Form LB-0030 (I-10; I-11; I-12) Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions - Tennessee

Form LB-0030 (I-10; I-11; I-12) Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions - Tennessee

What Is Form LB-0030 (I-10; I-11; I-12)?

This is a legal form that was released by the Tennessee Department of Labor and Workforce Development - a government authority operating within Tennessee. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form LB-0030?
A: Form LB-0030 is a Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions in Tennessee.

Q: What does Form LB-0030 waive?
A: Form LB-0030 waives workers' compensation benefits for specific medical conditions.

Q: Who needs to fill out Form LB-0030?
A: Employees in Tennessee who wish to waive their workers' compensation benefits for specific medical conditions need to fill out Form LB-0030.

Q: What are the specific medical conditions covered by Form LB-0030?
A: The specific medical conditions covered by Form LB-0030 are listed in the form itself.

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Form Details:

  • Released on November 1, 2015;
  • The latest edition provided by the Tennessee Department of Labor and Workforce Development;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form LB-0030 (I-10; I-11; I-12) by clicking the link below or browse more documents and templates provided by the Tennessee Department of Labor and Workforce Development.

Download Form LB-0030 (I-10; I-11; I-12) Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions - Tennessee

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  • Form LB-0030 (I-10; I-11; I-12) Notice of Waiver of Workers Compensation Benefits for Specific Medical Conditions - Tennessee, Page 1
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