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-Replacement C of A-8001 [pdf]
- Single Employer-Add Subsidiary Packet-8005 [pdf]
- Single Employer-Canceled Subsidiary Packet-8010 [pdf]
- Single Employer-Name Change-Lead Packet-8020 [pdf]
- Single Employer-Address Change-8030 [pdf]
- Single Employer-Security Review Packet-8055-Active [pdf]
- Single Employer-Security Review Packet-8055-Inactive [pdf]
- Single Employer-Withdrawal Packet-8057 [pdf]
- Single Employer-Merger Packet-8060 [pdf]
- Single Employer- Renewal Application Packet-8090 [pdf]
- Single Employer - Payroll and NCCI Requirement Packet-8091 [pdf]
- Single Employer-Fiscal Year End Filing Packet-8092 [pdf]
- Single Employer-Inactive Fiscal Year End Filing Packet-8093 [pdf]
- Single Employer-Premium Tax Requirement-8095 [pdf]
- Single Employer-Update Third Party Administrator Agreement-8045 [pdf]
- Single Employer-Update Excess Policy-8050 [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
- 2024 Workers Compensation Appeal Hearing Dates [pdf]
- 2024 Order Approving Workers' Compensation Voluntary Market Loss Cost Filing [pdf]
- 2024 Order Approving Workers' Compensation Assigned Risk Rate Filing and Loss Cost Multiplier [pdf]
- Procedures for Addressing Workers' Compensation Premium Disputes [pdf]
- 2022 ACWC Market Conditions Presentation [pdf]
- Workers' Compensation Loss Cost Multipliers [pdf]
- NCCI Contracting Group Classification Codes [pdf]