www.ers.net

Claims
 
Kentucky Forms
First Report of Work Injury or Illness IA-1
Medical Waiver and Consent 106
Average Weekly Wage Certificate AWW-1

Tennessee Forms
Employer’s First Report of Work Injury or Illness C20
Wage Statement C-41
Medical Waiver and Consent C-31
Employee’s Choice of Physician C-42

Reporting Instructions
First Reports of Injury may be submitted via facsimile to 270-782-7654, via e-mail to ersclaims@ers.net or via telephone 1-800-378-2540

Adjuster Contact Information
Leigh Anne Massey
lmassey@ers.net
1-800-378-2540 x 4325

Stephanie Ogles
sogles@ers.net
1-800-378-2540 x 4344

Karen Portugues
kportugues@ers.net
1-800-378-2540 x 4336

Helpful Links
Tennessee Department of Labor and Workforce Development – Division of Workers’ Compensation
Tennessee Department of Labor and Workforce Development – Drug Free Workplace Program
 
Copyright © www.ers.net. All rights reserved.