TNSIA 2010 Conference Presentation

4th Annual Conference
September 16, 2010

Willis Conference Center
Nashville, Tennessee
Agenda
7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths

8:00 – 8:30 Opening Remarks / TNSIA Business Meeting
8:30 – 9:30 Craig MacFarlane – Keynote Motivational Speaker
9:30 – 10:00 Terry Hill - Workers’ Compensation Legislation / Case Law
10:00–10:30 Break & Visit Vendor Booths in Refreshment Center
10:30 – 11:00 Mike Shinnick - TN Department of Commerce & Insurance
11:00 – 11:30 Sue Ann Head & Pete Halverstadt - TN Dept of Labor &
Workforce Development
11:30 – 12:30 Lunch in Atrium & Visit Vendor Booths
12:30 - 1:30 Steve Gill, Political Radio and Television Commentator
1:30 – 2:00 Break & Visit Vendor Booths in Refreshment Center
2:00 – 3:00 Mock Benefit Review Conference / Request for Assistance
Katherine (Kitty) Boyte - Constangy, Brooks & Smith, LLP
Bill Easterly - Bill Easterly & Associates PC
Patrick Ruth – Mediator, Dept of Labor
3:00 – 3:15 Door Prizes
3:15 –4:00 Hospitality Room in Refreshment Center
Gold Sponsor
2010
Tennessee Self-Insurers’
Association Conference
Opening Remarks – TNSIA Business Meeting
Terry Hill – TNSIA Executive Director
Gary Eastes – TNSIA Chairperson
Micheline Parkey - Treasurer

TNSIA Accomplishments
– Legislative Bills passed:
SB 1574 deals with the Overstreet decision and allows us to communicate with the authorized treating physician under certain
conditions.
SB 1909 places very specific restrictions on the ability to recover when injured during a recreational activity.
SB 1567 prevents an employee from reopening his case if the employer is bought out by another company and retains the
employee at the same or greater pay.
SB 2162 makes it clear that an employee who is an illegal alien may not recover more than 1.5 times his impairment rating.
– Drafted Legislation for 2010 Legislative Session, including the following:

Bill on closing medicals.
Bill on repetitive motion injuries.
Bill dealing with the Hartco Flooring case. This bill prohibits reconsideration when pay is the same or greater at the time of trial.
Bill dealing with reconsideration when the employees take a cut in pay due to economic conditions or when the employer is forced
by economic conditions to temporarily cut hours.
Bill dealing with pain management.
– Welcomed 5 New Board Members

Goodyear Tire – Randy Triplett
Ingram Industries – John Hayes
International Paper – Penny Humphrey
Johnson Controls – Ronald Jones
McKee Foods Corp. - Micheline Parkey
Marvin Windows & Doors of Tennessee – Kent Carter
Statement of Income and Expense
2010
From
1/1/2010
Cash Beginning of Year $ 61,198.00
Membership Due
2010 Memberships $ 16,500.00
2011 Memberships 650.00
Conference
Attendees 7,375.00
Sponsors 16,750.00
Total Revenue $ 41,275.00
Expenses
Web Hosting ($495/Month) $ 3,960.00
Manier & Herod ($2,000/Month) 11,000.00
Amicus Brief -
National Council of Self Insurers 444.00
Tennessee Chamber of Commerce -
Conference 3,183.95
Paypal 424.90
Tax Preparation 1,115.50
NCSI National Conference 3,811.20
Guarantee Fund -
Insurance -
Bank Charges 122.72
Total Expenses $ 24,062.27
Total Income $ 17,212.73
Cash On Hand as of August 31, 2010 $ 78,410.73

Executive Director
Terry Hill
Board of Managers
City of Knoxville McKee Foods Corporation

Gary Eastes– Chairperson Micheline Parkey - Treasurer
Ajax Turner Company Ingram Industries Inc. Nissan North America, Inc.
Todd Williams John Hayes Mike Berger
Averitt Express, Inc. International Paper Parker Hannifin Corp

David McDowell Penny Humphrey Curtis Gross
Cracker Barrel Johnson Controls, Inc. Tyson Foods, Inc.

