303 North Church Street
Murfreesboro, TN 37130
Phone: (615) 898-7715
Fax: (615) 867-4602
Workers Compensation – Frequently Asked Questions
- What is considered a work-related injury, illness or death claim?
- An injury, illness or death arising out of and in the course and scope of employment is by definition a compensable work-related claim. This means if employees are injured while performing assigned job duties during assigned work hours, they are covered under the workers’ compensation program.
Be aware that not all accidents, which happen at work, would be compensable under the workers' compensation law. What you are doing when the injury occurs may be more important than where you are.
Injuries sustained while engaging in unassigned job duties, during lunch and breaks, are not covered.
Compensation is not available if the injury results from the willful intention of the employee to injure or kill himself, herself or another employee. Moreover, workers’ compensation benefits are not provided for an injury or accident resulting from an employee’s willful misconduct or if the injury is due to intoxication from drugs, alcohol or misuses of prescribed medications.
Recreational and social activities are not compensable unless such recreational or social activities are an expressly required incident of employment and produce a substantial direct benefit to Rutherford County beyond improvement in employee health and morale that is common to all kinds of recreation and social life.
An injury suffered while going to or coming from work is not an injury arising out of and in the course of employment, whether or not Rutherford County Government provided the transportation and/or if such means of transportation was available for the exclusive personal use by the employee, unless the employee was engaged in a special errand or mission for Rutherford County Government.
An employee who is injured while deviating from the course of his/her employment (horseplay), including leaving the premises of their place of employment, is not eligible for benefits unless such deviation is expressly approved.
Heart attacks and strokes are not considered injuries under workers’ compensation unless it is shown by a preponderance of competent and credible evidence, which shall include medical evidence, that the condition was attributable to the performance of the usual work of employment.
- If I am injured on the job, what should I do?
- If there is a work-related accident, immediately notify the supervisor. Tell the supervisor exactly what happened, how it happened, who saw what happened and whether there was an injury as a result of the accident.
If you are a witness to a work related accident where a fellow employee is injured severely enough that the involved employee cannot notify the supervisor, an attempt should be made to notify the supervisor for the injured employee. This may be as simple as calling the supervisor to report that there was an accident.
The injured employee should report the injury in writing immediately, but no later than thirty (30) days after the injury. Fill out the First Report of Injury. Be as specific as possible when reporting the injury by indicating the date of the accident, how the accident occurred, and the nature and extent of injury. It should also be noted whether or not medical treatment is required. Prompt notification initiates workers’ compensation benefits in a timely manner.
- What happens if I cannot make a report of my injury?
- If the injury is such that a report cannot be made at that time, immediate medical assistance will be provided and a report will be made for the employee. Others reporting the injury should also be as specific as possible when reporting the accident and the report should be turned over to the supervisor as soon as possible.
- May I go to my personal physician for treatment of my work-related injury?
- No. The County has rules about medical treatment for work-related injuries that require the injured employee to seek treatment from an approved physician on the Panel of Physicians. The injured employee has the privilege of choosing one physician from the approved panel and is then required to accept treatment from that physician. Should the injured employee seek treatment by a physician not approved by the County, such medical treatment may not be eligible for payment under workers’ compensation benefits.
- What must I do if I need emergency treatment?
- In a true emergency situation, temporary medical care can be obtained from the nearest emergency location available. Once the emergency is over, however, treatment must continue with a physician from the approved panel of physicians.
- What happens if I need surgery?
- Prior to scheduling any major surgical procedures for a work-related injury, except in the case of an emergency, the treating physician will notify the claims adjuster. Once the adjuster has been contacted, the adjuster will work with the physician and/or his/her medical staff to ensure that all the necessary arrangements are made.
- What if the physician says that I need a MRI or CT Scan?
- The authorized treating physician or claims adjuster will arrange for these tests.
- If the physician prescribes medicines for me, what do I do?
- Prescription drugs are covered under workers’ compensation. If the employee pays for the prescription, the employee should submit the bill for reimbursement. The employee should fill the prescription at one of the following authorized pharmacies.
The list of authorized pharmacies is as follows:
• LaVergne Drug
• CVS (All Rutherford Locations)
• Eckerd (All Rutherford Locations)
• K-Mart (All Rutherford Locations)
• Krogers (All Rutherford Locations)
• Publix (All Rutherford Locations)
• Walgreens (All Rutherford Locations)
• Wal-Mart (All Rutherford Locations)
- What if I need physical therapy?
- The authorized treating physician will make the referral for physical therapy. Either the authorized treating physician or the claims adjuster will arrange the visits.
- Am I required to pay a portion of the cost of the medical care I receive for my work-related injury?
- No. All physician’s bills and reasonable medical bills are covered if treatment was with an authorized physician. All medical charges are paid according to the Tennessee Fee Schedule. If the medical provider charges above the Fee Schedule, the charges will be reduced to the Fee Schedule and that amount will be paid. THE INJURED EMPLOYEE IS NOT RESPONSIBLE FOR CHARGES ABOVE THE FEE SCHEDULE. However, if the employee is billed for those costs, contact the adjuster to assist in getting the charges corrected.
However, the injured employee will be responsible for bill(s) when:
- The injury is found by the court not to be compensable;
- The physician, who was not authorized by the employer at the time the services were rendered, knew that he/she was not an authorized physician;or
- The employee knew the physician was not authorized and it was not an emergency.
- Will I be contacted about my work-related injury?
