Ombudsman ProgramThe Ombudsman Program assists any non-represented party in a workers' compensation claim.
Injured workers should be provided with the appropriate medical treatment medically necessary to recover from a compensable work-related injury or illness. Most employers and insurance adjusters provide benefits without assistance from the Bureau. If you are not having problems with your claim, you do not need to contact us. However, if you are having problems, or just want to know what to expect, please read further. Basic information is available in our Beginner’s Guide to Tennessee Workers’ Compensation.
The Bureau's Ombudsman Program provides assistance to employees, employers or any other party in a workers’ compensation claim that is not represented by an attorney. The Ombudsman helps these self-represented employees and employers navigate the workers’ compensation claims process. Knowing accurate information about the law and the processes can help prevent disputes from becoming roadblocks to agreements.
How can I speak to an Ombudsman?
Any party that is not represented by legal counsel may request the services of a workers’ compensation Ombudsman by contacting the Bureau at its toll-free phone number: (800) 332-2667.
an absolute miracle worker
Ms. Swafford’s workers’ comp claim had been one disaster after another. She had been prescribed physical therapy three weeks earlier but had not yet been approved by the insurance carrier. Her adjuster justified the delay by saying he didn’t have the medical records. So she had a friend drive her to fill out the paperwork to send the records to the adjuster, but the physical therapy was still not approved. Ms. Swafford also complained that she not been paid any temporary total disability benefits since her injury. She told us that she could not express how horrible this whole process has been, and she felt mentally exhausted and tormented.
Ms. Swafford finally called the ombudsman line after hearing about us. The ombudsman, Susanne, made a few phone calls on Ms. Swafford’s behalf, and lo and behold, the next morning Ms. Swafford gets a call from the adjuster. Her physical therapy was approved and scheduled, her back pay was going to be paid before the end of the week, and the adjuster’s attitude toward her seems to be completely different. She said that Susanne is “an absolute miracle worker,” and she wishes she would have called sooner. She said that she was in awe that with just two or three phone calls, her problems were fixed within 12 hours of her call to the ombudsman line.
How can an Ombudsman help me?
An ombudsman can help injured employees if:
- Your supervisor refuses to provide you a list of medical providers;
- The insurance adjuster handling your claim won’t authorize your medical treatment;
- You are not receiving your benefits timely; or,
- Your claim has been denied but you believe your injury is work-related.
An ombudsman can help employers by providing important information that will help settle disputes and save money. See the information below.
What can an Ombudsman do?
An Ombudsman can:
- Meet with and provide information to parties not represented by legal counsel;
- Communicate with all parties and providers in the claim;
- Assist the parties in the completion of forms;
- Facilitate the exchange of medical records; and
- Investigate and attempt to resolve disputes without resorting to the Bureau’s Alternative Dispute Resolution Process and/or the Court of Workers’ Compensation.
Can an Ombudsman give me legal advice?
No. But while an Ombudsman cannot provide legal advice, an Ombudsman can:
- Provide information on workers’ compensation laws and the Bureau’s policies, practices, procedures, and rules;
- Inform participants of their rights and obligations under the law; and,
- Assist participants in completing forms, obtaining medical records and scheduling appointments.
Please realize, If you begin receiving the services of an Ombudsman and then hire an attorney, you must immediately notify the Bureau of your legal representation and discontinue the use of the services provided by an Ombudsman.
Other Available Resources
An Ombudsman can further help employees by providing information about available resources, such as:
Adult Education empowers individuals to become self-sufficient by providing the basic skills and knowledge necessary to complete a secondary education. Tennessee Adult Education provides basic skills upgrades and works with individuals to help them meet their educational and career goals.
Child Support Offices
The Tennessee Department of Human Services (DHS) offers numerous services to parents or legal guardians trying to obtain financial and medical support for their child or children.
Supplemental Nutrition Assistance Program (SNAP)
The Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) provides nutritional assistance benefits to children and families, the elderly, the disabled, unemployed and working families. SNAP benefits are issued and accessed electronically using a Benefit Security Card or EBT Card.