The terms contained within these rules that are not
specifically defined within these rules shall have the same definitions as
those established by the Workers' Compensation Law and the case law
interpreting it. When any terms that are used in these rules differ from the
definition established by the Tennessee Workers' Compensation Law, the
definition established by the Tennessee Workers' Compensation Law shall
govern.
(1) "Adjusting entity" means a
trade or professional association, managing general agency, pool, third party
administrator and/or insurance company licensed to write workers' compensation
insurance in Tennessee and shall also mean a self-insured employer or group of
self-insured employers possessing a valid certificate of authority from the
commissioner of commerce and insurance pursuant to T.C.A §
50-6-405.
(2) "Adjuster," "claims adjuster", "med-only
adjuster" or "claims handler" means a representative of an adjusting entity who
investigates workers' compensation claims for purposes of making compensability
determinations, files or causes claims forms to be filed with the Bureau,
commences benefits, and/or makes settlement recommendations based on the
insured's liability on behalf of a self-insured employer, trade or professional
association, third party administrator, and/or insurance company.
(3) "Administrator" shall have the same
definition of "Administrator" as in T.C.A. §
50-6-102.
(4) "Bureau" means the Tennessee Bureau of
Workers' Compensation as defined in T.C.A. §
50-6-102, an
autonomous unit attached to the Department of Labor and Workforce Development
for administrative matters only, pursuant to T.C.A. §
4-3-1409.
(5) "Electronic Data Interchange" or "EDI"
means the electronic communication method that provides standards for
exchanging data via any electronic means. The term "EDI" encompasses the entire
electronic data interchange process, including the transmission, message flow,
document format, and software used to interpret the documents using the
standards established by the IAIABC and the Release Version accepted by the
Bureau at the time of the filing.
(6) "Employee" shall have the same definition
of "Employee" as in T.C.A. §
50-6-102.
(7) "Employer" shall have the same definition
of "Employer" as in T.C.A. §
50-6-102.
(8) "File" means to successfully submit
claims information in the manner required by Bureau Rules. Success is achieved
when claims information is filed in the manner required by the Bureau Rules and
its acceptance is acknowledged by the Bureau. Success is not achieved if the
Bureau receives and its acceptance is not acknowledged by the Bureau or if the
Bureau subsequently rejects or returns claims information that has been
submitted but is incomplete or fails to use the correct form or
formats.
(9) "Form" means the
original document as is available on the Bureau's website on the date of the
filing.
(10) "IAIABC" means the
International Association of Industrial Accident Boards and
Commissions.
(11) "Insured" shall
have the same definition of "Employer" as in T.C.A. §
50-6-102.
(12) "Rate Service Organization" shall have
the same definition of "Rate Service Organization as in T.C.A. §
56-5-102.