- Yes. Upon verbal or written notice of the injury, the claims adjuster has to make verbal or written contact with the injured employee within two (2) working days to confirm facts of the claim, history of prior claims, work history, wages and job duties. This may include a recorded statement.
The claim adjuster has fifteen (15) days within verbal or written notice of the injury to determine if it is compensable. The injured employee will be notified, verbal or written, on the decision of their claim.
- What if I am unhappy with the physician I have selected from the panel?
- Under Tennessee Law, Rutherford County is not required to offer a second panel of physicians or a second opinion.
The injured employee may always seek a second opinion or obtain treatment with any physician at his/her own expense; however, only the diagnosis and/or restrictions of the authorized physician will be followed.
- What if the authorized physician orders light or restricted duty?
- If the authorized physician returns the injured employee to work with specific temporary restrictions (light duty) and a job can be provided within the restrictions, the employee MUST return to work and attempt the light duty. Failure to report for the light duty will terminate disability benefits.
- What if the authorized physician recommends part-time work?
- If, during medical treatment and before full recovery, the authorized physician determines that work can only be done on a part-time basis, then the injured employee is eligible for temporary partial disability benefits. The workers' compensation law provides for payment of 66 2/3% of the difference between the employee's wage at the time of the injury and the wage that the employee is able to earn while in a partially disabled condition, subject to the statutory maximums.
- What if the authorized physician determines I am unable to work or if there is no light, restricted or part-time work?
- If the authorized physician, in the course of treating the compensable injury, determines that the injured employee is temporarily unable to return to work, then the employee is eligible for temporary total disability benefits.
If the authorized physician releases the injured employee to light or restricted duty and there is no light, restricted or part-time work available, then the employee is eligible for temporary total disability benefits.
These benefits are intended to replace part of the income the employee may lose as a result of the compensable injury. The injured employee may not use accumulated sick and/or annual leave instead of receiving temporary total disability benefits
Under TN Workers’ Compensation Law, the date of injury and the first seven (7) days following the injury are the waiting period. Compensation begins on the eighth (8th) day of disability “from work”. Consult the supervisor about the use of sick time for the seven-day waiting period. Benefits are due for each day over the seven (7) day waiting period until the lost time reaches fourteen (14) days. If the lost time goes beyond fourteen (14) days, the employee is eligible for temporary total disability benefits (TTD) for the full period of disability. Temporary total disability benefits will be calculated beginning with the day following the injury and will be paid biweekly. However, an employee will not be compensated for the first seven days if sick or annual time was used. TTD benefits are based on 66 2/3% of the gross average weekly wage for the last 52 weeks worked prior to the injury. This is called the weekly compensation rate and is subject to the minimum and maximum rates in effect on the day of the work-related injury.
- What happens if my disability becomes permanent?
- If the compensable injury results in a permanent reduction in the employee’s ability to perform the work for which they are suited by education, age and training, then the employee will be eligible for permanent disability benefits.
It is payable based upon a percentage given by the authorized treating physician in accordance with current AMA Guidelines. The percentage is calculated by a formula that contains the number of weeks assigned by the State Board X the percentage rating X the Temporary Total Disability rate. However, not all injuries result in ratings assigned by a physician.
- Can I be compensated for occupational related diseases?
- Yes. If the disease meets certain tests imposed by law, the employee can be compensated. There must be a causal relationship between employment and the disease. It cannot be a disease that is an ordinary disease of life to which others are exposed.
- What happens if I re-injure a pre-existing condition or injury?
- The Workers’ Compensation Act limits the extent to which an aggravation of a pre-existing condition or injury is compensable. An aggravation of a work-related injury is compensable while the aggravation is the cause of the disability. Once the aggravation resolves and the employee returns to the pre-injury condition, the claim will no longer be compensable.
- Once I am treated for my injury and reach maximum medical improvement and begin having problems in the future due to my injury, may I receive additional treatment for this injury?
- Possibly. You should contact the claims adjuster and request medical treatment.
- Am I paid for work time lost to attend doctor visits or PT?
- No. Rutherford County does not pay for work time lost, except for the initial doctor’s visit on the day of injury. The employee may use sick, personal or vacation time to attend doctor visits or PT.
- What other income benefits are available under the Workers’ Compensation Program?
- Temporary Partial Disability Benefits:
• This benefit is payable to an employee when the employee returns to work in a job paying less as a result of a work-related accident. This lost wage amount is 66 2/3% of the difference between the employee’s average weekly wage before and after the injury. The maximum amount payable cannot exceed the maximum allowed under the law.
• When an injury results in death, the widow or widower or dependent orphan is entitled to 50% of the deceased employee's average weekly wage, not to exceed the maximum per week.
• If the deceased employee leaves a widow/widower and one or more dependent children, 66 2/3% of the deceased employee's average weekly wages, not to exceed the maximum per week, is due.
• If a deceased employee leaves other relatives dependent on the employee for support, compensation may also be payable to those dependents.
• When the deceased employee leaves no dependents, $20,000 shall be paid to the employee’s estate.
- Can I sue anyone for a work-related injury?
- If the injury was caused by the negligence of a third party other than another person who is also an employee of Rutherford County Government, the employee has a right to sue that party. If the employee sues and receives a dollar reward, Rutherford County Government has a right to recover some or all of the cost expended in the employee’s workers’ compensation claim. This is known as a subrogation lien. The lien would only be recoverable after you had been fully compensated for your loss resulting from your work-related injury.
Insurance – Frequently Asked Questions