(1) Upon the filing of a petition for benefit
determination (PBD, or Form LB 1095) for an Uninsured Employers Fund claim, the
matter shall be mediated under T.C.A. §
50-6-236.
(2) The mediator shall notify the Uninsured
Employers Fund benefit coordinator of the PBD filing, who will consult with the
Third-Party Administrator to open a file, make an initial investigation, and
determine if the circumstances warrant a medical causation opinion.
(3) Upon settlement, the mediator shall
complete the settlement agreement and arrange for court approval of the
agreement and the issuance of an order approving the settlement by the Court of
Workers' Compensation Claims. This settlement shall not be considered approval
of the claim against the UEF Benefit program.
(4) In the event of an impasse, the dispute
certification notice shall include information about the employee's eligibility
for Uninsured Employers Fund benefits in addition to identifying all disputed
issues. The cover letter to the first and second dispute certification notices
shall include the following language:
If you fail to provide workers'
compensation insurance coverage for your employee, you might be responsible for
workers' compensation benefits. If the Uninsured Employers Fund pays any
portion of these benefits to or on behalf of your injured employee, the
Uninsured Employers Fund may take action to collect the amount of payments made
as set forth in T.C.A. §
50-6-803,
or as otherwise allowed or permitted by law.
(5) The mediator shall send the dispute
certification notice or settlement agreement to the Uninsured Employers Fund
benefit coordinator.
Notes
Tenn. Comp. R. & Regs. 0800-02-30-.07
Original rules
filed January 2, 2019; effective April 2, 2019. Amendments filed February 2,
2022; effective 5/3/2022.
Authority: T.C.A.
§§
50-6-216,
50-6-236,
50-6-801,
50-6-802, and 50-6-803.
