Helpful Documents

The documents referenced on this page come from the State of Tennessee's Workers' Compensation website. The Nashville Tennessee Workers' Compensation law firm of Kevin Moore has put links to these documents on this site to make it easier for you to get all of the information you need to understand your case and the law. For specific questions and help, Contact the Firm for a free consultation.

FIRST REPORT OF INJURY OR ILLNESS
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

First Report of Injury or Illness (DFS-F2-DWC-1)

WAGE STATEMENT
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Wage Statement (DFS-F2-DWC-1a)

REQUEST FOR WAGE LOSS/TEMPORARY PARTIAL BENEFITS
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
Request for Wage Loss/Temporary Partial Benefits (DFS-F2-DWC-3)

Information Management
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Notice of Action/Change (DFS-F2-DWC-4 )

NOTICE OF DENIAL
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Notice of Denial (DFS-F2-DWC-12 )

CLAIM COST REPORT
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Claim Cost Report (DFS-F2-DWC-13 )

REQUEST FOR SOCIAL SECURITY DISABILITY BENEFIT INFORMATION
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Request for Social Security Disability Benefit Information (DFS-F2-DWC-14)

EMPLOYEE EARNINGS REPORT
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Employee Earnings Report (DFS-F2-DWC-19)

AUTHORIZATION AND REQUEST FOR UNEMPLOYMENT COMPENSATION INFORMATION
AGENCY FOR WORKFORCE INNOVATION
Tennessee DEPARTMENT OF FINANCIAL SERVICES

Authorization and Request for Unemployment Compensation Information (DFS-F2-DWC-30)

PERMANENT TOTAL OFF-SET WORKSHEET
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Permanent Total Off-Set Worksheet (DFS-F2-DWC-33)

PERMANENT TOTAL SUPPLEMENTAL WORKSHEET
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Permanent Total Supplemental Worksheet (DFS-F2-DWC-35)

STATEMENT OF QUARTERLY EARNINGS
FOR SUPPLEMENTAL INCOME BENEFITS
DIVISION OF WORKERS' COMPENSATION

Statement of Quarterly Earnings for Supplemental Income Benefits (DFS-F2-DWC-40)

AGGREGATE CLAIMS ADMINISTRATION CHANGE REPORT
Tennessee DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION

Aggregate Claims Administration Change Report (DFS-F2-DWC-49)

If you are injured as a result of a work-related accident, your employer's workers' compensation coverage provides medical and partial wage replacement benefits that you may be entitled to.

Important Workers' Compensation Information for Tennessee's Workers (DFS-F2-DWC-60)

IMPORTANT WORKERS' COMPENSATION INFORMATION FOR Tennessee'S EMPLOYERS

Important Workers' Compensation Information for Tennessee's Employers (DFS-F2-DWC-65)