1099-G Tax Information for Unemployment Will Be Available by January 31.

Electronic Data Interchange (EDI)

Electronic Data Interchange (EDI) affords insurers and the Bureau of Workers' Compensation a method of exchanging necessary workers’ compensation claims information electronically and thereby avoiding multiple entries of data into computer systems. EDI is fast, accurate, reliable and cost effective. Insurers sign a trading partner agreement with the Bureau. This agreement includes testing the reporting system to determine if the transmission mechanism is acceptable. Upon completion of testing, the Bureau will notify the trading partner of approval to submit production data.

Which Forms are Required to be Submitted via EDI?

The Tennessee Workers’ Compensation Act and Rules of the Bureau require adjusters and third-party administrators (TPA’s) to file claims forms throughout the life of a claim.

 

Below is a listing of the Coverage forms of the Bureau that are required to be submitted electronically.

I-1

Certificate of Insurer

 

I-2

Notice of Cancelation, Reinstatement or Endorsement

 

 

The Forms I-1 & I-2 are required to be electronically filed by the employer’s insurance carrier when coverage is obtained from a licensed Workers’ Compensation Carrier authorized to write workers’ compensation policies in the State of Tennessee.  It must be filed within 30 days from procurement or renewal of suitable workers’ compensation insurance.  Any errors submitted on the filings of Form I-1 or Form I-2 must be corrected by the insurance carrier that submitted the information.

Below is a listing of the Claims forms of the Bureau that are required to be submitted electronically.

C-20

First Report of Work Injury

FROI MTC 00

C-22

Notice of First Payment

SROI MTC IP = First Payment

SROI MTC RB = Reinstatement

C-23

Notice of Denial

FROI MTC 04 = Denial, no payments have been made

SROI MTC 04 = Denial, payments have been made

Note:  Denials may be filed via EDI but MUST be filed on form C23 as well.

C-26

Notice of Change/Termination of Benefits

SROI MTC CA = Change Benefits

SROI MTC S1/S9 = Termination of Benefit

C-29*

Final Report of Payment

Notice of Final Payment SROI MTC FN

 

* The C-29/FN must be filed on all claims that do not result in permanency (settlement). All cases that result in permanency will require the filing of the SD1. The SD1 must be filed with the court or with the Bureau at the time of settlement.

Form C-29 must be filed on all claims that do not result in permanency (settlement). All cases that result in permanency will require the filing of the SD-1. The SD-1 is a paper form and must be filed with the court or with the Bureau at the time of settlement.

Which forms are required to be submitted on paper?

Forms that must be filed on paper with the Bureau.

C-23*

Notice of Denial

FR0I MTC 04, SR0I MTC 04, SR0I 4P

SD-1

Statistical Data Form

 

* The C-23 must be filed  on paper and may also be filed via EDI.

SD-1 Statistical Data Form

The Bureau has developed the SD-1 Form for collecting data relevant to assessing the overall effectiveness of the Tennessee workers' compensation system by capturing information concerning the provision of medical treatment, disability benefits, and length of disability. 

Form SD-1

When are SD-1 Forms required?

The Tennessee Workers’ Compensation Act requires the SD-1 to be filed for every claim that is concluded by settlement, whether approved by the court or department.  

  • The form is required to be filed with the Bureau prior to being approved by the Bureau.  

  • The form is required to be filed with the court clerk at the same time that the final order is submitted for settlements approved by a court or by trial.

    • In cases involving a workers' compensation settlement that is approved by a court, the completed form shall be filed at the same time as the order approving the settlement is filed and shall be filed with the clerk of the court in which the settlement order is filed.

    • In cases involving a workers' compensation case that is resolved by trial, the completed form shall be filed at the same time as the final order is submitted to the trial court for approval and shall be filed with the clerk of the court in which the matter was tried.

      • A clerk of the court shall not accept a settlement order for filing, unless it is accompanied by a fully completed statistical data form.

  • Neither the settlement order nor the trial order is considered to be final until the form is fully completed and filed with the appropriate clerk.

When are SD-1 Forms not required?
  • SD-1s are not required for reconsideration claims or for claims that only involve the closing of future meds.  

  • A form is not required to be filed in cases that involve reconsideration of a prior settlement or trial judgment order for which a form was filed at the time of submission of the prior order.

  • A form is not required to be filed if the only issue resolved by an order is the closing of future medical benefits that remained open pursuant to a prior order for which a form was filed at the time of submission of the prior order.

Who is responsible for filing the SD-1 Form? 
It is the responsibility of the employer or the employer's agent to complete and file the SD-1 form.  The employee and any agent of the employee are required to cooperate with the employer in completing this form.

EDI Error Message Meanings

If an EDI filing is not correct when it is submitted, it will be rejected. An error message will provide the carrier the reason for the rejection. EDI files that are rejected due to an error by the carrier are not considered to have been actually filed and may put the carrier at risk for penalty if the error is not corrected timely.  If you receive an error message after submitting a file via EDI, we’ve created a guide to help resolve common errors. The EDI Error Message Meanings contains descriptions of the error codes that are received in the Acknowledgement File that is rejected when an EDI Claims file has been received by the Bureau of Workers’ Compensation. View our remedy guide for details.

Learn more

The International Association of Industrial Accident Boards and Commissions (IAIABC) offers education on reporting workers' compensation data electronically.


Need More Help?

If you have additional questions, please call 615-532-1313 or 800-332-2667 or contact us by email at wc.edi@tn.gov. Find out about other available assistance programs by contacting an ombudsman.