Section 0800-02-07-.03 - CASE MANAGEMENT THRESHOLD(1) Catastrophic Injuries. An employer or insurer should provide case management services in all cases where an employee has suffered a catastrophic injury. The employer or insured should assign a case manager within seven (7) calendar days of receiving notice that the employee has suffered a catastrophic injury. There shall be one face-to-face meeting within fourteen calendar days after the assignment. After the initial meeting, there should be face-to-face meetings or other communications as necessary for the progress of the patient until such time as case management services are concluded. Should an employee experience a significant decline in their medical condition, there should be a face-to-face meeting between the case manager and the employee within fourteen (14) calendar days of notification of such a change. Documentation evidencing the first face-to-face meetings shall be submitted to the Medical Director of the Tennessee Bureau of Workers' Compensation within thirty (30) calendar days of the first meeting on the Bureau's required case management form.(2) Non-catastrophic Injuries. For non-catastrophic injuries, there should be one initial face-to-face meeting if and when a case manager is assigned to the claim. This should occur within 14 days of the assignment. It is appropriate to consider case management services if medical expenses over $10,000 (ten thousand dollars), an impatient hospitalization, or lost work time over three months is anticipated. Further meetings and communication should occur as the case warrants. Documentation evidencing the initial face-to-face meetings shall be submitted to the Medical Director of the Tennessee Bureau of Workers' Compensation within thirty (30) calendar days, if medical expenses over $10,000 (ten thousand dollars), an impatient hospitalization, or lost work time over three months is anticipated, on the Bureau's required case management form.Tenn. Comp. R. & Regs. 0800-02-07-.03
Original rule filed January 28, 1993; effective May 13, 1993. Amendment filed May 13, 1997; effective July 27, 1997. Amendment filed March 20, 2007; effective July 27, 2007. Repeal and new rule filed May 31, 2016; effective 8/29/2016.Authority: T.C.A. §§ 4-5-202, 50-6-102, 50-6-122, 50-6-123, 50-6-233(c)(6), and Public Acts 1992, Chapter 900, § 3.