Form C-40 (LB-0381) Request for Mediation (For Injuries Prior to 7 / 1 / 2014 Only) - Tennessee

Form C-40 (LB-0381) Request for Mediation (For Injuries Prior to 7 / 1 / 2014 Only) - Tennessee

What Is Form C-40 (LB-0381)?

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 C-40 (LB-0381)?
A: Form C-40 (LB-0381) is a form used in Tennessee for requesting mediation for injuries that occurred before July 1, 2014 only.

Q: Who can use Form C-40 (LB-0381)?
A: Anyone who has sustained injuries prior to July 1, 2014 in Tennessee can use this form to request mediation.

Q: What is the purpose of Form C-40 (LB-0381)?
A: The purpose of this form is to request mediation for injuries that occurred before July 1, 2014 in Tennessee.

Q: When should I use Form C-40 (LB-0381)?
A: You should use this form if you want to request mediation for injuries that occurred prior to July 1, 2014 in Tennessee.

Q: Can I use Form C-40 (LB-0381) for injuries after July 1, 2014?
A: No, Form C-40 (LB-0381) can only be used for injuries that occurred prior to July 1, 2014 in Tennessee.

Q: What do I need to include in Form C-40 (LB-0381)?
A: You will need to include information about your injuries, the date they occurred, and other relevant details in Form C-40 (LB-0381).

Q: Is there a fee for submitting Form C-40 (LB-0381)?
A: No, there is no fee for submitting Form C-40 (LB-0381) in Tennessee.

Q: What happens after I submit Form C-40 (LB-0381)?
A: After you submit Form C-40 (LB-0381), your request for mediation will be reviewed and you will be notified about the next steps.

Q: What if I have injuries after July 1, 2014?
A: If you have injuries that occurred on or after July 1, 2014, you will need to use a different form for requesting mediation in Tennessee.

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Form Details:

  • Released on August 1, 2021;
  • 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 fillable version of Form C-40 (LB-0381) by clicking the link below or browse more documents and templates provided by the Tennessee Department of Labor and Workforce Development.

Download Form C-40 (LB-0381) Request for Mediation (For Injuries Prior to 7 / 1 / 2014 Only) - Tennessee

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