Old Country Store, Inc. Ronald Jones Allyn C. (Lynn) Tatum
Rob Behnke
Marvin Windows & Doors United Road Services
General Motors LLC Kent Carter Kristin Burman
Susan Azar
Wasco, Inc.
Goodyear Tire and Rubber Co Paul Kneedler
Randy Triplett
TNSIA Regular Members
Ajax Turner Company, Inc. Kennametal
American Electric Power Service Corp. Kroger
Ascension Health Marvin Windows & Doors
Averitt Express McKee Foods Corporation
City of Knoxville Nationwide-Express
Cracker Barrel Old Country Store, Inc. Nissan North America, Inc.
Det Distribution Parker -Hannifin Corporation
Eaton Corporation St. Jude Children's Research Hospital
Ford Motor Company The Pictsweet Company
General Motors LLC Thompson Machinery
Goodyear Tire & Rubber Company Tyson Foods, Inc.
Harrah's Entertainment, Inc. United Road
Ingram Industries Inc. Vanderbilt University
International Paper Company Wasco, Inc.
Johnson Controls, Inc.
TNSIA Associate Members
AccessOnTime Coventry Work Comp Services One Call Medical
Alternative Service Concepts Diagnostic Healthcorp Physical Therapy Provider Network
AON Risk Services Eckman/Freeman & Associates Premier Radiology
Beecher Carlson Insurance Services Fara Insurance Services Prime Health Services
Berkley Risk Administrators Company GENEX Services Ringler Associates Nashville
Brentwood Services Harmony Hearing Services Sedgwick Claims Mgmt Services
Brewer, Krause, Brooks, Chastain & Heartland Care management, Inc. Select Actuarial Services
Burrow
Heffernan Insurance Brokers Specialty Risk Services
CapRisk Consulting
Innovative Risk Consulting Tennessee Chamber of Commerce
Carlisle Medical, Inc.
Johnston & Associates Tennessee Urgent Care Associates
Casualty Actuarial Consultants
Leitner, Williams, Dooley & Napolitan Tristate Claims Services
Collins and Company
Manier Herod Waldrop & Hall
Commercial Insurance Associates
Marsh U.S. Wells Fargo Disability Management
Constangy, Brooks & Smith
Moore Ingram Johnson & Steele Willis of Tennessee
NuQuest/Bridge Pointe
Occusure Work Comp Specialists
Agenda

Craig MacFarlane
Keynote Motivational Speaker

Agenda

Terry Hill
TNSIA Executive Director
Tennessee Work Comp Update

 2010 Statutes
Passed by the Tennessee Legislature
 Case Law
Problems with Future Medical
Public Chapter No. 858 gives the
Department of Labor Specialist authority to:
1. Order employer to provide specific medical

care and treatment;
2. Order medical benefits; and
3. Award attorney’s fees and reasonable costs,
including court reporter expenses and expert
witness fees.
Problems with Pain
Management/Maximum
Medical Improvement
Public Chapter No. 920 clarifies the date of
maximum medical improvement when pain
management is involved.
The Chapter provides that a person is conclusively
presumed to be at MMI upon the earliest of the
following events:
1. At the time the treating physician concludes
that the Employee has reached MMI; or
2. 104 weeks after the commencement of pain
management treatment.
Return to Work at Reduced Hours
or Reduction in Pay Due to the
Economy
Public Chapter No. 1034 prevents employees
from reopening their cases when, due to the
economy, the Employer has had to cut back on the
hourly pay or cut back on the amount of hours
worked. The bill excludes employees involved in
layoffs, closure, or a termination of business
operations.
Workers’ Compensation
Requirements for
Construction Workers
A bill passed in 2008 that was intended to require
that all construction workers be covered by workers’
compensation. However, many solo employers
complained that the coverage was too expensive.
The House and Senate have agreed upon a
bipartisan bill that allows solo proprietors, partners,
LLC members, etc. to exempt themselves from the
workers’ compensation coverage requirements.
This involves specific filings with the Secretary of
State’s office.
The Case Law
All cases presented, except for the last two
cases are decisions from the Tennessee
Supreme Court’s Special Workers’
Compensation Panel, which is the
equivalent of a Court of Appeals right above
the trial court level.
Before we get started, there is one
preliminary matter we need to
address...
which is the problem of ....
Acronyms!!!
The Promise
Why do I call it the “problem”
of acronyms?
Personal Experience: My father-in-
laws’ retirement from the “SSA”
Never again will I torture people in a

presentation with acronyms by
assuming they know what they mean.
Ten Acronyms You Need
to Know in Tennessee
1. PTD = Permanent Total Disability

