Tenn. Comp. R. & Regs. 0800-02-07-.05 - INVESTIGATION OF COMPLAINTS; SANCTIONS AND APPEALS OF AGENCY DECISIONS
(1) Any physician, other provider, or an
injured employee who is receiving case management services may report instances
of inappropriate case management services to the Bureau of Workers'
Compensation Medical Director. The Medical Director may investigate and report
the results of the investigation to the Administrator. At the discretion of the
Administrator, a report may be sent to the Board of Nursing or other certifying
board for appropriate disciplinary proceedings.
(2) Failure by a party to comply with any
requirement in this Chapter 0800-02-07 shall subject such party to a penalty of
not less than one hundred dollars ($100.00) nor more than one thousand dollars
($1,000.00) per violation at the discretion of the Administrator. The Bureau
may also institute a temporary or permanent suspension of the right to perform
case management services for workers' compensation claims, if the case manager
or employing organization has established a pattern of violations.
(3) An agency decision assessing sanctions
and/or civil penalties shall be communicated to the party to whom the decision
is issued, and the party to whom it is issued shall have fifteen (15) calendar
days from the date of issuance to either appeal the decision pursuant to the
procedures provided for under the Uniform Administrative Procedures Act, T.C.A.
§§
4-5-101, et seq., or
to pay the assessed penalties to the Bureau or otherwise comply with the
decision.
(4) In order for a party
to appeal an agency decision assessing sanctions and/or civil penalties, the
party must file a petition with the Commissioner within fifteen (15) calendar
days of the issuance of the decision. This petition shall be considered a
request for a contested case hearing within the Department pursuant to the
Uniform Administrative Procedures Act, T.C.A. §§
4-5-101, et seq., and
the procedural rules of Chapter 0800-02-13 are incorporated as if set forth
fully herein. The Department is authorized to conduct the hearing pursuant to
T.C.A. §
50-6-118.
(5) If the agency decision assessing
sanctions and/or civil penalties is not appealed within fifteen (15) calendar
days of its issuance, the decision shall become a final order of the Department
not subject to further review.
Notes
Authority: T.C.A. §§ 4-5-314, 50-6-102, 50-6-118, 50-6-123, 50-6-126, 50-6-233, and Public Acts 1992, Chapter 900, §§ 7 and 10.
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