- When an Accident Occurs
A common question asked by state employees is "What do I do if I have an accident and am injured while on the job?" This section will outline in basic terms what you should do if you or a co-worker are injured while on the job.
Who To Notify
If you have an on-the-job accident, you should immediately notify your supervisor. You should tell your supervisor exactly what happened, how it happened, who saw what happened and whether you were injured as a result of the accident. If you are a witness to a work related accident where a fellow employee is injured severely enough that the involved employee cannot notify his supervisor, you should attempt to notify the supervisor for him. This may be as simple as calling the supervisor to report that an accident has occurred.
Seeking Medical Treatment
If you have an on-the-job accident which requires medical treatment, you must choose a provider who is authorized in the state's workers' compensation network. This will be the only physician authorized to treat you for your compensable injury. This means that the state will only accept and pay medical expenses submitted by this physician, unless your treating physician notifies Sedgwick that you have been referred to another network physician for treatment. The state will not pay any medical expenses you incur from a physician other than your treating physician or a network physician you are referred to by your treating physician.
When seeking medical treatment, you should notify the doctor's office that you were injured while at work and that you will be filing a claim for workers' compensation benefits with the state.
Filing An Accident Report
As soon as possible after an accident occurs, you or your supervisor should call the Workers' Compensation Call Center at 866-245-8588 (toll-free) and complete an accident form via telephone. Information obtained by the Call Center enables the claims adjuster to determine whether your injury is compensable under the workers' compensation law. A copy of the accident information completed by the Call Center will be sent to your personnel officer. You may also report the accident by going to https://sedgwickcms.claimcapture.com. You must obtain your agency's sign-on information from your personnel officer to log onto this secure site. If all the information requested is not provided, no decision can be made. This will result in a delay in payment of your medical/pharmacy bills and temporary total disability benefits. Generally, you will be notified as to whether your injury is compensable within 90 days of the date your claim information is received by Sedgwick.
Before seeking medical treatment you should complete and print a first fill form. The first fill form can be accessed by selecting the first fill tab from the menu at the top of this page or to the left of this page under "related topics." This form shold be presented along with your prescription to the network pharmacy of your choice. A network pharmacy can be found HERE. The network includes: CVS, Kroger, Publix, Rite-Aid, Target, WalMart and Walgreens as well as most independent pharmacies.
The first fill form can be used on a one-time basis at a network pharmacy of your choice with no out-of-pocket expense. The first fill form entitles you to a 10-day supply of medication. Upon acceptance of the claim, Cypress Care will mail a pharmacy card which is to be presented each time you fill a prescription.
For most injuries use of the first fill form allows for a 10-day supply of medicine with a limit of $150 per prescription.
For injuries involving blood borne exposures you are allowed a 14-day supply of a prophylactic medicine with a limit of $1,000 per prescription.
In summary, if you have an accident at work
- Contact your supervisor to report your injury.
- You can report an accident by calling 866-245-8588 (toll free) or by going to https://sedgwickcms.claimcapture.com. You must obtain your agency's sign-on information from your personnel officer to log onto this secure site.
- If you need medical treatment, call the State's Administrator, Sedgwick, at 1-800-526-2305, or Rockport Healthcare at 1-800-734-4460, for the name of a provider who is authorized to treat you. Or, choose a physician from the list of authorized providers. The provider directory can be accessed by selecting the Provider Directory from the menu at the top of this page. The list is also available from your personnel officer.
- Complete and print the first fill form. Present it to the network pharmacy of your choice along with your prescription. The first fill form can be accessed by selecting the first fill form tab from the menu at the top of this page or to the left of this page under "related topics."
Filing a Temporary Total Disability Benefits Claim
If you wish to file for temporary total disability benefits, contact the Sedgwick adjuster who is investigating your claim. Your personnel officer must certify that you were on leave without pay status during the period of time for which you are requesting temporary total disability benefits. Sedgwick will contact your physician, if necessary, to determine if your condition prevents you from working and when he anticipates that you will be able to return to work.
Temporary total disability checks are mailed biweekly. Should you have questions regarding the status of your claim for temporary total disability benefits, you should contact Sedgwick.
Permanent Disability Claims
Once your treating physician determines that you have reached your maximum medical improvement from your compensable injury, the Sedgwick claims adjuster will review your file to determine whether it is appropriate to offer you a permanent disability benefit; however, the majority of work-related accidents do not result in an employee sustaining an injury which permanently impairs his ability to perform his job. This offer is based upon the recommendations of your treating physician, the type of injury you sustained and other factors such as your training, experience, age, and education.
In cases where the recommendations of your physician are not conclusive, the claims adjuster may require you to be examined by a physician designated by the state to obtain additional information on your condition. This examination will be paid for by the state. If you wish, your treating physician may be present at the examination; however, you will be responsible for paying your physician. If the claims adjuster determines that you have incurred a permanent disability, you will be offered a permanent disability benefit based on the adjuster's understanding of your condition. In this offer, the adjuster will tell you the total amount which the state proposes to pay you and the conditions under which payment will be made to you. At this point, you may either accept this offer or suggest an alternate permanent disability benefit amount or conditions under which you would agree to settle your workers' compensation claim. The proposed settlement may be reviewed by a member of the Tennessee Claims Commission to determine whether the agreement ensures that you receive the benefits due to you under Tennessee's workers' compensation law. Once the settlement agreement has been approved by all parties, payments to you will begin.
Death Benefit Claims
Should your compensable injury result in your death, your dependents are eligible for certain death benefits under the workers' compensation law. To receive these benefits, your dependents should contact your personnel officer or Sedgwick to file a claim. Sedgwick will be able to determine if your death was work related, and, if approved, payment to your survivors will begin.
If You and the State Disagree
In the majority of workers' compensation claims filed against the state, the employee and the state are able to reach a mutually agreeable settlement to the claim; however, there will be instances where the employee and state will be unable to agree. The General Assembly has created the Tennessee Claims Commission to resolve disagreements between the state and state employees in workers' compensation matters. If you and the state are unable to reach an agreement on the terms of the settlement of your workers' compensation claim, or if you and the state disagree as to whether you qualify for workers' compensation benefits, you may file an appeal with the Tennessee Claims Commission. However, for accidents occurring on or after July 1, 2005, you must request a Benefit Review Conference with the Dept. of Labor and Workforce Development, Workers' Compensation Division. Sedgwick or the Division of Claims Administration will provide you with the appropriate form to request a Benefit Review Conference. If an impasse is reached at the Benefit Review Conference, then you can file an appeal to the Tennessee Claims Commission.
If the issue in dispute is not resolved at the Benefits Review Conference and you wish to file an appeal, you may contact the Division of Claims Administration for assistance or you may contact the commission directly at the address shown under the Contact Us page. Once the appropriate forms have been filed with the Tennessee Claims Commission, one of the members of the commission will hold a hearing at which time you will be able to explain your side of this issue. While it is not a requirement, you may wish to retain an attorney to represent you at the hearing. The state will be represented at the hearing by the state attorney general who will present the state's position on the disagreement. Once the hearing is completed, the commissioner will render a decision on the dispute and notify you and the state of the decision. If you are not satisfied with the commissioner's decision on your claim, you may appeal the decision to the Tennessee Supreme Court.
Under the workers' compensation law, you may sue the person who caused the accident which resulted in your injury if that person is not a fellow worker or your employer (in this case, the state of Tennessee). If you decide to sue the responsible party, you must notify Sedgwick of this in writing. The workers' compensation law states that if you recover any money from the responsible party, you must repay the state for any workers' compensation payments you have received from the state. The law allows an employer to recover only these amounts from you.