2. PPD = Permanent Partial Disability
3. SIF = Second Injury Fund - a/k/a “the Fund”
4. BAW = Body as a whole or WP for whole person
5. ATP = Authorized Treating Physician
Ten Acronyms You Need
to Know in Tennessee
6. IME = Independent Medical Evaluation

7. MIRR = Medical Impairment Rating Registry
8. DOL = The Tennessee Department of Labor
9. BRC = Benefit Review Conference
10. RFA = Request For Assistance
The Traveling Employee
MCDONNELL V. CONTINENTAL MACHINE

MOVERS., NO. M2008-00968-WC-R3-WC
TN employee assigned to Kentucky jobsite.
Employer paid for food & lodging.
Employee had an apparent seizure while waiting
for co-workers to return from breakfast.
IME said seizure caused shoulder dislocation.
Trial court ruled injury as compensable because
employee was a “traveling employee.”
The Traveling Employee
MCDONNELL V. CONTINENTAL
MACHINE MOVERS., NO. M2008-00968-
WC-R3-WC
Employer appealed.
Panel decided that injury did not arise out of
employment.
Panel reversed the trial court decision.
Psychological Injury Following Trauma
CATES V. BODY PANELS COMPANY, INC., 2009
WL 910214
Employee fell from a ladder at work:
Orthopedic surgeon released employee with no
physical impairment, no restrictions, and recommended
psychiatric evaluation.
Psychiatrist opined depression, panic disorder and
post-traumatic stress disorder (PTSD) were related to
the fall, permanent, & disabling.
Trial Court awarded Perm Total Disability (PTD) and
the Panel Court affirmed.
Superdoctor
Presumptive Correctness of MIRR
WILLIAM KEVIN BEELER V. LENOX HEARTH
PRODUCTS, INC., 2009 WL 396121
Treating physician assigned 2% impairment.
At employees request, an IME was conducted with
the evaluating physician assigning 7% impairment.
To resolve the disparity, the parties selected a
neutral physician from Medical Impairment Rating
Registry (MIRR) to conduct an examination.
MIRR physician concluded that 3%
was the accurate impairment rating.
Panel affirmed Trial Court’s reliance on

MIRR doctor.
Presumption applies unless there is

clear and convincing evidence to the
contrary.
BERTHA MAI CLAIBORNE V. ABC
GROUP FUEL SYSTEMS, INC., 2009 WL
4017167
Authorized Treating Physician (ATP) released

employee with no impairment.
Employee’s evaluating physician assigned
10% impairment.
Parties invoked MIRR process.
BERTHA MAI CLAIBORNE V. ABC GROUP
FUEL SYSTEMS, INC., 2009 WL 4017167
MIRR physician assigned 0% impairment.
Trial Court applied 10% rating, with no clear and
convincing rebuttal of MIRR physician’s opinion.
Upon review, the trial court was reversed & the
case was remanded for additional consistent
proceedings.
Exhaustion of Benefit Review Process
THE HOLLAND GROUP V. AUDREY
SOTHERLAND, ET AL., 2009 WL 1099275
Employer filed suit after Department of Labor (DOL)
issued an Order for Benefits on the Employee’s
Request for Assistance.
Employer denied the claim and sought
reimbursement for the cost of benefits provided
pursuant to the DOL order.
Employee eventually answered the lawsuit and
counter-claimed for benefits.
Neither the employer nor employee filed a Request
for Benefit Review Conference (BRC).
Exhaustion of Benefit Review Process
THE HOLLAND GROUP V. AUDREY
SOTHERLAND, ET AL., 2009 WL 1099275
The Second Injury Fund (SIF) (The Fund) filed a
motion for summary judgment, contending that the
trial court lacked subject matter jurisdiction because
the parties had not exhausted the benefit review
process.
The trial court granted the motion and dismissed the
action. The employee appealed.
It was concluded that the trial court lacked
jurisdiction over the subject matter, and therefore the
judgment was affirmed.
Accepting Retirement While
Treating For Injury - Caps on
STEVE IACONO V. SATURN
CORPORATION, 2009 WL 648962
Employee retired before his treatment ended.
Trial court applied the 1.5 cap against the
Permanent Partial Disability (PPD) claim.
Panel Affirmed.
Accepting Retirement While
Treating For Injury - Caps off
TAMMIE HAAKE V. SATURN
CORPORATION, 2009 WL 3925399
Trial Court declined to apply the 1.5
cap against the PPD claim, finding
retirement based in part on anticipated
disability.
Panel Affirmed.
Hearing Loss Cases
Hearing loss cases spawned a number of litigated cases
and appeals. There were approximately 8 Panel decisions
issued since January 2009. Issues addressed in the cases:
1. Discovery that the hearing loss may be attributable to
the work environment may come after retirement and
begin the running of the statute of limitations (SOL).
2. Hearing loss from exposure to noise is not

