Official Workers' Compensation form in fillable pdf and Word format.
Tennessee Notice of Revocation for Workers' Compensation
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FAQ
The LES Form DWC-1, or First Report of Injury or Illness, is the form used to report workers' compensation accidents or work-related illnesses to your insurance carrier or designated claims office. Delays and errors may increase costs related to processing the claim.
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. Step 5: Start the appeals process.
Medical. Surgical. Chiropractic. Acupuncture.
Workers Comp. Exemption Registry @tn.gov, or by calling (615) 741-0526. The application is hand printed in ink or computer generated and mailed along with the required filing fee to the Secretary of State's office at 6th FL - Snodgrass Tower, 312 Rosa L. Parks AVE, Nashville, TN 37243.
