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C-41/Wage Statement changes for workers' compensation claims go into effect 7/1/07

Beginning July 1, 2007, the TDOL will no longer accept printouts, adding machine tapes or other kinds of attachments to form C-41. All wage information must be included on the State authorized form, which must also include the employee's name, Social Security number, State File number, insurer claim number and date of injury. Incomplete forms will be rejected by the TDOL and returned to the preparer. The penalty for failing to timely file a wage statement can result in an employer's liability for compensation payments being assessed against the current highest wage level, currently set at $682.00 per week for permanent benefits and $750.00 per week for temporary benefits.

C-41/Wage Statements must be filed with the TDOL Workers' Compensation Division within 30 calendar days of a notice of injury if

(1) the injured worker sustains a work related injury that results in the employee not returning to work within 7 days of the injury;

(2) the injury results in death; or

(3) the injury results in permanent impairment.

The form available through the state website can be used, but the information added to the form cannot be saved for the employer's or insurers records. Employers may choose to replicate the form through software that would allow the report to be computer generated, but should first obtain approval by the WC Division by sending a sample to Bonnie.Hudgens@state.tn.us or telefaxing a sample to (615) 532-1942.

The most recent version of the C-41 is available HERE


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