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FORM C-42G TENNESSEE DIVISION OF WORKERS COMPENSATION Nashville Tennessee 37243-1002 Website www. tn.gov/labor-wfd/wcomp.html Telephone 1-800-332-2667 EMPLOYEE S CHOICE OF PHYSICIAN It is a crime to knowingly provide false incomplete or misleading information to any party to a workers compensation transaction for the purpose of committing fraud. State File Number Date of Injury Employee SSN Address City State Zip Employer JEFFERSON COUNTY Address P O BOX 1749 FEIN City DANDRIDGE State TN Zip...
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How to fill out tennessee division of workers
How to fill out tennessee division of workers
01
Obtain the necessary forms from the Tennessee Division of Workers' Compensation website
02
Fill in the required personal information such as name, address, and contact details
03
Provide details about your employer, including their name, address, and contact information
04
Specify the date and description of the injury or illness that occurred in relation to your work
05
Include information about any medical treatment received for the injury or illness
06
Attach supporting documents such as medical records, accident reports, or witness statements
07
Double-check all the information filled out in the form for accuracy
08
Submit the completed form to the Tennessee Division of Workers' Compensation either online or by mail
Who needs tennessee division of workers?
01
Employees who have suffered work-related injuries or illnesses in Tennessee
02
Employers who need to report workplace injuries or illnesses to the Tennessee Division of Workers' Compensation
03
Healthcare providers who are involved in treating patients with work-related injuries or illnesses in Tennessee
04
Insurance companies and attorneys who handle workers' compensation cases in Tennessee
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What is tennessee division of workers?
The Tennessee Division of Workers' Compensation is a state agency responsible for overseeing and regulating workers' compensation claims and benefits in Tennessee.
Who is required to file tennessee division of workers?
Employers in Tennessee are required to file the Division of Workers' Compensation to report workplace injuries and provide benefits to injured employees.
How to fill out tennessee division of workers?
Employers can fill out the Tennessee Division of Workers' Compensation forms online or submit them by mail. The forms require information about the injured employee, the nature of the injury, and details about any medical treatment provided.
What is the purpose of tennessee division of workers?
The purpose of the Tennessee Division of Workers' Compensation is to ensure that injured employees receive the benefits they are entitled to under the state's workers' compensation laws.
What information must be reported on tennessee division of workers?
Employers must report information such as the employee's name, date of birth, social security number, date of injury, nature of the injury, and any medical treatment provided.
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