Mediation Program Option

Problem Getting My Benefits

The Mediation and Ombudsman Services of Tennessee (MOST) program administers a three-stage process to help resolve disputes between injured employees and an insurance adjuster or employer in a workers’ compensation claim.  The goal of this program is to resolve disputes that involve compensability, medical treatment including future medical benefits, and/or temporary disability benefits which an employee believes might be due.  

Mediation Sure Beats Court Costs

Mediation, or alternative dispute resolution, can help resolve disputes between injured employees and an insurance adjuster (or employer) in a workers’ compensation claim.  Mediation is conducted privately between the parties with the assistance of a Mediation Specialist from the Tennessee Bureau of Workers' Compensation.  It is both quicker and less expensive to settle the matter through an alternative dispute resolution process than through the court system. 

Protecting Your Rights

The right to receive workers’ compensation benefits does not stay open forever.

In most cases, the deadline to file the request is one year from the date the injury occurred; or the date the last temporary disability benefits were paid or medical benefits were provided for the injury, whichever is latest. To protect your rights:


First Stage || Mediation/Alternative Dispute Resolution

This stage is designed to help parties voluntarily resolve disputes that involve medical or wage replacement (temporary disability payment) benefits.  An injured employee having difficulty receiving their benefits or medical treatment related to a workplace injury can seek assistance by submitting the proper form to this Bureau:

The process begins when the appropriate completed form is received by the Bureau.  

When received, the matter will be assigned to a Mediating Specialist.  The assigned Mediating Specialist is not a legal representative for the employee or employer.  Instead the mediator serves a neutral role and will attempt to resolve the disputed issues by communicating with the parties, learning their individual concerns and positions and seeking to reach a voluntary agreement.  If the issue(s) cannot be resolved through this initial mediation process, the process will move to the second stage.

The Bureau has established a goal of resolving disputes handled through the first stage of the Mediation process within 20 days.

Second Stage || Decision

The decision stage is designed to help resolve disputes by having the appropriate Bureau representative issue a decision in the matter.  

If the mediation stage described above is unsuccessful:

  • For injuries occurring on/after July 1, 2014, the Mediating Specialist will issue a Dispute Certification Notice (Spanish version click here) to the parties and shall file the Notice with the Clerk of the Court of Workers’ Compensation Claims. The file is transferred to the Court of Workers’ Compensation Claims and a Decision either denying or awarding benefits will be issued by a Judge there.  
  • For injuries occurring prior to July 1, 2014, the file remains in the MOST Program but is transferred to an Attorney Specialist who has the authority to resolve the issue(s) with the issuance of a Benefit Review Order either denying or awarding benefits. The parties must comply with a Benefit Review Order within fifteen (15) calendar days.  Orders issued in the MOST process can be appealed to the Administrative Review Program if either party thinks the Order was unjust.

Third Stage || Settlement

Some workplace injuries are so severe that the injured employee never fully recovers.  Some injured workers are left with a permanent disability, or impairment.  In these claims, the injured worker may be entitled to permanent disability benefits and/or future medical benefits.  The settlement stage is designed to help parties resolve the amount of permanent disability benefits and the right to future medical treatment.  

This stage also involves mediation.  This mediation, or alternative dispute resolution, may be conducted privately between the parties or with the assistance of a Mediation Specialist within the Bureau.  It is both quicker and less expensive to settle the matter through a mediation process than through the court system.  After the injured employee has reached a medical plateau, often referred to by the treating physician as “maximum medical improvement” (or MMI), this third stage can be requested by either party to the claim.  After the injured employee has reached MMI and is ready to mediate the settlement of his/her workplace injury, a party involved in the claim will need to complete and submit:

  • For injuries occurring on/after July 1, 2014, a Petition for Benefits Determination (Spanish version) to request the services of a Mediating Specialist within the Bureau.
    • If an agreement is reached during the mediation, the file is transferred to the Court of Workers’ Compensation Claims.  Terms of the settlement are included in a written Settlement Agreement that must be approved in order to become a binding legal document.  The Court conducts Approval Conferences, in which a Workers’ Compensation Judge will review the terms of the settlement with the injured employee, ensuring that the terms agreed to within the document are fair and equitable to all sides.  If an agreement is not reached, either party may request a hearing in the Court of Workers’ Compensation Claims after the issuance of a Dispute Certification Notice by the Mediating Specialist. 
  • For injuries occurring prior to July 1, 2014, a Request for Mediation  (Spanish version) must be filled to request the services of a Mediating Specialist within the Bureau.
    • The file remains in the MOST Program.   If an agreement is reached during the mediation, the terms of the settlement are included in a written Settlement Agreement that must be approved in order to become a binding legal document.  The Bureau conducts Approval Conferences, in which a staff Attorney Specialist will review the terms of the settlement with the injured employee, ensuring that the terms agreed to within the document are fair and equitable to all sides.  The approval process has the same standing as if it were approved through a Chancery or Circuit Court proceeding.  If an agreement is not reached, either party may file suit in a court of proper jurisdiction after the issuance of an Impasse Report by the Mediating Specialist.

It is important to remember that this third stage cannot be conducted until after an injured employee has been placed at MMI by the authorized treating physician.  And, while private negotiations are allowed, no party can file suit, in any court, to resolve issues regarding permanent disability benefits and/or future medical benefits prior to exhausting the MOST Process.  This requires the full and active participation of the parties in a mediation conducted by a Mediating Specialist within the Bureau.  The Mediating Specialist will issue the paperwork indicating that the process has been exhausted when he/she is convinced that continued mediations are not likely to result in an agreement and an impasse has been reached.  

The designated Discovery Attorney is authorized to resolve disputes between parties regarding exchange of information in a workers’ compensation claim that has not been filed in court.  The attorney may issue subpoenas, effect discovery, and issue protective orders where appropriate.  The designated Discovery Attorney is described in the Benefit Review Rules.

A case is resolved when there is an agreement between the injured employee and the employer/insurance adjuster or when a judge issues an order about the benefits that will be provided. In order to protect each party’s rights, whether represented by an attorney or not, settlements must be reviewed by a workers’ compensation Judge or Attorney Specialist, to determine whether they are fair and equitable to all sides.