progressive.
3. Unless there is continued exposure to harmful noise

levels, the impairment level will stop when effective
hearing conservation measures are observed.
Hearing Loss Cases
4. Medical evidence must support that the hearing loss is
work-related.
5. Hearing loss to both ears is a scheduled member loss

not subject to the 1.5 cap.
6. Hearing loss combined with tinnitus is not scheduled

and is subject to the 1.5 cap.
Hearing Loss Cases
Bain v. TRW, Inc., Slip Copy 2010 WL 1508519,
Tenn.Workers Comp. Panel, April 15, 2010 (No. M2008-
02311-WC-R3-WC).
McKamey v. Lockheed Martin Energy Systems,
Inc., Slip Copy, 2010 WL 845210, Tenn. Workers Comp.
Panel, March 12, 2010 (No. E2009-00715-SC-WMC-WC).
Resh v. Building Materials Corp., Slip Copy, 2010 WL
844784, Tenn. Workers Comp. Panel, March 11, 2010 (No.
M2009-00028-WC-R3-WC).
Hall v. TRW Automotive, U.S., LLC., Slip Copy, 2010
WL 366680, Tenn.Workers Comp.Panel, February 3, 2010
(No. M2008-02312-WC-R3-WC).
Hearing Loss Cases
Jacks v. East Tennessee Mechanical Contractors,
Inc., Slip Copy, 2009 WL 2589093, Tenn.Workers
Comp.Panel, August 24, 2009 (No. E2008-02501-WC-R3-
WC).
Douglas v. Goodyear Tire & Rubber Co., Slip Copy
2009 WL 2567777, Tenn.Workers Comp.Panel, August 19,
2009 (No. W2008-00533-SC-WCM-WC).
Crowell v. TRW, Inc., Not Reported in S.W.3d 2009 WL
1260319, Tenn.Workers Comp.Panel, May 8, 2009 (No.
M2007-02758-WC-R3-WC).
Ruffner v. Union Carbide Corp., Slip Copy, 2009 WL
692322, Tenn.Workers Comp.Panel, March 17, 2009 (No.
E2008-01873-WC-R3-WC).
PTD Employee Overdose
Leads to Death Claim
LISA SHELTON V. CENTRAL MUTUAL
INSURANCE COMPANY, 2009 WL 1110476
Employee was found to have PTD as a result of a
work-related injury.
In January 2006, he died as a result of an overdose of
prescription medication.
His widow sought workers’ compensation death
benefits, alleging that his death was the direct result of
his prior work injury.
PTD Employee Overdose;
Leads to Death Claim
LISA SHELTON V. CENTRAL MUTUAL
INSURANCE COMPANY, 2009 WL 1110476
Employer filed a motion for summary judgment
contending that the medical evidence was insufficient.
The trial court granted the motion. Employee’s
widow appealed.
Judgment reversed and remanded for further
proceedings by Panel.
Declined Surgery Leads to Presumptive MMI
THOMAS MICHAEL ROSS V. DELTA INDUSTRIAL
COATINGS, INC., ET AL., 2009 WL 2461853
Employee’s ATP recommended surgery, but employee
refused surgical treatment.
The trial court found the date of maximum medical
improvement (MMI) was January 26, 2007, and the
employee was entitled to temporary total disability (TTD)
until that date.
Employer appealed.
WC Panel reversed trial court’s finding as to date of MMI
& used earlier date when employee declined surgery.
SIF Not Liable Where
Employer Was Uninsured
JAMES R. SEIBER V. REEVES LOGGING, ET AL.,

284 S.W.3d 294 (TENN 2009).
Worker filed suit against employer and Director of SIF

seeking benefits.
Circuit Court awarded $286,616.00 in workers’

compensation benefits.
Circuit Court apportioned 15% of liability to employer and

