office or contract with a claims adjuster located within Tennessee. This requirement was also removed, statutorily