Chattanooga Workers’ Compensation Lawyers for Delayed Claims

What is a delayed workers’ compensation claim in Tennessee?

A delayed workers' compensation claim can happen if an employer or their insurance company doesn't act reasonably after being told about an injury at work. Insurance pays for workers' compensation payments for various injuries that happen on the job. Benefits can pay for medical care, lost earnings, and rehabilitation for workers. Your recovery and financial stability can suffer when they are halted.

Common types of delays in Tennessee include failure to:

• Allow approved medical treatment for the harm that happened at work
• Pay temporary disability benefits to make up for an injured worker's lost wages.
• Respond to any paperwork or filings that an employee has to make
• Investigate the workers' compensation claim within a reasonable timeframe

Tennessee law under TN Code § 50-6-201 generally requires an injured employee to provide written notice of their workplace injury to their employer within 15 days, unless the employer has actual knowledge of the injury or a reasonable excuse is shown.

Upon receipt of notice, employers and insurers must follow specific procedures, including filing required forms and issuing timely benefit decisions. If an insurance carrier unreasonably delays benefits, the matter may be brought before the Tennessee Court of Workers’ Compensation Claims.

Signs the insurance company may be acting in bad faith

Insurance companies have the right to investigate and defend a workers’ compensation claim. However, they must do so fairly. When an insurance carrier delays or denies benefits without a valid reason, it may be acting unreasonably or in violation of workers’ compensation regulations.

Common warning signs that your insurance carrier might be acting in bad faith include:

• Failure to acknowledge that you timely filed your claim.
• Failure to investigate your claim.
• Ignoring your phone calls, emails, or submitted medical records.
• Refusing to authorize medical treatment or therapy without a valid reason.
• Misclassifying your employment status to avoid paying benefits. For example, stating you are an independent contractor when you are not.
• Alleging a pre-existing condition without medical support.
• Forcing an early return to work despite written limitations from your authorized doctor.
• Denying permanent disability despite impairment findings.
• Repeatedly requesting unnecessary documentation to stall the claim. This includes demanding duplicative records or irrelevant information.

If your employer or the employer’s insurance company is intentionally delaying your claim, contact Wagner Workers Compensation & Personal Injury Lawyers. We can help you determine your next steps.

Why could my workers’ compensation claim face a legitimate delay in Tennessee?

Not every workers’ compensation delay is in bad faith. Tennessee employers and insurers do have the right to investigate a claim before approving workers' compensation benefits. Some delays can occur for valid reasons, such as if required information is missing or a legal issue must be resolved.

Common legitimate reasons for delay include:

• Missed reporting deadlines. Tennessee law requires employees to provide timely notice of a workplace injury. If notice is made late, the claim can trigger investigation, delay, or denial.
• Incomplete accident or medical documentation. If medical records are missing, injury reports are incomplete, physicians' opinions are conflicting, or there are gaps in treatment, a claim may be delayed while insurers gather all necessary documentation.
• Disputes over whether the injury is work-related. Further delays can occur if there are allegations that the injury occurred off the job, the injury is due to a pre-existing condition, or if there are questions about whether the injury occurred in the course and scope of employment.
• Request for an Independent Medical Examination (IME). An IME is an evaluation performed by a physician selected by the insurer. It is typically used to:

o   Confirm diagnosis

o   Evaluate causation

o   Determine work restrictions

• Assess maximum medical improvement (MMI). Any scheduling conflicts can temporarily delay benefit decisions
• Request for a Functional Capacity Evaluation (FCE). An FCE measures your physical ability to perform job tasks. Generally, it can:

o   Determine return-to-work restrictions

o   Assess permanent impairment

o   Evaluate disability level

• Employment classification disputes. Any disagreements over whether you are an employee, independent contractor or subcontractor can raise questions about eligibility for workers’ compensation coverage and delay benefit distribution.
• Questions about Average Weekly Wage (AWW) calculations. Temporary disability benefits are based on your average weekly wage. Delays may occur if there are disputes involving your wage, including overtime and bonuses.

If your benefits have stalled, even if the reason is valid, contact Wagner Workers Compensation & Personal Injury Lawyers. We may be able to help move your claim forward.

How long does an employer have to respond to a workers’ compensation claim in Tennessee?

In Tennessee, businesses and their insurance companies must act quickly when they learn that an employee has been hurt at work. The employer must provide the right injury reports to the Tennessee Bureau of Workers' Compensation (BWC) after an injury is documented. The BWC administers Tennessee’s workers’ compensation law to help both employees and employers minimize the impact of work-related injuries.

The insurer must evaluate the claim and issue benefit decisions in compliance with Tennessee Bureau of Workers’ Compensation rules.

If the claim is approved, the employee must get the medical care they need right away, and if they have to stop working, they must start getting temporary disability benefits. If an employer or insurance company doesn't meet these deadlines, the injured worker can ask for a Benefit Review Conference or a hearing before the Tennessee Court of Workers' Compensation Claims to talk about the delay.

What to do if your workers’ compensation benefits are delayed

If your workers’ compensation benefits are delayed, you don’t have to face the consequences alone. Timely benefit payments are important when you’re recovering from any workplace injury, but especially if you need funds to pay rent, purchase groceries, and cover medical bills. The real-world impact can feel overwhelming, but you need to act quickly.

If you have a workers’ compensation benefit payment delay, take the following steps:

• Confirm that your injury was reported in writing to your employer within 15 days of the injury.
• Contact the insurance carrier and request a written explanation for the delay.
• Continue all authorized medical treatment.
• Organize copies of medical records, pay stubs, and any relevant correspondence relating to your workers’ compensation claim, making sure to document any missed payments or denied care.

If the delay continues, the process may move through the Mediation and Ombudsman Services of Tennessee (MOST) program. The aim of MOST is to help resolve disputes between injured employees and an insurance adjuster or employer in a workers’ compensation claim. Their three-step process includes:

1. Informal assistance from an ombudsman
2. A Benefit Review Conference (BRC)
3. A hearing before a Judge in the Tennessee Court of Workers’ Compensation Claims

Delays do not have to be indefinite. At Wagner Workers Compensation & Personal Injury Lawyers, we intervene quickly to help address unreasonable delays. If your payments have stalled, contact us today for a free consultation and case review.

FAQ

What if the insurance company says my injury is pre-existing?

A pre-existing condition does not automatically disqualify you from workers’ compensation benefits in Tennessee. If your job made your condition worse, you may still have a valid workers’ compensation claim in Tennessee.

Do I have to pay for medical treatment for a compensable injury?

No. You do not need to pay for medical treatment provided by the authorized physician for a compensable claim.

Which employers must provide workers' compensation coverage for their employees?

In Tennessee, most employers with five or more employees must carry coverage. Construction employers must carry coverage with one or more employees; other industries have specific statutory rules.

Do you have a Chattanooga workers’ compensation attorney near me?

Yes. You can reach the attorneys at Wagner Workers Compensation & Personal Injury Lawyers at 701 Market Street, Suite 310, Chattanooga, TN 37402. If you are unable to make it into the office, we’re happy to meet you by phone or video call.

If you have a delay in your workers’ compensation benefits, please don’t hesitate to reach out. We are proud of the relationships we have built with our clients over generations, and we’re looking forward to helping you.