A Guide To Workers' Compensation
Under a 1984 act of the General Assembly, state employees are entitled to the same
workers' compensation benefits that are provided to persons employed by private employers
in Tennessee. This act placed responsibility for administering the state employee
Workers' Compensation Program in the Division of Claims Administration of the State
Tennessee workers' compensation laws are designed to provide benefits to employees who are injured as the result of an accident which occurs in the course of employment. There is no clear cut definition available to describe when an injury is or is not compensable. Employees should perform the duties of their job in a careful manner and report any conditions in the workplace which are hazardous to the Associate Director, Physical Plant.
This guideline is intended to be a summary of the Workers' Compensation Program and does not address every detail of the Program. Should you have questions regarding this Program, please feel free to contact Human Resources or the Division of Claims Administration (615-741-2734) for further information.
Who Is Eligible
Generally, an employee is eligible for workers' compensation benefits if employed by the state and receiving a state payroll check. Persons compensated through a contract with the state are not eligible.
The benefits provided under the Tennessee workers' compensation law are (1) payment of medical expenses directly related to the treatment of a compensable injury, (2) payment of temporary disability benefits to replace your salary until you are able to return to your job, (3) payment of permanent disability benefits if your compensable injury permanently lessens your ability to perform your job, and (4) death benefits which are payable to your survivors in the event your compensable injury leads to your death.
If an employee has an on-the-job accident which requires medical treatment, he/she
must choose a provider who is authorized in the state’s workers’ compensation network.
This will be the only physician authorized to treat the employee’s compensable injury.
This means that the state will only accept and pay medical expenses submitted by this
physician, unless the treating physician notifies Sedgwick James that they have been
referred to another network physician for treatment. The state will not pay any medical
expenses the employee incurs from a physician other than the treating physician or
a network physician they are referred to by the treating physician. When seeking medical
treatment, the employee should notify the doctor’s office that they were injured while
at work and that they will be filing a claim for workers’ compensation benefits with
The state, as your employer, is responsible for payment of any reasonable medical expenses that the employee incurs in seeking medical treatment of his/her compensable injury from and authorized provider from the state’s workers’ compensation preferred provider network. This means that if the employee sprains their ankle in a work related accident, the state will pay the medical expenses associated with the treatment of the ankle. However, if the doctor also treats any other condition which is not related to the compensable injury at the same time he treats the compensable injury, then the state will only pay the portion of the medical bill which is directly related to the treatment of the ankle. The employee and/or their insurance carrier is responsible for the cost of any medical treatment which is unrelated to the compensable injury. The names of authorized physicians may be obtained from Human Resources (7433, or by calling Sedgwick James of TN at 1-800-526-2305.
The state will not pay for any treatment rendered by an unauthorized non-network provider. If you seek treatment from a non-network provider, you will be responsible for all bills associated with that treatment.
Other Benefits Available
Assault pay is payable to an employee who has sustained a disabling injury due
to an assault arising in and out of the employee's employment.
Members of the Tennessee Consolidated Retirement System (TCRS) who become permanently and totally disabled prior to eligibility for a service retirement allowance may be eligible for accidental disability benefits if their injury occurred in the performance of duty. Contact the Human Resources Office or the TCRS disability office for additional information.
Who to Notify When an Accident Occurs
Employees experiencing an on-the-job accident or injury or job-related property
damage should immediately or as soon as reasonably practicable report the incident
to their supervisor stating exactly what happened, how it happened, who witnessed
the incident, and whether injury occurred 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 his/her supervisor, you should attempt to
notify the supervisor for him.
Examples of incidents which may occur include, but are not limited to the following:
- Accidents involving state-owned vehicles;
- Accidents and mishaps involving state-owned machinery or equipment;
- Accidents caused by state employees acting within the scope of their employment;
- Accidents on state-owned or state controlled property; and
- Injuries to state employees incurred within the scope of employment (workers compensation).
Injuries Not Covered
Compensation shall not be allowed for an injury or death due to any of the following reasons:
- Willful misconduct;
- Intentional self-inflicted injury,
- Intoxication, and
- Willful failure or refusal to use safety devices or perform a duty required by law.
Documentation of Accidents
The supervisor or employee should immediately contact the Human Resources Office
once an accident has been reported. Close coordination will be required to ensure
required forms are completed on a timely and accurate basis. As soon as possible after
an accident occurs, the supervisor must complete a Supplementary Record of Occupational
Injuries and Illnesses Form. If the employee needs medical treatment, he/she must
complete an Accident Report Form. The employee should fill out the Accident Report
as completely as possible, sign the form at the bottom, and give the form to their
supervisor to complete and sign. All completed forms and any medical bills should
be submitted to the Human Resources office for processing to Sedgwick James of Tenn.
within 3 days of the injury. In the event that the employee is unable to work due
to the work related injury, Human Resources should be contacted.
The employee is responsible for providing information from the treating physician to his/her supervisor regarding his/her ability to return to work. Should the employee elect to receive sick and annual pay rather than temporary total disability benefits, the employee should sign a statement that this is a voluntary election on their part and realize that they will not be eligible to receive temporary total disability benefits during this period. Sedgwick James will provide benefits to the employee until he/she is released from the doctor's care.
Limitation of Time
Claims must be filed no later than one year from the date of occurrence. Failure to do so will result in disallowance of the claim unless evidence of extenuating circumstances is presented.
The party employing the attorney must pay the attorney's fees. The law allows an attorney to charge up to 20 percent of the payments received. Sedgwick James should be notified in writing of the name and address of the employee's attorney.
Death Benefit Claims
Should an employee's compensable injury result in death, survivors are eligible for certain death benefits under the workers' compensation program. To receive these benefits, the surviving spouse (or other surviving dependent) should file a completed Accident Report Form with Human Resources. Human Resources will then forward this form to Sedgwick James. Once this form has been filed and any requested documentation has been provided, Sedgwick James will be able to determine if the employee’s death was work related, and, if approved, payment to survivors will begin.