Tools & Documents for Policyholders
ACH Form - One Time Draft
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- Last Updated
- 2023-07-26
Beginner's Guide to Workers' Compensation in Tennessee
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- Last Updated
- 2023-07-26
Beginner's Guide to Workers' Compensation in Tennessee (Spanish Version)
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- Last Updated
- 2023-07-26
EFT/ACH Premium Payment Form
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- Last Updated
- 2023-07-26
First Fill Program Pharmacy Card
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- DOC
- Last Updated
- 2023-07-26
Notice of Employer Rights and Responsibilities
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- Last Updated
- 2023-07-26
Payment Portal FAQ Document
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- Last Updated
- 2024-01-12
Policyholders - Do You Know Where to Bring an Injured Worker for Care?
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- Last Updated
- 2023-07-26
Prompt Return to Work Information Sheet - Policyholder
Prompt Return to Work (PRTW) is a team approach to getting an injured worker back to work as soon as possible. The team consists of the worker’s employer or supervisor, vocational rehabilitation counselor, LUBA’s claims adjuster, injured worker and the assigned physician.
- Type
- Last Updated
- 2023-07-26
Prompt Return-to-Work Program Booklet
At LUBA Workers’ Comp, our intent in regard to Prompt Return to Work (PRTW) is to create a situation which benefits all parties involved. A PRTW Program is an effective tool in helping us create such a situation. This program is designed to help facilitate the return of an injured worker to the workplace.
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- Last Updated
- 2023-07-26
Quick Reference Guide for New Class Code 0012 (Paid Furloughed Employees)
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- Last Updated
- 2023-07-26
Tennessee Choice of Physician Form_English
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- Last Updated
- 2023-07-26
Tennessee Choice of Physician Form_Spanish
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- Last Updated
- 2023-07-26
Tennessee First Report of Injury
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- Last Updated
- 2023-07-26
Tennessee Next Step Program Brochure_English
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- Last Updated
- 2023-07-26
Tennessee Next Step Program Brochure_Spanish
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- Last Updated
- 2023-07-26
Tennessee Required Employer Workers' Comp Posting Notice (poster)_ English
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- Last Updated
- 2023-07-26
Tennessee Required Employer Workers' Comp Posting Notice (poster)_Spanish
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- Last Updated
- 2023-07-26
Tennessee Wage Statement Form
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- Last Updated
- 2023-07-26
TN Sample Drug and Alcohol Drug Policy
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- Last Updated
- 2023-07-26
Workers' Comp Coverage Form - All States
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- Last Updated
- 2023-07-26