Additional Forms

(1) Any corporate officer who personally elects to be exempted from the Workers’ Compensation Law shall file written notice of such election with the employer with a copy provided to the Bureau in accordance with the provisions of T.C.A. § 50-6-104 on Form I-6. Any corporate officer who had previously filed a Form I-6 and elects to revoke that decision and wishes to be covered by the Workers’ Compensation Law shall immediately notify the employer and the Bureau on Form I-7. (2) Employers that are exempt from the Workers’ Compensation Law and elect to be covered shall indicate that election by properly securing workers’ compensation coverage. Such employers that subsequently wish to withdraw their acceptance of the provisions of the Workers’ Compensation Law shall notify each of their employees affected by the withdrawal of the acceptance via certified mailing to the last known address of each affected employee at least ten (10) working days prior to canceling or not renewing the coverage. Such withdrawal shall not be effective until this notification has occurred. (3) An employee or prospective employee who wishes to waive compensation for claims arising out of aggravation or repetition of the conditions of heart disease, heart attack, or coronary failure or occlusion or who wishes to waive receipt of compensation for any aggravation of a specific identified occupational disease, pursuant to the provisions of the Workers’ Compensation Law, or who are diagnosed as epileptics and who elect, pursuant to the provisions of the Workers’ Compensation Law, not to be subject to the Workers’ Compensation Law for injuries resulting because of epilepsy shall request the approval of the Bureau of the waiver on Form I-10, 11, 12. Requests for the revocation of a previously approved Form I-10, 11, 12 shall be furnished to the Bureau on Form I-13. (4) Common carriers who wish to provide workers’ compensation insurance coverage under the Tennessee Workers’ Compensation Law to a leased operator and/or a leased owner/operator shall notify the Bureau on Form I-14 & 16. Any such previously filed Form I-14 may be terminated by the leased operator, leased owner/operator, or common carrier by providing written notice of such termination to the Bureau and to all other parties on Form I-16. (5) General contractors who wish to provide workers’ compensation insurance coverage under the Workers’ Compensation Law to an individual subcontractor shall notify the Bureau on Form I-15. Such previously filed Form I-15 may be terminated by the subcontractor or general contractor by providing written notice of such termination to the Bureau on Form I-17. GENERAL RULES OF THE WORKERS’ COMPENSATION PROGRAM CHAPTER 0800-02-01