(1) Medical Payment Committee (the Committee)
Review Procedure:
(a) When a valid request
for Committee Review is received by the Bureau's Medical Director, the parties
will be notified at least seven (7) business days in advance when the Committee
will consider the dispute. The Committee may consider the dispute at any
meeting during which it has a quorum of the voting members. Members may
participate by telephone or by video conferencing or by properly executed
proxy. Members that participate by telephone or video conferencing or properly
executed proxy shall be counted as present for purposes of establishing a
quorum.
(b) The parties will have
the opportunity to submit documentary evidence and present arguments to the
Committee prior to and during the Committee meeting in which the dispute will
be heard. Written submissions to the committee shall be received by the Bureau
at least one week in advance of the meeting. A redacted copy of all written
material shall be included with any submission.
(c) The Committee shall consider the dispute
and issue its decision on the merits as to the proper resolution of the
dispute, based upon a simple majority vote of the members present for the
purpose of a quorum. If the dispute cannot be decided in one meeting, then the
Committee may continue it to the next meeting.
(d) If the parties to the dispute do not
follow the decision of the Committee, then either party may proceed in any
court of law with proper jurisdiction to decide the dispute.
(2) Computation of Time Periods:
In computing a period of time prescribed or allowed by the Rules, the day
of the act, event or default from which the designated period of time begins to
run shall not be included. The last day on which compliance therewith is
required shall be included. If the last day within which an act shall be
performed or an appeal filed is a Saturday, Sunday, or a legal holiday, the day
shall be excluded, and the period shall run until the end of the next day which
is not a Saturday, Sunday, or legal holiday. "Legal holiday" means those days
designated as a Tennessee State holiday.
Notes
Tenn. Comp. R. & Regs. 0800-02-17-.22
Public
necessity rule filed June 5, 2005; effective through November 27, 2005. Public
necessity rule filed November 16, 2005; effective through April 30, 2006.
Original rule filed February 3, 2006; effective April 19, 2006. Amendment filed
December 26, 2013; effective March 26, 2014. Repeal and new rules filed
November 27, 2017; effective February 25, 2018. Amendments filed June 12, 2019;
effective September 10, 2019. Administrative changes made to this chapter on
September 10, 2019; "Tennessee Workers' Compensation Act" or "Act" references
were changed to "Tennessee Workers' Compensation Law" or "Law." Amendments
filed June 27, 2023; effective 9/25/2023.
Authority: T.C.A. ยงยง
50-6-204,
50-6-205, and
50-6-233 (Repl. 2005) and Public
Chapters 282 & 289 (2013).
