(a)

medical exam

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Terms Used In Tennessee Code 50-6-904

  • Board: means the state board for licensing contractors. See Tennessee Code 50-6-901
  • Employer: includes any individual, firm, association or corporation, the receiver or trustee of the individual, firm, association or corporation, or the legal representative of a deceased employer, using the services of not less than five (5) persons for pay, except as provided in §. See Tennessee Code 50-6-102
  • Month: means a calendar month. See Tennessee Code 1-3-105
  • Partner: means any person who is a member of an association that is formed by two (2) or more persons to carry on as co-owners of a business or other undertaking for profit and such association is active and in good standing as reflected in the records of the secretary of state. See Tennessee Code 50-6-901
  • Person: means only a natural person and does not include a business entity. See Tennessee Code 50-6-901
  • provider: means any person or entity engaged in the construction industry. See Tennessee Code 50-6-901
  • Registry: means the construction services provider workers' compensation exemption registry established pursuant to this part and maintained by the bureau of workers' compensation. See Tennessee Code 50-6-901
  • Sole proprietor: means one (1) person who owns a form of business in which that person owns all the assets of such business. See Tennessee Code 50-6-901
(1)

(A) Any construction services provider applying for an exemption from § 50-6-902(a) who has not been issued a license by the board shall obtain a construction services provider registration from the bureau of workers’ compensation at the same time such provider applies for such exemption.
(B) The bureau of workers’ compensation is authorized and directed to issue the construction services provider registration on behalf of the board. The bureau of workers’ compensation shall issue an identification number assigned to the provider’s registration. The board shall obtain such identification number and other identifying information from the bureau of workers’ compensation.
(2) Any construction services provider requesting exemption from § 50-6-902(a) shall submit an application along with the required filing fees to the bureau of workers’ compensation. The applicant shall provide sufficient documentation for the bureau of workers’ compensation to assure that such applicant meets the requirements set out in § 50-6-902, including, but not limited to:

(A) The applicant’s full legal name;
(B) The applicant’s birth month;
(C) The applicant’s physical address; provided, that the applicant may provide a post office box number for purposes of receiving mail from the bureau of workers’ compensation, as long as the applicant also provides a physical address for the business entity for which the applicant is an officer, member, partner or owner;
(D) A telephone number through which the applicant can be reached;
(E) The name of the business entity through which the applicant is seeking the workers’ compensation exemption;
(F) The federal employer identification number issued to the applicant if a sole proprietor or a business entity for which the applicant is an officer, member, partner or owner seeking exemption pursuant to § 50-6-903, and the last four (4) digits of the applicant’s social security number; provided, however, that if an applicant seeks an exemption pursuant to § 50-6-903(c), the applicant may provide the last four (4) digits of a control number issued to the applicant by the social security administration instead of the last four (4) digits of the applicant’s social security number;
(G) The contractor license number issued by the board to such applicant or the construction services provider registration number issued by the bureau of workers’ compensation to such applicant;
(H) A current license issued by a local government pursuant to § 67-4-723, if the business entity through which the applicant is seeking the workers’ compensation exemption is required by law to obtain such license;
(I) Any other information the bureau of workers’ compensation deems necessary to identify such applicant; and
(J) If the construction services provider is applying for an exemption pursuant to the criteria set out in § 50-6-903(c), the provider shall submit a copy of an approved Internal Revenue Service Form 4029 or similar form used by the internal revenue service, to show that an application for exemption from social security and medicare taxes and waiver of benefits has been approved for such provider applying for an exemption pursuant to this part.
(3) The bureau of workers’ compensation shall verify that the applicant meets the qualifications set out in § 50-6-902 upon a review of its records and the records provided by such applicant.
(4) If the bureau of workers’ compensation is unable for any reason to verify that the applicant meets the qualifications set forth in this part for inclusion on the exemption registry, or if the applicant, or any person completing or submitting the application on the applicant’s behalf, misstates any material information on the application, then the applicant is not eligible for exemption under this part, and any exemption previously granted to the applicant is revoked.
(b) The application shall be on a form designed by the bureau of workers’ compensation and shall contain a statement that specifies the eligibility requirements for exemption, contain an attestation that the applicant meets the eligibility requirements and contain a statement that a false statement on such application is subject to the penalties of perjury set out in § 39-16-702.
(c) The application, as well as a process for submission of such application, shall be available through the bureau of workers’ compensation’s website or by contacting the bureau of workers’ compensation’s office in person or by mail.
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