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Tennessee Workers Compensation Forms

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TN FORMS

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Tennessee Workers Comp Coverage

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Tennessee Work
Comp Quote

All Tennessee employers and employees may download and use any of our TN workers comp forms, applications, and guides for free.  We are always updating our Tennessee Forms Library so check back often for the latest versions.

If you need help completing or locating a form, please contact us for assistance.  We are happy to answer your questions about current coverage and to provide information about our current comp programs and premium rates for Tennessee coverage. 

You can start a workers compensation quote online by clicking Tennessee state to the right or give us a call today at 888.611.7467.

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TN Workers Comp Information

Questions? Call 888.611.7467 for a Workers Compensation Shop Specialist

 

 TN Comp Forms

 

Tennessee Workers Compensation Forms

Tennessee Workers Compensation Employer Notice

This posting is required to be displayed in every insured's workplace by The TN Department of Insurance to be

Tennessee Acord 130 Workers Compensation Application

The standard Acord 130 application form for workers comp coverage in Tennessee.

Tennessee First Report of Injury Form

First Report of Injury Form.  Employers should complete this form and send to their insurance company each time an injury occurs.

Tennessee Application for Exclusion of Officers

Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.

Tennessee Application for Exemption for Workers' Compensation Insurance

Complete this form if you are a sole-proprietor, partnership with no employees or a sole officer of a corporation and would like to be exempt from coverage.

Workers’ Compensation Contact Information

This document contains contact information for various workers' compensation assistance programs.

Choice of Physician Agreement Form

This document contains information regarding the Agreement Between Employer/Employee Choice of Physician Policy.

Drug Free Workplace Poster

Poster promoting a Drug Free Workplace.

Drug Free Workplace Information Guide

A guide on how to build a drug-free workplace program for you business.

Tennessee Workers' Compensation Information Guide

Complete the form and post it so that employees will know who to contact in case of a work related injury.

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Tennessee State Resources

Tennessee Department of Insurance

 www.state.tn.us/commerce/

insurdiv.html
500 James Robertson Parkway
Nashville, TN 37243
615-741-2218 | 800-342-4029

State of Tennessee

www.tennessee.gov/

TN Department of Labor and Workforce Development

www.tennessee.gov/labor-wfd/

Tennessee Workers’ Compensation Division

www.state.tn.us/labor-wfd/wcomp.html
710 James Robertson Parkway
Gateway Plaza, Second Floor
Nashville, Tennessee 37243-0665
(800) 332-2667

Tennessee is under the State Jurisdiction of the National Council for Compensation Insurance (NCCI).  However, the state operates it's own state fund and does not contract with NCCI for assigned risk administration.  Assigned Risk coverage may only be purchased from The Tennessee Workers’ Compensation Insurance Plan.  Employers must first have coverage declined by one or more private insurance providers.

 

Learn more about workers compensation insurance in Alabama

 
TN Workers Comp Penalties

Tennessee employers who are required to purchase workers compensation may be subject to state penalties for non-compliance.  The TN Commissioner of Labor and Workforce Development may fine employers up to 2.5 times the average annual premium and may even close a business down if coverage is not immediately obtained.

 

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