85% to the Fund.
SIF Not Liable Where
Employer Was Uninsured
JAMES R. SEIBER V. REEVES LOGGING, ET AL.,
284 S.W.3d 294 (TENN 2009).
Supreme Court held that employer was not properly insured

within meaning of precondition that had to exist before the
Fund could be held liable for workers’ compensation
benefits.
Employer permitted workers’ compensation coverage to

lapse when employee was injured was not “properly insured”
within meaning of precondition that had to exist before the
SIF could be held liable. Therefore employee was not
entitled to recover benefits from SIF.
C-32 & Unavailable Physician
ANDREW CARTER V. QUALITY OUTDOOR

PRODUCTS., INC., ET AL., 303 S.W.3d 265
Employer moved to exclude the medical report of

the physician who performed an IME when it was
unable to depose the physician.
Supreme Court held that employer did not waive
its right to object to the medical report.
C-32 & Unavailable Physician
ANDREW CARTER V. QUALITY OUTDOOR
PRODUCTS., INC., ET AL., 303 S.W.3d 265
The physician’s unavailability for a deposition precluded

the use of medical report; and
The exception to the hearsay rule for unavailable
declarants did not authorize the admission of the medical
report.
Although the physician was unable to testify at the
hearing because of his physical or mental illness or
infirmity, the report was not from prior testimony.
Agenda

Agenda

Mike Shinnick
Workers’ Compensation Manager

TN Department of Commerce & Insurance
Topic of Discussion
Key Factors Impacting the
Workers’ Compensation Self Insurance Environment
2009 Market Segments
Individual Self Insureds are on an equivalent basis
$900 $832
$800 -
19%
Million in Premiums
$676
$700
2008
$600
2009
$500
$400
-15%
$300
$200
$200 $170
- -28%
$100 27%$33 $24
$47 $34
$0
Voluntary Self Insurers SI Groups* TWCIP
* Excluding government sponsored groups
54
TN Large Deductibles History
3500 300
3400 250
3300
200
3200
150
3100
100
3000
2900 50
2800 Policy Count 0 Policy Year Premium

'02 '04 '06 '08p '02 '03 '0 4 '05 '06 '07 '08p
(millions)
Source: NCCI 55
Workers’ Compensation Countrywide
Indemnity Claims Cost Increases
12.00%
10.00% 10.10%
9.20%
8.00%
6.00% 5.80%
5.00% 5.00%
4.10% 4.50%
4.00%
3.10% 3.10%
2.00% 1.70%
0.00%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Source: NCCI (2009 is preliminary)
56
WC Countrywide Medical Claim Cost
Trends
(Lost Time Cases)
16%
14% 13.50%
12%
10%
8.80% Med Severity
8% 7.30% 7.30% 7.40%
Med CPI
5.60% 6.70%
6% 5.40%
5.40% 5.00%
4%
2%
0%
04
06
07
00
01
02
03
05
08
*
Sources: NCCI - Med Severity; Economy.com – Medical CPI
09
20
20
20
20
20
20
20
20
20
20
* preliminary
57
Lost Time Countrywide Frequency
Continues to Decline
0%
-1%
-2%
-3% -3.00%
-3.40%
-3.70%
-4% -4.10% -4.00%
-4.50% -4.50%
-5%
-6% -6.20%
-6.60%
-7% -6.90%
Source: 2NCCI
000 2001 2002 2003 2004 2005 2006 2007 2008 2009*
* Preliminary 58
Tennessee Direct Premium Written
History
1,000,000,000
900,000,000
-
800,000,000 19%
700,000,000
600,000,000
500,000,000
400,000,000
300,000,000
200,000,000
100,000,000
0
Source: NAIC (Annual
2000 2 Statements)
001 2002 2003 2004 2005 2006 2007 2008 200
59
Contributions to WC Direct
Premium Written Premium Decline
Calendar Years 2007-2009
2-Year Change in TN Direct Written Premium 25%

Known Pricing Impacts
Change in TN Loss Costs -13%
Change in Carrier Pricing - 2%
Economic Impact (US)
Change in Total Payroll -5%
Other Impacts -5%
Source: NCCI
60
Tennessee Voluntary Market Loss
Cost Multipliers (LCMs)
Market appears at 1.5
this stage to have 1.45 1.49
bottomed out. 1.4
1.46 1.46
1.43
Multipliers are based 1.35
1.40
1.37
on prior year 1.3
1.35
1.33 1.
premium “weighted 1.25
average” market 1.2
1.26
shares. 1.15
1.1
20012002200320042005200620072008200920
61
Impact of 2004 Reforms on WC
Premiums: Estimated $562M Savings Since
2004 (50-6-134)
Calendar Direct Premium Net Estimated Annual %
Yr Written Savings* Savings
2004 $883M $20M 2.2%
2005 $943M $98M 9.4%
2006 $947M $139M 12.8%
2007 $947M $114M
10.8%
2008 $879M $105M 10.7%

