Workers' Compensation




Lindsey Jackson, CWCP

Workers' Compensation Coordinator




Workers' Compensation Forms

  • First Report of Injury - (C-20) to be completed by the employee supervisor at time of injury, and submitted to Risk Management office immediately following injury.
  • Panel of Physicians Request Form - (C-42G) to be submitted to the Risk Management office immediately following injury.  The employee must document his/her selection of physician by signature and date. The supervisor provides a copy to the injured employee.
  • Medical Release Form- (C-31)to be signed by employee at the time of injury and submitted to the Risk Management office.

Frequently Asked Questions

Q: What should an employee do if he/she is hurt after hours?

A: Go to the East TN Medical Group Care Today Clinic or Blount Memorial Hospital ER.

Q: Can an employee be terminated for reporting a work related injury?

A: No.

Q: Are prescriptions covered?

A: Yes.

Q: Can an employee use a pharmacy of his/her choice?

A: Yes. Always tell the pharmacy that you are employed by Blount County Government and that this is a workers' comp. issue.  If an employee pays for a prescription, turn in receipts, and he/she will be reimbursed.

Q: Can an employee be reimbursed for the mileage to/from a medical appointment?

A: Yes.  The employee is reimbursed for travel beyond a 15 mile radius, or a 30 mile round trip, of home or work.  The current mileage rate is based on the current mileage allowance for state employees.  The current state travel regulations can be found at http://state.tn.us/finance/act/travel.html

Q: Can an employee go to his/her doctor of choice?

A: The employee should choose from the Panel of Physicians (C-42G) for workers' compensation to pay; unless otherwise approved by Risk Management.

Q: Can employees change doctors after choosing from the Panel?

A: Yes. Risk Management will provide the employee with an alternate Panel of Physicians from which the employee can make a selection.

Q: What should an employee do if he/she receives a medical bill?

A: Contact Lindsey Jackson (273-5771)

Q: When do workers' compensation benefits end?

A: When an employee returns to work w/o restrictions.


Workers' Compensation for Employees

If you are injured of the job:

  • Notify Supervisor
  • Ensure First Report of Injury (Form C-20) is completed
  • If medical attention is desired, select a physician from the Panel of Physicians (Form C-42G)
  • Any questions or concerns, call Risk Management at (865) 273-5770