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Employer Toolkit - Tennessee

Your resource for State Specific Forms and Regulatory Links

Visit our Employer FAQ page for answers to employer related questions.

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State Forms

  • TN Application for Drug-Free Workplace Premium Credit

  • TN Election of Sole Proprietor or Partner to Come within the Provisions of Workers' Compensation Law [Form I-4]

  • TN Notice of Corporate Officer to Employer of Election Not to Accept Provisions of Workers' Compensation Act [Form I-6]

  • TN Notice of Corporate Officer's Revocation of Exemption [Form I-7]

  • TN Notice of Election to Accept or Reject an Insurance Deductible

  • TN Notice of Withdrawal [Form I-5]

  • TN Workers' Compensation Insurance Posting Notice

  • TN Workers' Compensation Insurance Posting Notice - Spanish

Claim Forms

  • First Report of Injury [Form LB-0021]

  • Initial Treatment Authorization

  • Medical Waiver and Consent [Form C-31]

  • New Policyholder Welcome Packet - TN

  • No Injury Certificate

  • No Treatment Requested Letter

  • Pharmacy Authorization - TN

  • TN Application for Drug-Free Workplace Premium Credit

  • TN Notice of Employer Rights and Responsibilities in a WC Claim

  • TN Overview of 2018 Revisions to the Tennessee Bureau of WC Rules for Employers

  • Wage Statement [Form C-41]

  • Workers' Compensation System Guide - FL

Links

Bureau of Workers’ Compensation

FFVA Mutual Insurance Co.
PO Box 948239
Maitland, FL 32794

321-214-5300
800-346-4825
Fax: 321-214-0220

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