0800-02-07-.02
Case Management System
Cite as Tenn. Comp. R. & Regs. 0800-02-07-.02
(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 catastrophic and/or non-catastrophic injuries 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:
GENERAL RULES OF THE WORKERS’ COMPENSATION PROGRAM
CHAPTER 0800-02-07
CASE MANAGEMENT
(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
and, upon request, the authorized medical providers of the identity of the assigned case
manager(s) or case manager assistant(s) for workers’ compensation cases for the employer,
and 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 information shall be
provided to the case management provider.
(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.