Tenn. Comp. R. & Regs. 0800-02-27-.07

Current through October 22, 2024

Section 0800-02-27-.07 - CERTIFICATION PROCESS FOR ADJUSTING ENTITIES

(1) Prior to being designated a "certified" adjusting entity an entity shall:

(a) Make proper application, provide all required documentation and pay all appropriate fees.

(b) Establish and implement a training program that complies with the requirements set forth in these Rules for adjusters that process Tennessee claims.

1. Verifiable training provided by the adjusting entity to its adjusters that was provided within twelve (12) months of an adjusting entity's initial application that meets the requirements stated within these Rules may be used to satisfy the requirements of this section.

(c) For the cumulative twelve (12) calendar months prior to application, meet or exceed the requirements of the Bureau's Rules Claims Handling Standards, Rules 0800-02-14 and General Rules, Rules 0800-02-01, and the Medical Fee Schedule, Rules 0800-02-17-.20 in the timely filing/provision of:

1. First Report of Work Injury Forms

2. Employee Choice of Physician Forms

3. First Report of Payment of Compensation Forms

4. Notice of Change or Termination of Compensation Benefits Forms

5. Statistical Data Forms

6. Payment(s) to medical providers

(d) Have at least 60% of its adjusters that process Tennessee workers' compensation claims be recognized as "certified" by the Bureau.

(e) Have at least 75% of its supervisors that supervise adjusters that process Tennessee workers' compensation claims be recognized as "certified" by the Bureau, and

(f) Be approved by and recognized as such by the Bureau.

(2) Documentation submitted with the application shall include:

(a) The individual names and total number of persons adjusting Tennessee workers' compensation claims, including claims supervisors, on behalf of the applicant on the date of the application;

(b) The total number of adjusters and medical-only adjusters who have been awarded a Tennessee Adjuster Certification as of the date of the application;

(c) An audit of the adjusting entity's achievements relative to the benchmarks listed above for the twelve (12) calendar months ending with the month three months prior to the date of the application (example: For an application dated June 1, the audit would be for the months of April 1 of the previous year through March 31 of the current year).

(3) The term for a certification designation is twenty-four (24) months from the date of designation.

(4) Failure of a certified adjusting entity to fulfill the requirements for post-designation training shall result in that entity being no longer considered a certified adjusting entity.

(5) An adjusting entity which is not designated by the Bureau to be a certified adjusting entity shall not identity itself as holding such recognition.

Tenn. Comp. R. & Regs. 0800-02-27-.07

Original rule filed March 2, 2018; effective 5/31/2018.

Authority: T.C.A. §§ 50-6-101, 50-6-119, 50-6-127, 50-6-233, 50-6-415, and 50-6-419.