Tennessee Claims Dispute & Statutory Guide
Tennessee operates an At-Fault automobile insurance framework under Title 55 and Title 56 of the Tennessee Code Annotated (T.C.A.). The state enforces a strict 1-year statute of limitations for personal injury. Medical providers utilize optional first-party Medical Payments (MedPay) and enforce statutory hospital liens under Tenn. Code Ann. § 29-22-101, which are capped at one-third of the patient's tort recovery.
Statutory Framework & Jurisdiction
At-Fault / Traditional Tort (1-Year Statute of Limitations & Tennessee Hospital Lien Act)
Tennessee is a modified comparative fault jurisdiction (49% rule, McIntyre v. Balentine). Auto liability insurance is mandatory, while first-party Medical Payments (MedPay) coverage is optional. Personal injury tort claims are subject to one of the shortest statutes of limitations in the United States: exactly one year from the date of the collision under Tenn. Code Ann. § 28-3-104. Healthcare providers treating accident victims utilize MedPay assignments and enforce statutory hospital liens against third-party liability proceeds under Tenn. Code Ann. § 29-22-101.
PIP / MedPay Coverage & Medical Fee Rules
optional Med Pay Coverage
MedPay is optional in Tennessee (typically written in limits of $1,000 to $10,000+), covering reasonable medical, surgical, dental, ambulance, and funeral expenses incurred as a result of an automobile collision
made Whole Doctrine
Under Tennessee common law (York v. Sevier County Ambulance Authority), an insurer's contractual subrogation right for MedPay benefits is subordinate to the injured insured's right to be made whole for all economic and non-economic damages
assignment Of Benefits
Healthcare providers routinely accept patient assignments of MedPay benefits to bill auto insurers directly
Official Medical Fee Schedule & Reimbursement Standards
name
Reasonable and Customary Fee Standard
rules
Tennessee does not enforce a statutory fee schedule table for motor vehicle accident medical bills. Providers bill based on reasonable and customary charges prevailing in the local healthcare community for comparable care.
cpt Basis
CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims
Preauthorization & Decision Point Review
requirement
Preauthorization is not required by statute for emergency medical stabilization or acute outpatient diagnostics. Elective procedures, specialized pain management injections, and extended physical therapy plans are evaluated under insurer medical necessity guidelines.
independent Medical Review
Insurers may request medical records or independent physician reviews to evaluate causal relationship to the motor vehicle crash.
Administrative Appeals & Dispute Mechanism
statutory Bad Faith Penalty
Under Tenn. Code Ann. § 56-7-105, if an insurer fails to pay a covered loss within 60 days after demand, and the refusal is not in good faith, the court or jury may award an additional bad-faith penalty of up to 25% of the loss plus liability.
hospital Lien Act
Under the Tennessee Hospital Lien Act (Tenn. Code Ann. § 29-22-101 et seq.), any hospital in Tennessee has a statutory lien upon all claims and judgments of an injured person for reasonable hospital charges. The lien must be recorded in the circuit court clerk's office within 120 days of discharge. Under § 29-22-101(b), the hospital lien cannot exceed one-third (33.3%) of the patient's gross settlement or judgment.
dispute Forum
Tennessee Circuit Court or General Sessions Court (for claims within general sessions monetary jurisdiction) for civil recovery actions.
Critical Statutory & Dispute Deadlines
| Dispute Phase / Trigger Event | Statutory Timeline / Deadline |
|---|---|
| Accident Notice | Notice to insurer as soon as reasonably practicable |
| MedPay Claim Submission | Submission within standard policy billing deadlines (typically 1 to 3 years) |
| Insurer 60-Day Demand Window | 60 calendar days from formal written demand before 25% bad-faith penalty attaches (Tenn. Code Ann. § 56-7-105) |
| Hospital Lien Perfection | Must be filed with circuit court clerk within 120 days of patient discharge (Tenn. Code Ann. § 29-22-102) |
| Statute of Limitations | 1 year from accident date for personal injury tort claims (Tenn. Code Ann. § 28-3-104); 6 years for contract claims |
Required Evidentiary Filing Checklist
- ✓Tennessee MedPay Claim Application Form
- ✓Executed Assignment of Benefits (AOB) and medical records authorization
- ✓Itemized CMS-1500 or UB-04 billing statement with CPT/HCPCS codes and ICD-10 diagnostic coding
- ✓Contemporaneous medical records, emergency intake documentation, operative reports, and imaging findings
- ✓Filed Notice of Hospital Lien with circuit court clerk recording stamp (for hospital claims under Tenn. Code Ann. § 29-22-102)
- ✓Insurer Explanation of Benefits (EOB) or written explanation of claim determination
Official Primary Sources & Legislative Authorities
Governing Regulatory Authorities
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