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Tennessee Workers’ Compensation: Your Right to Medical Care

Employees who work for an employer covered by the Tennessee Workers’ Compensation Act who have been injured while within the course and scope of their employment are entitled to receive medical care through the employer’s workers’ compensation insurance carrier. Tennessee law obligates the employer to provide an injured employee with medical benefits for any work-related injury. For medical care to be covered by the employer or workers’ compensation insurance carrier, the injury must arise primarily out of and in the course and scope of employment, and the employment must contribute more than 50% in causing the injury, considering all causes. The employee has the burden of establishing every element of his or her claim by a preponderance of the evidence.

In July 2014, the statutory definition of injury under the Tennessee Workers’ Compensation Act was updated to exclude aggravation of pre-existing conditions unless it can be shown, to a reasonable degree of medical certainty, that the aggravation is more than 50% caused by the employment.  The opinion of the authorized treating physician through the workers’ compensation insurance carrier is presumed correct on the issue of causation, but this presumption can be rebutted by a preponderance of the evidence.

In a Tennessee workers’ compensation claim, determining whether an injury is work-related is a decision to be made by a physician, not by the employer or insurance carrier. The Court of Workers’ Compensation Claims and the Workers’ Compensation Appeals Board have held that as long as the employee comes forward with sufficient evidence to support a conclusion that their injuries may be work-related, the employer should provide medical care. From there, the authorized physician should make a determination as to whether the injury is causally related to the employment.

Tenn. Code Ann. § 50-6-204 requires the employer to provide the employee with a group of three (3) or more independent reputable physicians, surgeons, chiropractors, or specialty practice groups in the injured employee’s community, or, if no such providers are available in the community, within a one hundred (100) mile radius of the employee’s community. If the employer fails to provide medical care in accordance Tennessee law, it is well settled that the employer then runs the risk that it will be held responsible for medical benefits obtained through a provider of the employee’s choice.

If the employee is not properly provided with medical care, the employee may file a Petition for Benefit Determination through the Tennessee Bureau of Workers’ Compensation. Following the filing of this Petition, the Bureau will commence a mediation process, and if the parties are unable to reach an agreement, either party seeking further resolution of any disputed issues can file a request for a hearing with the clerk for the Court of Workers’ Compensation Claims.

Where a proper panel of medical providers is timely given, the employee should choose one of the listed providers offered. It is this selected medical provider that will become what is known as the employee’s authorized treating physician.  If this physician refers the employee to a specialist, for example an orthopedic physician or neurologist, the workers’ compensation insurance carrier must accept this referral unless the carrier timely provides the employee with a new panel of three (3) or more independent and reputable specialist physicians or specialty practice groups. All medical care received through the authorized treating system is covered through the workers’ compensation insurance carrier, and no costs will be assessed against the injured employee. Further, in many instances, an injured employee may be entitled to ongoing future medical benefits after a final settlement has been reached or a trial on the merits has been conducted.

If you have suffered an injury on the job, it is important to act quickly and promptly report the injury to your employer. At Nahon, Saharovich & Trotz, our Memphis workers’ compensation attorneys may be able to assist you in your claim. Call us at 1-800-LAW-4004 to schedule a free consultation. You may also complete our online form.