Definitions

The terms contained within these rules that are not specifically defined within these rules shall have the same definitions as those established by the Workers’ Compensation Law and the case law interpreting it. When any terms that are used in these rules differ from the definition established by the Tennessee Workers’ Compensation Law, the definition established by the Tennessee Workers’ Compensation Law shall govern. (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 of 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 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. GENERAL RULES OF THE WORKERS’ COMPENSATION PROGRAM CHAPTER 0800-02-01 (5) “Electronic Data Interchange” or “EDI” means the electronic communication method that provides standards for exchanging data via any 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. (6) “Employee” shall have the same definition of “Employee” as in T.C.A. § 50-6-102. (7) “Employer” shall have the same definition of “Employer” as in T.C.A. § 50-6-102. (8) “File” means to successfully submit claims information in the manner required by Bureau Rules. Success is achieved when claims information is filed in the manner required by the Bureau Rules and its acceptance is acknowledged by the Bureau. Success is not achieved if the Bureau receives and its acceptance is not acknowledged by the Bureau or if the Bureau subsequently rejects or returns claims information that has been submitted but is incomplete or fails to use the correct form or formats. (9) “Form” means the original document as is available on the Bureau’s website on the date of the filing. (10) “IAIABC” means the International Association of Industrial Accident Boards and Commissions. (11) “Insured” shall have the same definition of “Employer” as in T.C.A. § 50-6-102. (12) “Rate Service Organization” shall have the same definition of “Rate Service Organization as in T.C.A. § 56-5-102.