Section 0800-02-14-.02 - DEFINITIONS(1) "Adjusting entity" means a trade or professional association, managing general agency, pool, third party administrator and/or insurance company licensed to write workers' compensation insurance in Tennessee and shall also mean a self-insured employer or group self-insured employers possessing a valid certificate of authority from the commissioner of commerce and insurance pursuant to T.C.A. § 50-6-405.(2) "Adjuster", "claims adjuster", "med-only adjuster", or "claims handler" means a representative of an adjusting entity who investigates workers' compensation claims for the purposes of making compensability determinations, files or causes claims forms to be filed with the Bureau, commences benefits, and/or makes settlement recommendations based on the insured's liability on behalf of a self-insured employer, trade or professional association, third party administrator, and/or insurance company.(3) "Administrator" shall have the same definition of "Administrator" as in T.C.A. § 50-6-102.(4) "Bureau" means the Tennessee Bureau of Workers' Compensation as defined in T.C.A. § 50-6-102, an autonomous unit attached to the Department of Labor and Workforce Development for administrative matters only, pursuant to T.C.A. § 4-3-1409.(5) "Claim" means a demand for something as due; an assertion of a right or an alleged right.(6) "Electronic Data Interchange" or "EDI" means the electronic communication method that provides standards for exchanging data via electronic means. The term "EDI" encompasses the entire electronic data interchange process, including the transmission, message flow, document format, and software used to interpret the documents using the standards established by the IAIABC and the Release Version accepted by the Bureau at the time of the filing.(7) "Electronic Form Equivalent" means the original document, provided on the Bureau's website, which is to be used when a sender reports required data via a paper document. When forms are reproduced, they shall be reproduced in their entirety, including instructions and shall not be modified without written consent of the Administrator. A form may be revised at any time at the discretion of the Administrator and will be available at no cost.(8) "Employee" shall have the same definition of "Employee" as in T.C.A. § 50-6-102.(9) "Employer" shall have the same definition of "Employer" as in T.C.A. § 50-6-102.(10) "First Report of Work Injury" means the EDI equivalent of the form available on the Bureau's website and designated by the Bureau as the appropriate document to initially report a claim of injury.(11) "Form" means the document as is available on the Bureau's website on the date of the filing.(12) "IAIABC" means the International Association of Industrial Accident Boards and Commissions.(13) "Injury" and "personal injury" shall have the same definition of "injury" as in T.C.A. § 50-6-102.(14) "Insured" shall have the same definition of "Employer" as in T.C.A. § 50-6-102.(15) "Medical-only" claim or "med-only" claim means a claim requiring medical attention, but which has no indemnity benefits due or paid. Any claim in which no indemnity benefits are due or paid, but which has medical treatment provided by any medical personnel qualifies the claim for medical only status, regardless of whether or not a bill is generated and regardless of whom pays for the medical care.(16) "Trading partner" means an entity approved by the Bureau to exchange data electronically with the Bureau on behalf of an adjusting entity.Tenn. Comp. R. & Regs. 0800-02-14-.02
Original rule filed December 15, 1997; effective February 28, 1998. Amendments filed May 4, 2018; effective 8/2/2018.Authority: T.C.A. §§ 50-6-102, 50-6-113, and 50-6-233
.