Upon the report of a workplace injury, an employer should provide the employee, in writing, a choice of physicians on An Agreement Between Employer/Employee Choice of Physician (Form C-42). The form must be completed, provided to the employee to allow him/her to designate the authorized treating physician, signed by the employee with a copy given to the employee, and the original kept on file with the employer. The physicians listed should be located in or near the employee's community of residence. The employee has the privilege of choosing a physician from the list. The one selected becomes the “ authorized treating physician.” The employee is then required to accept treatment from the treating physician and should not seek treatment from any other medical provider unless the treating physician makes a referral.
Employers must also immediately submit all known or reported injuries or illnesses to their insurance carriers unless the employer is qualified and certified as a self-insured employer. Self-insured employers must either report the claim to their Third Party Administrator (TPA) or internal claims handling program. Reportable workplace injuries or illnesses are those that cause:
- An employee to receive medical treatment outside of the employer’s premises;
- Their absence from work, or their retention of a permanent impairment; or,
- Their death.”
Download forms at https://www.tn.gov/workforce/general-resources/forms.html