Tenn. Comp. R. & Regs. 0800-02-14-.05 - CLAIMS HANDLING AND INVESTIGATING

(1) The adjuster shall make verbal or written contact with the employee within two (2) business days of receiving a verbal or written notice of any injury, including those considered to be "medical-only". For "medical-only" claims, this contact is satisfied by the mailing of the Notice of Reported Injury referenced herein. In claims that involve lost time from work, this contact is not satisfied by the mailing of the Notice of a Reported Injury referenced herein. The purpose of this contact is to:

(a) Provide each employee with the adjuster's name and contact information, which shall include the adjuster's direct phone number, fax number, email address, and mailing address; and,

(b) Investigate the facts of the claim and obtain a history of prior claims, including work history, wages, and job duties.

(2) Adjusters shall make personal, written or telephone contact with the employer within two (2) business days of the notice of the injury to verify details regarding the claim.

(3) An adjuster assigned to a claim which had previously been assigned to a different adjuster shall make verbal or written contact with the employee within two (2) business days of the assignment and shall provide the employee with the newly assigned adjuster's name and contact information, which shall include that adjuster's direct phone number, fax number, email address, and mailing address. In instances involving a mass transfer of files, such as might occur if an adjusting entity purchased or merged with another adjusting entity, the time required to provide this notice will be extended to seven (7) business days.

(4) In claims when compensability is questioned, adjusters shall contact all authorized medical providers, or their staff members, who have rendered medical services to an employee within three (3) business days of an initial office visit to investigate details concerning the injury and treatment and make a preliminary compensability determination.

(5) All employers, adjusting entities and providers of services related to workers compensation claims in the State of Tennessee subject to provisions of the Workers' Compensation Law shall provide the Bureau all information and documentation that is requested, and only that information that is requested, for the purposes of monitoring, examining, or investigating the entity's operations and processes within ten (10) calendar days unless the Bureau allows an extension of time.

Notes

Tenn. Comp. R. & Regs. 0800-02-14-.05

Original rule filed December 15, 1997; effective February 28, 1998. Amendments filed May 4, 2018; effective 8/2/2018.

Authority: T.C.A. §§ 50-6-101, 50-6-233, 50-6-415, and 50-6-419.

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