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Tennessee Compliance



Physician Selection

For injuries on or after July 1, 2014   50-6-204

Upon the report of a workplace injury, an employer should provide the employee, the C-42 Agreement Between Employer / Employee Choice Of Physician

If the date of injury is on or after July 1, 2014, the form should include:

  • At least three independent physicians;
  • Not practicing at the same location; and
  • Within the community of the injured employee.  If three physicians cannot be located within the community of the injured employee, the employer may create a list of three independent physicians within a 100-mile radius of the community of the injured employee.

Effective until 7/1/14  50-6-204

If the date of injury is prior to July 1, 2014, the form should include:

  • At least three physicians;
  • Not associated together in practice together; and
  • Within the community of the injured employee, if available.  If there are not enough physicians available within the community of the injured worker, names of physicians from outside the community should be added.
  • If the injury involves the employee’s back, the number of named physicians listed must be expanded to at least four (4) names, one of whom must be a chiropractor. 

The employee has the right to choose a physician from the list.  The physician selected by the employee becomes the “authorized treating physician”.  The employee is required to accept treatment from the authorized treating physician and should not seek treatment from any other medical provider unless the authorized treating physician makes a referral.  The C-42 form must indicate the name of the physician chosen by the injured employee, be signed by the employee with a copy given to the employee, and the original kept on file with the employer.  Employees may also be asked to sign a C-31 Medical Waiver and Consent Form. to allow the employer and/or insurance adjuster to receive copies of medical notes and reports from the chosen physician.