Tenn. Comp. R. & Regs. 0800-02-14-.10 - ENFORCEMENT

(1) The Bureau has the authority to monitor and audit the performance of adjusters and adjusting entities to ensure compliance with the Workers' Compensation Law and Bureau Rules as often as it deems necessary which includes, but is not limited to, the review of the following:

(a) Ongoing review of data provided to the Bureau by adjusting entities;

(b) Timeliness, completeness and accuracy of all filings with the Bureau in any format;

(c) Timeliness and accuracy of indemnity and/or payments to medical providers;

(d) Denied claims;

(e) Timeliness and accuracy of the provision of a panel of physicians;

(f) The alleged or suspected harassment, coercion or intimidation of any party;

(g) Timeliness of the response to a Request for Assistance, Petition for Benefits Determination or any equivalent form;

(h) Timeliness of the compliance with an Order from a Judge of the Court of Workers' Compensation Claims or Workers' Compensation Appeals Board, a Workers' Compensation Specialist, Administrative Law Judge, or an Administrator's Designee;

(i) Claims-handling practices;

(j) Timeliness of authorizing medical treatment and medications;

(k) Mailing of the Notice of a Reported Injury;

(l) Mailing of the Notice of Employer Rights and Responsibilities in a Workers' Compensation Claim required by Rule 0800-02-01 to the employer.

(2) Reports resulting from the Bureau's monitoring, examination or investigation conducted under this Chapter are considered public records and may be shared in any means deemed appropriate by the Bureau and may include publicizing those adjusting entities that exceed or fail to meet the Bureau's established thresholds for claims handling excellence.

(3) In addition to other penalties provided by applicable law and regulation, violations of any of the above rules shall be subject to enforcement by the Administrator pursuant to T.C.A. § 50-6-419(c).

Notes

Tenn. Comp. R. & Regs. 0800-02-14-.10

Original rules filed May 4, 2018; effective 8/2/2018.

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

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