First Report of Work Injury or Illness IA-1 Medical Waiver and Consent 106 Average Weekly Wage Certificate AWW-1
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
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
Tennessee Department of Labor & Workforce Development – Division of Workers’ Compensation Tennessee Department of Labor & Workforce Development – Drug Free Workplace Program
U.S. Food & Drug Administration (FDA) Medscape Nursing
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