Workers Compensation

Applications and Forms

• Licensed Insured
  
  • Insurance Company Licenses
  • Insurance Company Lookup
• Licensed Pools Self-Insured WCs:
  
  • Pools New Admission Application Packet [pdf]
  • Pool Investment Schedule [pdf]
• Licensed Single Self-Employer Self Insurer WC
  
  • Single Self-Insured New Admision Application Packet  [pdf]
  • Single Self-Insured Renewal Application Packet-8090  [pdf]
  • Single Employer Self-Insured Payroll Requirement  Packet-8091 [pdf]
    
  • Single Employer-Fiscal Year End FilingPacketC-8092  [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]
• Workers Compensation Consumer Fact Sheet [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