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REQUEST FOR BENEFIT REVIEW CONFERENCE SF # STAMP-DATE RECEIVED TENNESSEE DEPT OF LABOR & WORKFORCE DEVELOPMENT Division of Workers' Compensation RFA # http://www.tn.gov/labor-wfd/wcomp.html Toll.

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Tennessee Workers' Compensation Maximum Compensation Rate The weekly maximum compensation rate for a Permanent Total Disability and a Permanent Partial Disability is $752.00 (100% of average wages in Tennessee).

(a) A petition for benefit determination (PBD) is a written request for the Bureau to assist in resolution of disputed issues and is the document that initiates the litigation process as described in Tennessee Code Annotated section 50-6-203(b).

Compensation Rates DatesMini RateBenefit %7/1/21 - 6/30/22$159.0066.67%7/1/20 - 6/30/21$149.1066.67%7/1/19 - 6/30/20$144.0066.67%7/1/18 - 6/30/19$139.3566.67%29 more rows

Yes, if you are settling your workers' comp claim for a lump sum and still need surgery, the settlement amount should reflect the costs of that upcoming procedure. This should increase your workers' comp settlement amount.

The impairment rating is then multiplied by 450 to determine how long your benefits will be paid (this is called the “compensation period”). The compensation period is then multiplied by 66 2/3% of the average weekly wages you received pre-injury (subject to the state maximum).

How Do You File a Workers' Compensation Claim in Tennessee? 5 steps to filing a workers' compensation claim in the Volunteer State. ... Step 1: Get medical treatment. ... Step 2: Report your injury to your employer. ... Step 3: Make sure your employer files the proper form. ... Step 4: Wait to hear if your claim is accepted or denied.

Form C-41 Wage Statement. This form enables EMPLOYERS to calculate the correct compensation due to an injured employee. Please complete the form and submit to EMPLOYERS within 5 days after your knowledge of any accident that has caused your employee to be disabled for more than 7 calendar days.

Permanent Total Disability (PTD) Benefits: An injured worker's wage paid is 66 2/3%. The weekly payment minimum is $112.80. The weekly maximum is $752, 100% of the Tennessee state average weekly wage.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232