(a) The bureau of workers’ compensation shall, by rule promulgated pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, establish and collect penalties for the following:

medical exam

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Terms Used In Tennessee Code 50-6-118

  • Administrator: means the chief administrative officer of the bureau of workers' compensation of the department of labor and workforce development. See Tennessee Code 50-6-102
  • Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Commissioner: means the commissioner of labor and workforce development. See Tennessee Code 50-6-102
  • Department: means the department of labor and workforce development. See Tennessee Code 50-6-102
  • Employee: includes every person, including a minor, whether lawfully or unlawfully employed, the president, any vice president, secretary, treasurer or other executive officer of a corporate employer without regard to the nature of the duties of the corporate officials, in the service of an employer, as employer is defined in subdivision (11), under any contract of hire or apprenticeship, written or implied. See Tennessee Code 50-6-102
  • Employer: includes any individual, firm, association or corporation, the receiver or trustee of the individual, firm, association or corporation, or the legal representative of a deceased employer, using the services of not less than five (5) persons for pay, except as provided in §. See Tennessee Code 50-6-102
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
(1) Failure of a covered employer to provide workers’ compensation coverage or qualify as a self-insurer;
(2) Late filing of accident reports;
(3) Bad faith denial of claims;
(4) Late filing of notice of denial of claim;
(5) Failure of any party to appear or to mediate in good faith at any alternative dispute resolution proceeding;
(6) Failure of any party to comply, within the designated timeframe, with any order or judgment issued by a workers’ compensation judge;
(7) Performance of any enumerated action provided in § 29-9-102 in relation to any proceedings in the court of workers’ compensation claims;
(8) Failure of any employer to timely provide medical treatment made reasonably necessary by the accident and recommended by the authorized treating physician or operating physician;
(9) Failure of an employer to timely provide a panel of physicians that meets the statutory requirements of this chapter;
(10) Wrongful failure of an employer to pay an employee‘s claim for temporary total disability payments;
(11) Wrongful failure to satisfy the terms of an approved settlement;
(12) Refusal to cooperate with the services provided by an ombudsman; and
(13) Any violation of § 50-6-215 by an individual or entity not licensed by the department of commerce and insurance.
(b) All penalties collected by the bureau from an employer for failure to provide workers’ compensation coverage or failure to qualify as a self-insurer shall be paid into and become a part of the uninsured employers fund. All other penalties collected pursuant to an assessment made under this section shall be paid to the bureau for use by the bureau, at the discretion of the administrator, to offset the cost of administering this chapter.
(c) The bureau of workers’ compensation may assess the penalties authorized by this chapter, upon providing notice and an opportunity for a hearing to an employer, an employee, an insurer, or a self-insured pool or trust. If a hearing is requested, the commissioner, commissioner’s designee, or an agency member appointed by the commissioner shall have the authority to hear the matter as a contested case, and the authority to hear the administrative appeal of an agency decision, relating to the assessment of the penalties authorized by this chapter. When a hearing or review of an agency decision is requested, the requesting party shall have the burden of proving, by a preponderance of the evidence, that the penalized party was either not subject to this chapter, or that the penalties assessed pursuant to this chapter should not have been assessed. Any party assessed a penalty pursuant to this section shall have the right to appeal the penalty assessed by the bureau and affirmed by the commissioner, the commissioner’s designee or an agency member in the manner provided in this subsection (c), pursuant to the Uniform Administrative Procedures Act.
(d)

(1) If an employee receives a settlement, judgment, or decree under this chapter that includes the payment of medical expenses, and the employer or workers’ compensation carrier unreasonably fails to reimburse the employee for any medical expenses actually paid by the employee within sixty (60) days of the settlement, judgment, or decree, or unreasonably fails to provide reasonable and necessary medical expenses and treatment, including failure to reimburse the employee for reasonable and necessary medical expenses, after receiving actual notice of the obligation to provide the medical treatment and a reasonable opportunity to obtain the information and documentation necessary to pay medical expenses or provide medical treatment, then the employer or workers’ compensation carrier is liable, in the court’s discretion, to pay the employee a sum not exceeding twenty-five percent (25%) of the expenses, in addition to the amount due for medical expenses paid. The court may exercise this discretion only if the court finds that the refusal to pay the claim inflicted additional expense, loss, or injury upon the employee.
(2) An employer or workers’ compensation carrier is not liable under subdivision (d)(1) if payment of the subject medical expense is issued, or reasonable and necessary medical treatment is authorized, within sixty (60) days of the employer’s or workers’ compensation carrier’s receipt of information and documentation reasonably necessary to issue payment of the subject medical expense or to determine liability for reasonable and necessary medical treatment.
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