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 120 State Forms found

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STATISTICAL DATA FORM FOR INJURIES ON/AFTER JULY 1, 2014—Form SD-2

 LB-3261 (REV 8/23)

ADJUSTING ENTITY CERTIFICATION APPLICATION

 LB-3266 (4/18)

Notice of Employer Rights and Responsibilities in a Workers’ Compensation Claim

 LB—3265 4/2018

Notification of Primary Liaison and Adjusters Processing or Supervising Tennessee Workers’ Compensation Claims

 LB-3263 (9/25)

REQUEST FOR PRIOR WORK INJURY INFORMATION

 LB-3271 (7/18)

EMPLOYEE MISCLASSIFICATION TIP FORM

 LB-0977 (REV 10/15)

MEDICAL RECORD CERTIFICATION (Spanish)

 LB-1097 rev 9/19

HEARING REQUEST (Spanish)

 LB-1098 (Rev. 3/21)

SUBPOENA (Spanish)

 LB-0476 No Form/Rev Date

Independent Contractor/Subcontractor

 LB-3276 REV 4/19

REQUEST FOR BENEFITS FROM THE UNINSURED EMPLOYERS FUND

 LB-3284 (REV 10/24)

NOTICE OF DENIAL (Spanish)

 Form C-23s / LB-0283 (REV 12/21)

NOTICE OF ELECTION (Spanish)

 FORMULARIO I-4 / LB-0228s (REV 11/15)

DRUG FREE WORKPLACE PROGRAM APPLICATION (Spanish)

 LB-1111s (REV 05/22)

(Discontinued by the State). - REQUEST TO RESUME MEDIATION

 LB -385 DEACTIVATED (09/22)
Disclaimer: These forms may not be the most recent version. Tennessee may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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