1. (1) The appropriate resolution form must be submitted to the Bureau in all claims when they are resolved.

   1. (a) In matters concluded by settlement or resolved by trial, the Employer or the Employer’s agent must file a fully completed appropriate version of the Statistical Data Form contemporaneously with the filing of the final order or settlement.

      1. 1. To be considered fully complete, the form must contain all required data, as determined by the Bureau, and reflect information that is current as of the date the information is submitted to the court for approval, whether or not an appeal of the matter is anticipated or filed.
      2. 2. The Employee and any agent of the Employee must cooperate with the adjusting entities in completing the Statistical Data Form.
   2. (b) In matters not concluded by settlement or resolved by trial, adjusting entities must submit the required information via EDI within thirty (30) days following the final payment of compensation. The filing must include all compensation benefits paid on a claim, including all disability benefits, medical expenses (including but not limited to in- patient, out-patient, pharmacy, case management, therapy, and others), death benefits and funeral expenses, and legal costs.
2. (2) A fully completed appropriate version of the Statistical Data Form is also required for every worker’s compensation matter even if the only issue resolved is the closing of future medical benefits that had remained open pursuant to a prior order. This requirement applies even if a Statistical Data Form was filed at the time of submission of the prior order. The subsequent Statistical Data Form should reflect only the amount paid or being paid since the filing of the last Statistical Data Form.
3. (3) Pursuant to T.C.A. § 50-6-244, an order of the court is not final until the Statistical Data Form has been completed and filed with the appropriate clerk of the court or Bureau office.
4. (4) If the Administrator or the Administrator’s designee determines that an Employer or the Employer’s agent fails to fully complete or timely file the Statistical Data Form, the Bureau may assess a civil penalty against the offending party not to exceed one hundred dollars ($100) per violation. A party assessed a penalty by the Administrator pursuant to this subsection may appeal the penalty by requesting a contested case hearing pursuant to Rule 0800-02-13.

Authority: T.C.A. §§ 50-6-206 [Applicable to injuries occurring prior to July 1, 2014], 50-6-233, 50-6-244, and 50-6-419. Administrative History: Original rule filed December 15, 1997; effective February 28, 1998. Amendments filed May 4, 2018; effective August 2, 2018. Amendments filed April 29, 2021; effective July 28, 2021. Amendments filed August 12, 2025; effective November 10, 2025.