Section 0800-02-07-.02 - CASE MANAGEMENT SYSTEM(1) An insurer who provides workers' compensation insurance regulated by the provisions of T.C.A., Title 50, Chapter 6 or a self-insured employer may provide for a system of case management for cases involving compensable injuries under T.C.A., Title 50, Chapter 6.(a) Any insurer providing workers' compensation insurance under T.C.A., Title 50, Chapter 6, may provide for or contract for case management services when such services are provided.(b) The insured employer may choose to provide case management services itself or through a third party administrator. If so, the insured employer shall inform its insurer in writing of its choice.(2) The Administrator may provide or contract for certain case management services. The case management services which may be provided or contracted for may include, but are not limited to, providing:(a) A review of an individual case when an employee, employer, or health care provider seeks review of a decision or action by the employer's case manager by the Bureau of Workers' Compensation;(b) A review of case management services provided by case managers or case management firms for an employer for workers' compensation cases; and(c) Development of reports and summaries of case management of medical care and services in workers' compensation cases in Tennessee.(3) It shall be the responsibility of every employer who elects to provide case management services to injured workers, either directly or through its insurer or third party administrator, to give basic information to and encourage the injured worker's participation in case management. It shall further be the responsibility of those parties to inform the injured worker of the identity of the contractor and of the case management providers for workers' compensation cases for the employer, and of the possibility that the injured worker will be contacted by the case management provider for the employer. Those parties shall also inform the injured worker that provision of information to the contractor and to the case management provider for the employer for purposes of case management is strongly encouraged.(4) In all cases in which the employer uses case management services, it is the responsibility of the injured worker to cooperate with the case manager in all reasonable requests including, but not limited to, requests for information, provider appointments (and changes to provider appointments), and other communication relevant to helping the employee progress toward the best medical outcome.Tenn. Comp. R. & Regs. 0800-02-07-.02
Original rule filed January 28, 1993; effective May 13, 1993. Amendment filed March 20, 2007; effective July 27, 2007. Amendment filed December 26, 2013; effective March 26, 2014. Repeal and new rule filed May 31, 2016; effective 8/29/2016.Authority: T.C.A. §§ 4-5-202, 50-6-102, 50-6-122, 50-6-123, 50-6-126, 50-6-233, Public Acts 1992, Chapter 900, § 3 and 7, and Public Acts 2013, Chapters 282 and 289.