Benefits Review Conference - a nonadversarial, informal dispute resolution proceeding to mediate and resolve workers' compensation disputes; required for disputes on claims occurring on or after 7/1/05 and before a state employee can proceed with an appeal before the Tennessee Claims Commission.
Compensable Injury - An accidental injury or occupational disease which the Division of Claims, its third party administrator or the Tennessee Claims Commission has determined to have occurred during the course and scope of your employment.
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Death Benefits - Benefits payable to surviving dependents or to the estate of an employee whose compensable injury results in death.
Division of Claims Administration - The division of the Treasury Department of the State of Tennessee responsible for overseeing the administration of workers' compensation benefits for state employees.
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Maximum Benefit Payable - The maximum total benefits (excluding medical expense payments) which may be paid under the workers' compensation law for temporary total disability benefits, permanent disability benefits and death benefits combined. For accidents occurring between 7/1/2007 and 6/30/2008, the maximum is $285,200.00; for accidents occurring between July 1, 2008 and June 30, 2009, the maximum is $300,800; for accidents occurring between July 1, 2009 and June 30, 2010, the maximum is $304,400; for accidents occurring between July 1, 2010 and June 30, 2011, the maximum is $306,000; for accidents occurring between July 1, 2011 and June 30, 2012, the maximum is $315,600.
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Maximum Medical Improvement - The highest degree of recovery that the treating physician believes will ever be reached from the compensable injury. In some instances, maximum medical improvement will be reached because the injury has fully healed; in other cases, maximum medical improvement will be reached because the physician has determined that no further improvement can be expected.
Medical Expenses - Doctor, hospital, health facility, or pharmacy bills incurred as a result of compensable injury.
Permanent Disability Benefits - Benefits which may be paid after the treating physician and the state have determined that the maximum medical improvement has been reached and the disability will be permanent.
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Preferred Provider Network - A panel of physicians and health care facilities designated to provide treatment to injured state employees.
Subrogation - The right under the workers' compensation law of the employer (the state) to recover payments made (including medical) if the injured employee receives monies for the injury from a responsible third party.
Temporary Partial Disability Benefits - Benefits paid to an employee who is able to work on a part-time basis while undergoing treatment for a work-related injury.
Temporary Total Disability Benefits - Benefits paid during the time the treating physician prohibits the employee from returning to work and before maximum medical improvement has been reached.
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Tennessee Claims Commission - The state commission appointed to resolve disagreements over workers' compensation benefits.
Third Party Administrator (TPA) - A company with whom the state has contracted to investigate and administer workers' compensation benefits for state employees.
Treating Physician - The doctor approved to treat the compensable injury. This physician is selected from the state's workers' compensation preferred provider network.
Workers' Compensation Benefits - The general term used to describe all benefits (medical expense payments, temporary disability benefits, permanent disability benefits and death benefits) available under the workers' compensation program.
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