2009 $710M $85M 10.7%
* These preliminary estimates are based on the impact of loss costs and the most recent NCCI
study of the estimated decreases in system costs seen in data periods impacting 2007 through
2009 premiums.
62
WC Premium Tax Revenues
YE 8/31/06 YE 8/31/07 YE 8/31/08 YE 8/31/09
Self $11,780,936 $10,164,858 $9,662,965 $8,013,028

Insurance
Insurance $31,458,936 $32,789,581 $35,317,758 $31,791,246
Total $43,239,872 $42,954,439 $44,980,723 $39,804,274

Premium
Tax*
Data excludes .4% TOSHA Surcharge
63
TN Assigned Risk Market Share - NAIC
Direct Premium Written
35
30
25
20 Trigger
15
10
4.8
5
0
00
02
04
06
08
96
98
20
20
20
20
20
19
19
64
TN Assigned Risk Premium
Bookings Down 10% in 2010
5
4.5
4
3.5 2009
Millions
3 2010
2.5
2
1.5
1
0.5
0
65
Jan Feb Mar April May June July
Overview of Self-Insurance Market
(2009)
Self-Insured Employers – 101
Number of employees – 244,673
Total “Premium Equivalent” – $170 million
Self-Insured Groups – 6
Number of employees – 34,144
Total Premium – $24 million
66
Overview of the Tennessee
Workers’ Compensation Market
Conditions and Environment
Copies of Presentation:
tn.gov/commerce/insurance
67
Agenda

Sue Ann Head
Administrator of the Workers’ Compensation Division
Pete Halverstadt
Attorney
Congratulations
Sue Ann!!
SUE ANN WELCH
“Men are like buses, there’s always another one coming along.”
Programs Within the Tennessee
Workers’ Compensation Division
The Workers Compensation Division manages ten
different programs concerning employees’ and
employers’ rights and responsibilities. They are:
– Claims and Coverage—Dark Ages (1919)

– The Second Injury Fund—1946
– Benefit Review—1992
– Case Management/Utilization Review—1992
– The Drug Free Workplace Program—1996
– The Uninsured Employers Fund (UEF)—2001
– The Penalty Program—2004
– The Medical Fee Schedule—2005
– The Medical Impairment Rating (MIR) Registry—2005
– The Administrative Review Program—2006
75
Claims Statistics
July 1, 2009 through June 30, 2010
Medical Only
1 to 7 days off work with physician statement
Lost Time & Medical

If 8 days or more off work with physician statement
indemnity benefits are due to the claimant
– 42,165 Lost Time Claims
– 63,248 Medical-Only Claims
105,413 Total Claims
76
Coverage Statistics
Proof of coverage is received electronically
from NCCI (National Council on
Compensation Insurance)
108,855 Proofs of coverage received
195,196 Notices of cancellation, reinstatement,

endorsements
77
Uninsured Employers Fund
In fiscal year 2009-2010, the UEF
conducted 2,118 investigations.
The UEF penalized 300 employers for
non-compliance i.e. failing to have
workers’ compensation insurance
coverage.
In fiscal 2009-2010, the UEF collected
penalties in the amount of $1,039,389.20
from non-compliant employers.
78
Benefit Review
Regional and Satellite Offices
Macon Pickett
Montgomery Robertson Clay Hancock Sullivan Johnson
Claiborne
Stewart Sumner Fentress Scott Hawkins
Lake Obion Trousdale Campbell
Henry Jackson Overton Washington
Weakley Cheatham
Houston Union Grainger Carter
Davidson Wilson Smith Hamblen Greene
Dickson Morgan
Gibson Carroll Putnam Anderson
Dyer Benton Unicoi
Humphreys Knox Jefferson
De Kalb White Cumberland
Williamson Roane Cocke
Rutherford
Lauderdale Crockett Hickman Cannon Loudon Sevier
Blount
Henderson Warren Van Buren
Haywood Madison Decatur Perry Rhea
Maury Bledsoe
Lewis Bedford Coffee Meigs
Tipton
Monroe
Chester Sequatchie McMinn
Marshall
Grundy
Shelby Moore
Wayne
Fayette Hardeman Hardin Giles
McNairy Lawrence Lincoln Franklin Hamilton Bradley
Fayetteville Marion Polk
Dyersburg Clarksville Nashville Chattanooga

