Workers Compensation

Applications and Forms

• Licensed Insured
  
  • Insurance Company Licenses
  • Insurance Company Lookup
• Licensed Pools Self-Insured Workers' Compensation:
  
  • Pools-New Admission Application Packet [pdf]
  • Pools-Investment Schedule [pdf]
• 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]
    
• 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]
• 2020 ACWC Market Conditions Presentation [pdf]
• Workers' Compensation Loss Cost Multipliers [pdf]
• NCCI Contracting Group Classification Codes [pdf]

Company Examinations

• Current Company Examination Reports 2005+

Regulatory Actions and Appeals

• Disciplinary Agent Actions
• Company Actions and Rating Appeals