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Tools & Documents for Policyholders

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ACH Form - One Time Draft

Type
PDF
Last Updated
2023-07-26

First Fill Program Pharmacy Card

Type
DOC
Last Updated
2023-07-26

Online Self-Reporting ACH Form

Type
PDF
Last Updated
2024-05-09

Payment Portal FAQ Document

Type
PDF
Last Updated
2024-01-12

Prompt Return to Work Information Sheet - Policyholder

Prompt Return to Work (PRTW) is a team approach to getting an injured worker back to work as soon as possible. The team consists of the worker’s employer or supervisor, vocational rehabilitation counselor, LUBA’s claims adjuster, injured worker and the assigned physician.

Type
PDF
Last Updated
2023-07-26

Prompt Return-to-Work Program Booklet

At LUBA Workers’ Comp, our intent in regard to Prompt Return to Work (PRTW) is to create a situation which benefits all parties involved. A PRTW Program is an effective tool in helping us create such a situation. This program is designed to help facilitate the return of an injured worker to the workplace.

Type
PDF
Last Updated
2023-07-26

Tennessee First Report of Injury

Type
PDF
Last Updated
2023-07-26

Tennessee Wage Statement Form

Type
PDF
Last Updated
2023-07-26

TN Sample Drug and Alcohol Drug Policy

Type
PDF
Last Updated
2023-07-26