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Statistical Data Form

The Bureau has developed the Statistical Data Form for collecting data relevant to assessing the overall effectiveness of the Tennessee workers' compensation system by capturing information concerning the provision of medical treatment, disability benefits, and length of disability.

The Tennessee Workers’ Compensation Act requires the SD-1 to be filed for every claim with dates of injury on or before June 30, 2014, that is concluded by settlement, whether approved by a circuit or chancery court or the Bureau.

  • The form is required to be filed with the Bureau prior to being approved by the Bureau.  

  • The form is required to be filed with the court clerk at the same time that the final order is submitted for settlements approved by a circuit or chancery court or by trial.

    • In cases involving a workers' compensation settlement that is approved by a circuit or chancery court, the completed form shall be filed at the same time as the order approving the settlement is filed and shall be filed with the clerk of the court in which the settlement order is filed.

    • In cases involving a workers' compensation case that is resolved by trial, the completed form shall be filed at the same time as the final order is submitted to the trial court for approval and shall be filed with the clerk of the court in which the matter was tried.

      • A clerk of the court shall not accept a settlement order for filing unless it is accompanied by a fully completed statistical data form.

  • Neither the settlement order nor the trial order is considered to be final until the form is fully completed and filed with the appropriate clerk.

The Bureau's Rules on Mediation and Hearing Procedures require the SD-2 to be filed for every claim with dates of injury on or after July 1, 2014, that is concluded by settlement and approved by the Court of Workers' Compensation Claims

  • The form is required to be filed with the Bureau prior to being approved by the Bureau. 
  • The form is required to be filed with the Bureau at the same time that the final order is submitted for settlements approved by the Court of Workers' Compensation Claims
  • In cases involving a workers' compensation settlement that is approved by a workers' compensation judge, the completed form shall be filed at the same time as the order approving the settlement is filed and shall be filed with the Bureau in the office in which the settlement order is filed.
  • In cases involving a workers' compensation case that is resolved by trial, the completed form shall be filed within ten business days of the final order and shall be filed with the clerk of the Court of Workers' Compensation Claims.
    • The Bureau shall not accept a settlement order for filing unless it is accompanied by a fully completed statistical data form.
  • The settlement order will not become final until the statistical data form is fully completed and received by the Bureau.

It is the responsibility of the employer or the employer's agent to complete and file the Statistical Data form. The employee and any agent of the employee are required to cooperate with the employer in completing this form.


Need More Help?

If you have additional questions, please call 615-532-1313 or 800-332-2667 or contact us by email at wc.edi@tn.gov. Find out about other available assistance programs by contacting an ombudsman.