How to Complete a Tennessee Workers' Compensation Exemption Application

Why a Workers' Compensation Exemption Matters

In Tennessee, employers with fewer than 10 employees, or those whose payroll totals under $250,000, may qualify to file a Workers' Compensation Exemption Application. Exempting a business can reduce insurance costs, but the exemption is not automatic. Employers must demonstrate that they meet statutory criteria and that workers have no claims against them in the past two years. The application is the gateway to that exemption.

Gathering Required Information

Before printing the form, collect:

• Employer's legal name, address, and contact details.
• Business type and industry classification.
• Number of employees and average weekly payroll.
• Records of any workers' compensation claims filed in the last two years.
• Proof of liability insurance, if applicable.

Printing the Official Form

Download the latest PDF from the Tennessee Department of Labor and Workforce Development website. Print on standard 8.5" x 11" paper. Use a black ink pen; typed entries are acceptable only if the form allows it. Keep a copy for your records before submitting.

Filling Out the Application

Section 1 – Employer Details

Enter the company's legal name, physical address, and phone number. Verify the EIN (Employer Identification Number) is correct; a mismatch can delay approval.

Section 2 – Business Classification

Choose the correct North American Industry Classification System (NAICS) code. If uncertain, use the Tennessee Department's online tool to find the appropriate code for your industry.

Section 3 – Employment and Payroll

Indicate the total number of employees and the average weekly payroll. If you have seasonal workers, calculate the average across the entire year.

Section 4 – Claim History

List any workers' compensation claims filed in the past two years. If none, write "None." Attach supporting documentation if claims are disputed.

Section 5 – Insurance Status

Check the box that best describes your current insurance situation. If you hold a valid policy, attach a copy of the certificate of insurance.

Section 6 – Declaration

Sign and date the declaration, affirming that all information is accurate to the best of your knowledge. A false statement can lead to penalties.

Submitting the Application

Mail the completed form to:

• Tennessee Department of Labor and Workforce Development
• Attn: Workers' Compensation Exemptions
• PO Box 2020, Nashville, TN 37202-2020

Alternatively, submit electronically via the Department's online portal if you have a registered account. Keep the receipt or confirmation number.

Processing Time and Follow‑Up

Processing typically takes 4–6 weeks. If the Department needs additional information, they will contact you by mail or email. Respond promptly to avoid delays.

Common Mistakes to Avoid

• Submitting incomplete employee counts.
• Failing to provide proof of no claims.
• Using a non‑standard font or color that obscures text.
• Missing the signature or date on the declaration.

What Happens After Approval

Once approved, you receive a written notice confirming exemption. You can then remove workers' compensation coverage from your policy, potentially saving up to 30% on premiums. Maintain records of the exemption notice for future audits.

Renewal and Re‑evaluation

Exemptions are valid for five years. Before expiration, review your employee count and payroll. If you exceed the thresholds, you must reapply for coverage or submit a new exemption application if you remain below limits.