Resources

Claims Administration

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 (800) 378-2540

Helpful Links

Tennessee Department of Labor & Workforce Development – Division of Workers’ Compensation
Tennessee Department of Labor & Workforce Development – Drug Free Workplace Program

Medical Management

Informational Sites

U.S. Food & Drug Administration (FDA)
Medscape Nursing

Licensing Branches

KY Department of Insurance
IL Division of Insurance
Missouri Insurance Market Regulation Division
State of Tennessee Department of Commerce & Insurance
State of Indiana Department of Insurance
AR Department of Health & Human Services

Center Of Insurance

Curneal Hignite

Houchens Benefits

Roeding Insurance

Roeding Insurance Public Entity

Van Meter Insurance