Workers Compensation
Applications and Forms
- Licensed Insured
- Licensed Pools Self-Insured Workers' Compensation:
- Licensed Single Employer Self-Insurer Workers' Compensation:
- Single Employer- New Admission Application Packet [pdf]
- Single Employer- Renewal Application Packet-8090 [pdf]
- Single Employer - Payroll Requirement Packet-8091 [pdf]
- Single Employer-Fiscal Year End Filing Packet-8092 [pdf]
- Single Employer-Premium Tax Requirement-8095 [pdf]
- Single Employer-Updated Third Party Administrator Agreement-8045 [pdf]
- Service of Process [pdf]
- Tennessee Summary of Supporting Information Form [pdf]
- General Contractor Notice For Commercial Construction Projects [pdf]
- Workers Compensation TPA Application Packet [pdf]
Notices and Other Information
- Sample Commercial CSP Policyholder Notice
- 2021 Workers Compensation Appeal Hearing Dates [pdf]
- 2020 Order Approving Workers' Compensation Loss Cost and Rating Values Filings [pdf]
- 2020 Order Approving Workers' Compensation Assigned Risk Filing and Establishing Loss Cost Multiplier [pdf]
- Procedures for Addressing Workers' Compensation Premium Disputes [pdf]
- 2021 ACWC Market Conditions Presentation [pdf]
- Workers' Compensation Loss Cost Multipliers [pdf]
- NCCI Contracting Group Classification Codes [pdf]