§ 50-6-802 — Request for benefits from fund

Tennessee § 50-6-802

• Jurisdiction: Tennessee
• Title: 50

Text

(a) An eligible employee may request that the bureau provide the employee temporary disability benefits, medical benefits, or death benefits, pursuant to § 50-6-801(d) , by submitting a request for benefits from the uninsured employers fund to the bureau no more than sixty (60) days after conclusion of the claim, including all appeals. The request shall be made on a form prescribed by the bureau, and shall be submitted to the bureau via certified mail. The eligible employee shall include a copy of the judgment with the request. Any request for benefits that does not meet the requirements of this subsection (a) shall not be considered. (b) For claims with a date of injury that is on or after July 1, 2015, the bureau may, upon receipt of a request for benefits pursuant to subsection (a) from an eligible employee, provide the employee temporary disability benefits, medical benefits, or death benefits. The bureau shall promulgate rules, pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, setting forth the circumstances under which benefits may be paid pursuant to this part. (c) If the bureau pays workers' compensation benefits to the injured employee, then the bureau shall pay the workers' compensation benefits to the employee from the uninsured employers fund and the amount paid to, or on behalf of, an injured employee, pursuant to this part, shall not exceed sixty thousand dollars ($60,000). Of the sixty thousand dollars ($60,000), the bureau shall pay no more than twenty thousand dollars ($20,000) for medical benefits, no more than twenty thousand dollars ($20,000) for temporary disability benefits, and no more than twenty thousand dollars ($20,000) for death benefits. However, if no more than twenty thousand dollars ($20,000) has been paid to the employee for temporary disability or medical benefits and the employee has secured a judgment for temporary disability or medical benefits in an amount greater than twenty thousand dollars ($20,000), then the administrator may pay to the employee the remaining funds not exceeding a total of forty thousand dollars ($40,000) for both temporary disability and medical benefits combined, exclusive of death benefits, if applicable. The administrator shall not pay benefits pursuant to this part to, or on behalf of, an employee for more than one (1) workplace injury. (d) (1) In order to establish medical causation, the administrator shall have authority to provide medical benefits to an employee who meets the requirements of § 50-6-801(d)(1)-(4) for the payment of the cost associated with the employee's visit with a physician to perform an evaluation and provide an opinion on medical causation. The employer shall be required to reimburse the bureau for the payment of benefits pursuant to this section even when the employee's injury is determined not to be compensable under this chapter. (2) When medical benefits have been provided pursuant to subdivision (d)(1), the amount of payment shall be deducted from the total amount of benefits that may be provided under subsection (c) in the event that those benefits are provided. However, the provision of medical benefits pursuant to this subsection (d) shall not automatically entitle the employee to the benefits provided by subsection (c) even when the claim is determined to be compensable under this chapter. (e) (1) If medical causation is established and a workers' compensation judge determines that an employee, who meets the requirements of § 50-6-801(d)(1)-(4) , is entitled to temporary disability or medical benefits, following an expedited hearing as provided in § 50-6-239(d) , the administrator has the discretion to begin paying temporary disability or medical benefits. (2) If the administrator makes any payments of temporary disability or medical benefits pursuant to this subsection (e) and the employee fails to prosecute the claim, the bureau has authority to seek recovery of the payments from the employee. (3) The provision of medical benefits pursuant to this subsection (e) shall not automatically entitle the employee to the benefits provided by subsection (c) even when the claim is determined to be compensable under this chapter.

Legislative History

Amended by 2023 Tenn. Acts, ch. 145, Secs.s 7, s 8 eff. 7/1/2023, app. upon becoming a law for the purposes of promulgating rules. Amended by 2023 Tenn. Acts, ch. 145, s 6, eff. 7/1/2023, app. upon becoming a law for the purposes of promulgating rules. Amended by 2020 Tenn. Acts, ch. 731, s 4, eff. 6/22/2020. Added by 2014 Tenn. Acts, ch. 765, s 3, eff. 4/24/2014.