Jackson Columbia Murfreesboro Knoxville
Memphis Cookeville Kingsport
79
The Benefit Review Program Stats
TTD/Med: Assistance with resolution of temporary
disability and medical benefits
BRC: Benefit Review Conference: Mediation of final

settlements
Approvals: Approval of settlements reached with or

without mediation
FY FY FY FY FY FY
04/ 05 05/ 06 06/ 07 07/ 08 08/ 08 09/ 10
TTD/ M ed 2,733 4,008 4,987 4,948 5,665 4,547

BRC 6,173 6,976 7,311 6,444 7,044 6,716
A pprovals 5,872 6,988 7,053 7,065 7,938 6,464
TO TA LS 14,778 17,972 19,351 18,457 20,647 17,727
80
Administrative Review
Total Number of Requests: 769

Untimely Filed: 29
Withdrawn: 53
Orders Issued: 683
– Of Orders Issued
Affirmed: 506 74%
Not Affirmed: 177 26%
81
Penalty Program
25% Penalties
Number of Penalty Referrals: 107
Number of Penalties Assessed: 49
Total Penalties Assessed: $75,477.51
$10,000+ Penalties
Number of Penalty Referrals: 27
Number of Penalties Assessed: 11
Total Penalties Assessed: $45,113.12 82
MIR Registry
By the end of Fiscal Year 2009/2010:
• There were 140+ Tennessee-licensed physicians on
the Registry—
Practicing in nearly 200 offices in 40+ Tennessee
counties, and in Mississippi and Georgia, too
• There had been over 276 valid requests for

evaluations—
Of which 28 cases settled prior to the evaluation
• Every completed evaluation was conducted in a

timely manner
83
2010-2011 Compensation Levels
Maximum weekly benefits as of July 1:

– Temporary benefits--$841.50
– Permanent benefits--$765.00
Minimum weekly benefit as of July 1

– Temporary benefits--$114.75
84
Utilization Rules
On November 12, 2009, new utilization rules
became applicable to all recommend medical
treatments and procedures.
The trigger for UR is no longer a monetary

amount—instead it is triggered when the
payor disputes the medical necessity of the
recommended treatment or procedure.
The UR Rules provide timelines for

conducting the UR.
85
Utilization Review cont.
The UR agent must be a TN-license.,
Board-certified doctor in the same or
similar specialty as the recommending
physician.
The only issue under consideration
during UR is medical necessity.
The UR agent’s decision must be in
writing and distributed to all parties.
Expedited appeal only for UR denials.
86
ADJUSTER TRAINING
The TDOL has just begun putting together
concepts & ideas for adjuster training.
Establish minimum standards of training,
experience, and skill to adjust TN workers
compensation claims
Mandatory certification and renewed-
certification processes.
Failure to comply will result in civil
penalties.
87
Contact Information
Sue Ann Head, Administrator

SueAnn.Head@tn.gov
Pete Halverstadt, Assistant Administrator

Pete.Halverstadt@tn.gov
Website: www.state.tn.us/labor-wfd/wcomp
Phone Number : 1-800-332-
2667
88
Agenda

TNSIA Thanks our 2010
SILVER SPONSORS
Agenda

Steve Gill
Political Radio and Television Commentator

Agenda

Agenda

A Journey Through the Administrative
Process of the Department of Labor &
.
PATRICK RUTH
Workers’ Comp Specialist IV – TN Dept of Labor & Workforce Development
BILL EASTERLY
Attorney at Law - Easterly and Associates - Nashville, TN
KITTY BOYTE
Attorney at Law - Constangy, Brooks & Smith - Nashville, TN
JOHN SMITH
v.
HAUL ‘EM FREIGHT
(an entirely fictitious hypothetical situation)
TCA 50-6-236
WORKERS’ COMPENSATION
SPECIALISTS
Establishes a program to assist injured or disabled

employees, persons claiming death benefits,
employers, and other persons in protecting their
rights and obtaining information under the
workers’ compensation laws.
TCA 50-6-238
REQUEST FOR ASSISTANCE
Any party or their attorney may request the

