Get Tn Lb-0973 2013-2026

The TN LB-0973 form, also known as the Certificate of Readiness, is essential for filing a Request for Benefit Review Conference. This guide provides clear instructions for users to complete the form online, ensuring all necessary information is accurately submitted.

Follow the steps to successfully complete the TN LB-0973 form.

1. Click the ‘Get Form’ button to obtain the TN LB-0973 form and open it in your chosen online editor.
2. Begin by entering the employee's Social Security Number, as this information is crucial for identification purposes.
3. Fill in the Date of Injury, which should accurately reflect when the incident occurred.
4. Complete the section noting that a Request for Benefit Review Conference was previously filed with the Division, including the date of that filing.
5. Indicate that the employee has reached Maximum Medical Improvement (MMI) and provide the MMI date and the impairment rating, along with the affected body part.
6. Confirm that all information regarding the claim has been exchanged between the parties or their representatives, ensuring that all agree on no additional discovery requirements.
7. Establish the weekly compensation rate by selecting 'yes' or 'no' in the relevant section.
8. If applicable, provide the name of the Second Injury Fund Attorney in the specified space.
9. Discuss and list three agreed-upon dates and times for conducting the mediation, making sure to circle the desired time slot.
10. Complete the contact information sections for the employee and both attorneys, carefully providing accurate addresses, phone numbers, and email addresses.
11. Lastly, the requesting party or their representative must certify the accuracy of the information by printing their name and signing the form.
12. Once all information is filled out and reviewed, save your changes, and consider downloading, printing, or sharing the completed form as needed.

Complete your TN LB-0973 form online today for a smooth filing process.