Tennessee Workers' Compensation Insurance

TENNESSEE WORKERS’ COMPENSATION INSURANCE
Employers: The law requires this notice to be conspicuously posted at the employer’s place of business so all
employees have access to it.
WHO IS REQUIRED TO HAVE WORKERS’ COMPENSATION INSURANCE?
All employers with five (5) or more full or part-time employees.
All employers engaged in the mining and production of coal with one (1) or more employees.
All workers in the construction industry unless they are specifically exempted.
To confirm if an employer is subject to the workers’ compensation law and if so to obtain the name of the
workers’ compensation insurance company contact:
__________________________________________________________________________________
Name of employer representative authorized to provide information on workers’ compensation
__________________________________________________________________________________
Telephone number of employer representative to provide information on workers’ compensation
__________________________________________________________________________________
Address of employer representative to provide information on workers’ compensation
WHAT SHOULD AN EMPLOYEE DO IF INJURED AT WORK?
1. Report the injury to the employer immediately. Employer notification is required.
and 2. Select a treating physician from a panel provided by the employer.
To report an injury contact:
__________________________________________________________________________________
Name of employer representative to notify in event of a work related injury
__________________________________________________________________________________
Telephone number of employer representative to notify in event of a work related injury
__________________________________________________________________________________
Address of employer representative to notify in event of a work related injury
WHAT SHOULD AN EMPLOYER DO WHEN AN INJURY IS REPORTED?
1.
and 2.
Immediately complete a First Report of Work Injury form and send it to the workers’ compensation insurance
company or the third party administrator to be filed with the Tennessee Dept. of Labor and Workforce
Development, Workers’ Compensation Division.
Offer a panel of physicians.
The employer shall designate a group of three (3) or more physicians or surgeons not associated together in
practice from which the injured employee shall have the privilege of selecting the operating surgeon or the
attending physician. If the injury is a back injury, the panel shall be expanded to four (4), one of whom must
be a doctor of chiropractic. If a doctor of chiropractic is chosen, chiropractor visits may be authorized for up to
twelve (12) visits per back injury. More than twelve (12) visits to such doctor of chiropractic must be
specifically approved by the employer or insurance carrier. The provisions for chiropractic care shall not apply
to workers’ compensation self insurer pools established pursuant to Section 50-6-405(a)(1). If the injury
requires the treatment of physician or surgeon who practices orthopedic or neuroscience medicine then the
employer may appoint a panel of physicians or surgeons practicing orthopedic or neuroscience medicine
consisting of five (5) physicians, with no more than four (4) physicians affiliated in practice together. The
employee may select a treating physician or surgeon from the employer panel.
The Tennessee Department of Labor and Workforce Development, Division of Workers’ Compensation, has
staff available to help both employees and employers. For more information contact:
TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT
DIVISION OF WORKERS’ COMPENSATION
220 FRENCH LANDING DRIVE
NASHVILLE, TENNESSEE 37243-1002
615-532-4812 OR TOLL FREE 1-800-332-2667 OR 1-800-332-2257 (TDD)
www.tn.gov/labor-wfd/wcomp.html
LB-0922 (REV. 03/12)
RDA 10183