Workers' Compensation Toolkit

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This kit is provided to new workers' compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms.

PANEL of PHYSICIAN RULE (Important Update) As of May 31, 2018, a panel of physicians must be provided to an employee no later than three (3) business days after the employer receives notices of a workplace injury. Failure to comply with the rule may result in a civil penalty and the inability to enforce a panel of physicians offer.

Tennessee Contact Information:

Nationwide Insurance - East Office*
PO Box 182079
Columbus, OH 43218-2079
Fax: (800) 363-8904

Harleysville Insurance
PO Box 244
Harleysville, PA 19438-0244
(888) 595-9876
Fax: (800) 441-4118

Agribusiness Mailing Address for Claims Related Mail
P O BOX 182066
Columbus, OH 43218-2066
Phone: (800) 228-6700
Fax: (800) 842-1482

Below are a few additional tools to help you manage your workers' compensation claim:

Locate medical providers - Are you an employer or injured worker looking for doctors, hospitals or pharmacies? We can help you find local medical professionals.

First Fill program - The First Fill program allows one-time prescription processing before a workers' compensation claim is established, resulting in no out-of-pocket cost for the injured worker. Ask your claims representative for more details.

eBill submission for Medical Providers -

Nationwide Workers’ Compensation accepts eBill submission from medical providers in all states on all claims. Providers seeking eBill submission of medical bills may do so by contacting their own eBill clearinghouse, by registering with a clearinghouse of their choice, or by contacting


WorkCompEDI, Inc.
(800) 297-6909
Payor ID: CB151 (Nationwide, Allied, Harleysville)
Payor ID: 28223 (Nationwide Agribusiness)


NOTE: If you experience difficulty opening/accessing the PDF's using the links below:

Open to access the documents

Tennessee Compliance Information:

Posting Requirements
Reporting Of Claim By Employer
Penalties for Late Reporting
Physician Selection

Posters and Publications

POSTER - Tennessee Workers' Compensation Insurance Posting Notice Required

POSTER - Tennessee Workers' Compensation Insurance Posting Notice (Spanish) Required

POSTER - Drug Free Workplace Required

BROCHURE - A Beginner's Guide to Workers' Compensation - date of accident prior to 7/1/2014

BROCHURE - A Beginner's Guide to Workers' Compensation - date of accident on or after 7/1/2014 Required

Notice of Reported Injury Required

Notice of Employer Rights and Responsibilities in a Workers’ Compensation Claim Required


First Report of Work Injury ( C-20 )

Wage Statement

Agreement Between Employer / Employee Choice of Physician

Agreement Between Employer / Employee Choice of Physician (Spanish)

Governmental Entities Agreement Between Employer / Employee Choice of Physician Form (available via e-mail request only)

Please Note: The information on this site is maintained by a third-party, Nationwide does NOT warrant or represent that the information will be error-free. Your use of the site is on an as-is basis, at your sole discretion and risk. The site is for informational purposes, and nothing included in the site shall replace the need for qualified legal counsel. We recommend that you consult with legal counsel, agents, or risk managers regarding workers' compensation obligations.

This service uses a proprietary system to pre-fill certain claims office and insurance company data on some forms. This may prompt a request by your Adobe Reader program to "trust" the source of the files. Please designate this as a trusted source in order for that information to be pre-filled for you.

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