Articles & Publications

Tennessee Workers' Comp 2012 Legislative Changes

Pain Management Treatment

As of July 1, 2012, pain management treatment, including the prescribing of Schedule II, III and IV controlled substances, are subject to the following provisions:
• The prescribing of Schedule II, III and IV controlled substances for a period greater than 90 days is subject to Utilization Review.
• Utilization Review cannot be used for the initial pain management evaluation.
• If a treating physician finds that pain “is persisting . . . beyond an expected period of healing,” a referral for pain management is allowed.
• If a referral is made, the employer/insurer may provide a panel of three, which can include physicians board certified in:
o Anesthesiology;
o Neurosurgery;
o Orthopedic surgery,
o Radiology;
o Physical medicine and rehabilitation (physiatry); or
o Osteopathy.
• The panel physicians need only be within 175 miles of the Employee’s residence or work.
• The Employee is not entitled to a second opinion on the issue of impairment, diagnosis or prescribed treatment relating to pain management.
• If the Employee submits in writing to the employer a statement that the pain management treatment “fails to meet medically accepted standards,” then the Employer shall submit the prescribed treatment to Utilization Review.  This is limited to one such request.
• The pain management provider may ask the Employee to sign a “drug contract.”
• More than one violation of the drug contract disqualifies the Employee from receiving Schedule II, III or IV controlled substances.
• For injuries on or after 7-1-12, the violation will be deemed to be “misconduct” for purposes of sec. 50-6-241(d), meaning that the Employee cannot seek reconsideration of an award limited to 1.5 times the medical impairment rating.
• If the violation occurs prior to trial or settlement, then “the incapacity to work due to lack of pain management shall not be considered when determining whether the injured employee is entitled to permanent total disability.”

(The schedules of Controlled Substances can be found at:
http://www.deadiversion.usdoj.gov/schedules/index.html)

Effective Date

This bill provides that it shall take effect July 1, 2012 “and shall apply to pain management, including the prescription of Schedule II, III or IV controlled substances, prescribed on or after such date.”

SUMMARY OF RECENT TDOL CHANGES

As of May 1, 2012, the TDOL has instituted a new procedure for addressing Requests for Assistance (“RFAs”):

• RFAs will first be examined by a Specialist II or III.  Within a specified time frame, they will attempt to “assist the parties in resolving areas of disagreement.”
 
• If resolution is not achieved, the RFA will be referred to a Specialist IV (licensed attorney), who will conduct a telephonic hearing, then issue an Order.

NEW RATES

7-1-12 – 6-30-13 MAX PPD: $806.00; MAX TTD: $886.60; MIN Rate: $120.90