Tennessee workers compensation 2025

1. Click ‘Get Form’ to open the Tennessee Workers Compensation form in the editor.
2. Begin by entering your name in the 'NAME' field, followed by your title in the 'TITLE' section. This identifies you as the case manager.
3. In the 'CERTIFICATIONS' section, list your certifications along with their corresponding certification numbers and dates issued. Ensure accuracy for each entry.
4. Indicate whether your certifications are temporary or permanent by checking the appropriate box and providing the expiration dates where applicable.
5. Fill in your company name and address in the designated fields, ensuring that all contact information is current and correct.
6. Provide your company telephone number, office phone number, and fax number to facilitate communication.
7. List any providers with whom you self-contract in the provided space to complete this section.
8. Finally, sign the form at the bottom to validate your submission before saving or sending it directly from our platform.

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