Tenn. Comp. R. & Regs. 0800-02-05-.09 - EXHAUSTION OF THE BENEFIT REVIEW CONFERENCE PROCESS

(1) The Benefit Review Conference Process shall be deemed exhausted only upon occurrence of any of the following:

(a) Issuance of a Benefit Review Report which indicates an Order Denying Benefits based upon non-compensability of the claim has been issued by a Workers' Compensation Specialist, provided that:

1. if Administrative Review of the Specialist's Order Denying Benefits based upon a finding of non-compensability is not requested, the Benefit Review Report referenced in (1)(a) above will be issued fifteen (15) days after the issuance of the Order Denying Benefits;

2. if Administrative Review of the Specialist's Order Denying Benefits based upon a finding of non-compensability is requested, the Benefit Review Report referenced in (1)(a) above will be issued fifteen (15) days after issuance of an Order by the Administrator's Designee that upholds the Order Denying Benefits;

3. A Specialist's Order Denying Benefits on grounds other than compensability does not exhaust the Benefit Review Conference process.

(b) Reaching a mediated settlement, as evidenced by a signed document executed by the proper parties and the Workers' Compensation Specialist;

(c) Issuance of an impasse report signed and dated by a Workers' Compensation Specialist.

(d) Conducting and completing mediation by private Rule 31 mediator, provided the Department has failed to conduct a BRC within 60 days of receipt of such a request, pursuant to Tenn. Code Ann. § 50-6-239(c);

(e) Issuance of a written waiver signed by the Director of the Benefit Review Program or the Director's designee;

(2) When a Benefit Review Report is issued, such Report shall specify whether the Benefit Review Process is exhausted. The date and time noted on the Report issued by a Workers' Compensation Specialist shall determine when the Benefit Review Process is exhausted.

(3) If the parties have mutually agreed to a settlement without a Benefit Review Conference, the parties shall not be required to exhaust the Benefit Review Conference Process before submitting the settlement to an appropriate Court or to the Workers' Compensation Specialist for approval. If the settlement is not approved, the parties shall then be required to exhaust the Benefit Review Conference Process.

(4) The Benefit Review Conference Process shall not be deemed exhausted upon the occurrence of the following:

(a) The filing of a Request for Assistance or a determination thereof on grounds other than non-compensability pursuant to Tenn. Code Ann. §§ 50-6-236 or 50-6-238;

(b) Any penalty Orders pursuant to Title 50, Chapter 6 of Tennessee Code Annotated;

(c) Withdrawal of a Request for Assistance or Request for Benefit Review Conference;

(d) Involuntary dismissal pursuant to Tenn. Code Ann. § 50-6-203(f) (2005 Repl.)

Notes

Tenn. Comp. R. & Regs. 0800-02-05-.09

Original rule filed March 9, 2006; effective May 23, 2006. Amendments filed December 12, 2007; effective April 29, 2008.

Authority: T.C.A. §§ 4-5-202, 50-6-101 through 50-6-103, 50-6-118, 50-6-203, 50-6-205, 50-6-206, 50-6225,50-6-233, and 50-6-236 through 50-6-242.