PDF
Word
Form LB-0290S (I-10; I-11; I-12) Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions - Tennessee (English / Spanish)
What Is Form LB-0290S (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 the Form LB-0290S?A: The Form LB-0290S is the Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions in Tennessee.
Q: What does the form waive?A: The form waives workers' compensation benefits for specific medical conditions.
Q: What is the purpose of the form?A: The form is used to waive workers' compensation benefits for certain medical conditions in Tennessee.
Q: Is the form available in English and Spanish?A: Yes, the form is available in both English and Spanish.
Q: Who can use the form?A: The form can be used by individuals who wish to waive workers' compensation benefits for specific medical conditions in Tennessee.
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;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form LB-0290S (I-10; I-11; I-12) by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Tennessee Department of Labor and Workforce Development.
Download Form LB-0290S (I-10; I-11; I-12) Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions - Tennessee (English / Spanish)
1
2