assistance of a workers’ compensation specialist
in the determination of whether temporary
disability or medical benefits are appropriate . . .
TCA 50-6-238(d)(1)(A)and (B)
If a specialist issues an order that either denies
benefits to the employee or issues an order for
payment of workers’ compensation benefits, the
party against whom the order was issued may
request the administrator of the division of workers’
compensation to administratively review the
specialist’s order . . . .
TCA 50-6-237
BENEFIT REVIEW CONFERENCE
A benefit review conference is a non-adversarial, informal

dispute resolution proceeding designed to:
(1) Explain the rights of the respective parties to a workers’

compensation claim and the procedures necessary to protect
those rights;
(2) Discuss the facts of the claim, review available information

in order to evaluate the claim, and delineate the disputed issues;
TCA 50-6-237
A benefit review conference is a non-adversarial,

informal dispute resolution proceeding designed to:
(3) Mediate and resolve disputed issues by mutual

agreement of the parties;
(4) Provide an opportunity for, but not to compel, a

binding settlement of some or all the issues present at the
time;
TCA 50-6-237
A benefit review conference is a non-adversarial, informal

dispute resolution proceeding designed to:
(5) Facilitate the resolution of issues without the expense of

litigation or attorneys’ fees for either party; and
(6) Determine, under any proposed settlement, whether any

employee is receiving, substantially, the benefits to which (s)he
is entitled under the workers’ compensation act.
Agenda

Agenda

Reminder:
Conference Evaluation Forms
Recycle Name Badges

at Registration Table
TNSIA Thanks
for Non-Monetary Donations

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4th Annual Conference

September 16, 2010

7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths

Terry Hill – TNSIA Executive Director

Gary Eastes – TNSIA Chairperson

Micheline Parkey - Treasurer

– Drafted Legislation for 2010 Legislative Session, including the following:

– Welcomed 5 New Board Members

Cash Beginning of Year $ 61,198.00

2010 Memberships $ 16,500.00

2011 Memberships 650.00

Total Revenue $ 41,275.00

Web Hosting ($495/Month) $ 3,960.00

Manier & Herod ($2,000/Month) 11,000.00

National Council of Self Insurers 444.00

Tennessee Chamber of Commerce -

Tax Preparation 1,115.50

NCSI National Conference 3,811.20

Bank Charges 122.72

Total Expenses $ 24,062.27

Total Income $ 17,212.73

Cash On Hand as of August 31, 2010 $ 78,410.73

City of Knoxville McKee Foods Corporation

Averitt Express, Inc. International Paper Parker Hannifin Corp

Cracker Barrel Johnson Controls, Inc. Tyson Foods, Inc.

7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths

Keynote Motivational Speaker

7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths

Tennessee Work Comp Update

1. Order employer to provide specific medical

which is the problem of ....

Never again will I torture people in a

1. PTD = Permanent Total Disability

6. IME = Independent Medical Evaluation

MCDONNELL V. CONTINENTAL MACHINE

Panel affirmed Trial Court’s reliance on

Presumption applies unless there is

Authorized Treating Physician (ATP) released

2. Hearing loss from exposure to noise is not

3. Unless there is continued exposure to harmful noise

5. Hearing loss to both ears is a scheduled member loss

6. Hearing loss combined with tinnitus is not scheduled

JAMES R. SEIBER V. REEVES LOGGING, ET AL.,

Worker filed suit against employer and Director of SIF

Circuit Court awarded $286,616.00 in workers’

Circuit Court apportioned 15% of liability to employer and

Supreme Court held that employer was not properly insured

Employer permitted workers’ compensation coverage to

ANDREW CARTER V. QUALITY OUTDOOR

Employer moved to exclude the medical report of

The physician’s unavailability for a deposition precluded

7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths

7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths

Workers’ Compensation Manager

2800 Policy Count 0 Policy Year Premium

2-Year Change in TN Direct Written Premium 25%

2008 $879M $105M 10.7%

Self $11,780,936 $10,164,858 $9,662,965 $8,013,028

Insurance $31,458,936 $32,789,581 $35,317,758 $31,791,246

Total $43,239,872 $42,954,439 $44,980,723 $39,804,274

Data excludes .4% TOSHA Surcharge

7:30 - 8:00 Registration, Continental Breakfast, Visit Vendor Booths

– Claims and Coverage—Dark Ages (1919)

Lost Time & Medical