C-42Employee's Choice of Physician / Medical Panel
Issued by Tennessee Bureau of Workers' Compensation
Employee's Choice of Physician / Medical Panel (C-42) — equivalent or narrative-based clinician report used by the state workers’ comp agency.
Key facts
Clinicians fill out · Submitted to regulator · Employers file
- When it’s used
- Tennessee does not prescribe a specific physician work-status reporting form. Medical reports are required for claim proceedings and disputes. Treating physician provides narrative medical documentation of treatment, work restrictions, and return-to-work status.
- Who fills it out
- Treating physician of record. Tennessee allows NPs and PAs to treat workers' compensation patients within their scope of practice. The authorized treating physician from the employer's medical panel is responsible for medical management.
- Who signs
- Tennessee allows NPs and PAs to treat workers' compensation patients within their scope of practice. The authorized treating physician from the employer's medical panel is responsible for medical management.
- Where it goes
- C-42 (Medical Panel): delivered within 3 business days of injury report. Physician medical reports: as needed for claim proceedings, when work status changes, and for settlement conferences. No fixed periodic physician reporting interval.
- Electronic submission
- Supported — Tennessee Bureau of Workers' Compensation provides electronic filing through its online portal. BWC electronic filing system for claim documents.
- Narrative substitution
- Tennessee uses narrative-based physician reporting rather than a standardized work-status form. Treating physician provides medical documentation including work restrictions and return-to-work assessments in narrative format.
Sources & citations
Every form we publish traces to an authoritative government source. We cite the issuing agency, the underlying statute, and the operative regulation so you can verify scope and signing authority for your own records.
Issuing agency
TN Bureau of Workers' Comp
Statute
TCA §50-6 (Workers' Comp)
Form library
BWC Forms Page
Attribution. Researched and maintained in collaboration with the wc-hub workers’ compensation reporting project (TN). BlueHive does not modify the underlying government PDF; the file you download is the agency original.
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