Tenn. Comp. R. & Regs. 0800-02-14-.02 - DEFINITIONS
(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
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 the 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) "Claim" means a demand for something as
due; an assertion of a right or an alleged right.
(6) "Electronic Data Interchange" or "EDI"
means the electronic communication method that provides standards for
exchanging data via 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.
(7) "Electronic Form Equivalent" means the
original document, provided on the Bureau's website, which is to be used when a
sender reports required data via a paper document. When forms are reproduced,
they shall be reproduced in their entirety, including instructions and shall
not be modified without written consent of the Administrator. A form may be
revised at any time at the discretion of the Administrator and will be
available at no cost.
(8)
"Employee" shall have the same definition of "Employee" as in T.C.A. §
50-6-102.
(9) "Employer" shall have the same definition
of "Employer" as in T.C.A. §
50-6-102.
(10) "First Report of Work Injury" means the
EDI equivalent of the form available on the Bureau's website and designated by
the Bureau as the appropriate document to initially report a claim of
injury.
(11) "Form" means the
document as is available on the Bureau's website on the date of the
filing.
(12) "IAIABC" means the
International Association of Industrial Accident Boards and
Commissions.
(13) "Injury" and
"personal injury" shall have the same definition of "injury" as in T.C.A.
§
50-6-102.
(14) "Insured" shall have the same definition
of "Employer" as in T.C.A. §
50-6-102.
(15) "Medical-only" claim or "med-only" claim
means a claim requiring medical attention, but which has no indemnity benefits
due or paid. Any claim in which no indemnity benefits are due or paid, but
which has medical treatment provided by any medical personnel qualifies the
claim for medical only status, regardless of whether or not a bill is generated
and regardless of whom pays for the medical care.
(16) "Trading partner" means an entity
approved by the Bureau to exchange data electronically with the Bureau on
behalf of an adjusting entity.
Notes
Authority: T.C.A. §§ 50-6-102, 50-6-113, and 50-6-233
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