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Tennessee workers compensation 2026

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The document is a registration form (FORM C-39) from the Tennessee Department of Labor and Workforce Development for providers involved in utilization review within the Division of Workers' Compensation. It requires information such as company name, address, contact details, licensing information, credentials, and subcontracted providers.

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Click ‘Get Form’ to open the Tennessee Workers Compensation form in the editor.
Begin by entering your company name and address in the designated fields. Ensure that all information is accurate to avoid any processing delays.
Next, provide your telephone number and fax number. This contact information is crucial for communication regarding your registration.
Fill in the TN License number assigned by Commerce & Insurance. This is essential for verification purposes.
Indicate your credentials along with the date issued and date expires. Keeping this updated ensures compliance with state regulations.
If applicable, list any providers with whom you subcontract. This helps maintain transparency in your operations.
Finally, enter the name of the person submitting the form along with their title to complete the registration process.

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