Tennessee's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers and sole proprietors who are engaged in the construction industry.
Exemptions from coverage may apply to certain employees, including employees of very small employers, agricultural workers, domestic employees, and casual laborers.
Medical Benefits are provided to employees entitled to workers' compensation benefits, including medical services that are deemed to be necessary, appropriate, efficient and accepted treatments for the worker's injury. The initial treating physician is selected by the employer. The employee may change physicians if ordered by the workers' compensation commission, or if approved by the employer or workers' compensation insurer.
An employee may be able to obtain a second opinion for recommendations of surgery, for impairment ratings or for certain diagnoses. If the workers' compensation insurer won't pay for the second opinion, the injured worker may obtain a rating from an independent medical examiner at the employee's own expense. Second opinions may also be obtained by an employee based upon the approval of the employer or workers' compensation insurer, or by court order.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 7 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 14 days indemnity benefits become retroactive to the date of the injury. Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's pre-injury average weekly wage, subject to a cap. TDD benefits for physical injuries may continue for the duration of the temporary disability. For psychological injuries or after the commencement of pain management, TTD benefits are limited to 400 weeks. Offsets may apply if the worker receives benefits from Social Security or from employer-funded disability insurance.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Tennessee PTD benefits are calculated based upon 2/3 of the injured worker's pre-injury wage, subject to a cap. PTD benefits may continue until the worker qualifies for Social Security retirement benefits, or for 260 weeks if the worker's injury occurs on or after age 60. Offsets may apply for Social Security benefits.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In Tennessee PPD benefits are determined based on a statutory schedule and a functional impairment of the injured worker. For unscheduled injuries the impairment rating is considered along with factors such as the worker's age, occupation and education. Benefits are calculated based upon 2/3 of average weekly wage, subject to a cap. PPD benefits for unscheduled injuries are payable for a maximum of 400 weeks.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Tennessee, TPD benefits are paid based upon 2/3 of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in both ears.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on a statutory formula, subject to a cap in amount. Benefits may continue for minors until the age of 18, the age of 22 if the dependent is a student, or indefinitely in the event of disability subject to the cap. Spousal benefits end upon remarriage. If a deceased worker has no dependents, an additional amount is paid to the estate.
Attorney fees are calculated pursuant to a statutory formula, and are determined on a case-by-case bass by the judge, commissioner or magistrate, or by agreement of the parties. Fees may not exceed 20% of the amount of the recovery or award.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is: Tennessee Department of Labor and Workforce Development Division of Workers' Compensation 220 French Landing Drive Nashville, TN 37243-1002 (615) 532-4812 or 1-800-332-2667