Can I Appeal a Denied Workers’ Compensation Claim in Tennessee?
Posted on behalf of Greg Coleman Law on Dec 27, 2017 in Workers' Compensation
If your workers’ compensation claim has been denied, or you believe that you were provided inadequate benefits for medical treatment and lost wages, you have the right to appeal this decision. However, there are several stages in the appeal process, outlined below.
If you are considering appealing your workers’ compensation claim decision in Tennessee, it is important to have an experienced workers’ compensation lawyer to help guide you through the appeals process. Do not hesitate to contact Greg Coleman Law to schedule a free, no obligation consultation to discuss your claim and find out if you have legal options.
Petition for Benefits Determination
To begin the workers’ compensation appeals process, you must file a Petition for Benefits Determination with the Tennessee Bureau of Workers’ Compensation. However, you must file your claim within one year of:
- The accident that resulted in your injury
- The last authorized medical treatment; or
- The time your employer stopped making payments of compensation to you or on your behalf, whichever occurred later.
Additionally, if the claim is filed by a surviving member of the worker’s family, the deadline to file a Petition for Benefits Determination is one year from the date of the worker’s death. The petition should be filed with the regional office closest to the worker’s home.
The first step to resolving a workers’ compensation claim dispute is through an informal process called “mediation” that requires both parties to participate in good faith toward resolving the claim.
The goal of mediation is to settle disagreements between injured employees and an employer’s workers’ compensation insurer. This process is handled by the Bureau of Workers’ Compensation’s Mediation and Ombudsman Services of Tennessee (MOST).
Through MOST, you will be assigned a neutral third-party Mediating Specialist who will attempt to resolve the dispute between you and your employer’s insurer. Mediation is often used to resolve disputes concerning:
- Medical treatment
- Temporary disability benefits
Typically, the Bureau will try to resolve disputes handled through the Mediation process within 20 days. If the disputing parties are able to reach an agreement through Mediation, the issue is resolved and there is no need to continue appealing the claim.
If the mediation stage is unsuccessful, the Mediation Specialist will issue a Dispute Certification Notice to the parties involved in the dispute and file the Notice with the Clerk of the Court of Workers’ Compensation Claims.
The Notice will list the following information:
- Issues the parties agreed upon
- Issues that remain in dispute
- Defenses each party raised during the mediation
If either party involved in the dispute objects to the Notice, the grievance must be filed within five days of the decision. The Mediation Specialist may then file a revised version of the Notice within 60 days, at his or her discretion.
The final Dispute Certification Notice establishes a limited and final list of issues and defenses each party may bring to the Workers’ Compensation Court to resolve.
If the disputing parties reach a resolution during the mediation process, the Mediation Specialist will prepare a Settlement Agreement and file it with the Clerk of the Court of Workers’ Compensation Claims.
The settlement stage is designed to help parties resolve the amount of permanent disability and determine if the injured employee is entitled to future medical treatment. The settlement process will also involve mediation and can be conducted privately between the two disputing parties or through the court system with the assistance of a Mediation Specialist.
The settlement stage can be requested by either party and occurs once the injured worker has reached maximum medical improvement (MMI).
Once a settlement has been reached, the decision will be included in a written Settlement Agreement that must be confirmed during an Approval Conference. A Workers’ Compensation Judge will review the terms of the settlement to ensure the agreed upon terms are fair to all sides.
However, if neither side is able to agree on a settlement, either party may request a hearing in the Court of Workers’ Compensation Claims.
Court of Workers’ Compensation Claims
To request a judicial review of your disputed claim, you can file a Request for Hearing with the Court of Workers’ Compensation Claims.
This request should be submitted within 60 days after the Mediation Specialist issues the Dispute Certification Notice. If the request is accepted, an initial hearing will be held within 30 days.
After the initial scheduling hearing, the parties will be given time to gather and exchange evidence. Once this period ends, both parties must once again participate in a mediation process to reach a resolution.
If this is unsuccessful, the mediator will file a new Dispute Certification Notice, where the Workers’ Compensation Judge either conducts a compensation hearing or reviews the evidence without holding a hearing.
During the hearing, the judge will decide only on the disputed issues included in the most current Dispute Certification Notice and state his or her decisions in a compensation order. A compensation order may include the following:
- Findings of fact
- Conclusions of law
- The amount of compensation that must be awarded
Workers’ Compensation Appeals Board
Any party dissatisfied with a Workers’ Compensation Court order can appeal for a review by the Board of Workers’ Compensation Appeals, or the state supreme court if the compensation order is final. The appeal must be made within 30 days after the judge enters the compensation order.
The Board of Workers’ Compensation Appeals is a panel comprised of three judges that review Workers’ Compensation Court decisions. The panel will only review evidence in the Workers’ Compensation Court record and will not consider new findings or testimony from the disputing parties.
Based on the panel’s review, it will either affirm the compensation order or modify it to be fair to both parties involved in the dispute.
Contact a Workers’ Compensation Lawyer
Although it is not required, having a seasoned workers’ compensation lawyer at every stage of the appeals process can provide critical assistance.
During your free consultation, our workers’ compensation lawyers will review your claim to determine if you were provided less benefits than what you deserve. We can estimate the value of your claim to help negotiate for a higher amount of benefits during mediation and advise you whether to accept an offer made by an insurance company.
If your case proceeds to a hearing, we will work to build a case that supports your claim and help ensure that you follow all of the necessary legal procedures. We will provide all of our services at no upfront cost and only get paid if you are awarded the benefits you deserve.
Call (865) 247-0080 to schedule a free consultation.