In observance of Thanksgiving, WCC offices will be closed on Thursday, November 24, 2022.

Employer Forms

 

link opens in new browser tab    Form 43

PDF File:  1 page; Last revised October 1, 2021
 

Notice to Administrative Law Judge and Employee of Intention to Contest Employee's Right to Compensation Benefits

The Form 43 is to be completed by the respondent (employer/workers’ compensation insurance carrier) to notify the Administrative Law Judge, the claimant (employee/decedent), and all parties to the claim of its intention to deny the compensability of all or part of the claimant’s claim to workers’ compensation benefits.

 


 

link opens in new browser tab    Form 98

PDF File:  1 page; Last revised April 29, 2008
 

Mandatory Notice to Dependents by Employer or Insurer to be filed upon Death of Employee who is receiving Weekly Disability Benefits

The Form 98 is to be completed by an employer or its workers’ compensation insurance carrier to notify surviving dependents of a deceased employee of their possible eligibility for dependents’ benefits under the Workers’ Compensation Act.

 


 

link opens in new browser tab    Employer's First Report of Occupational Injury or Illness

PDF File:  1 page; Last revised July 13, 2009
 

Employer's First Report of Occupational Injury or Illness

The Employer's First Report of Occupational Injury or Illness form is to be completed by an employer or its workers' compensation insurance carrier to notify the Workers' Compensation Commission of occupational injuries or illnesses that result in incapacity for one day or more.

Unlike many Commission forms, the Employer's First Report of Occupational Injury or Illness form must be sent directly to the Commission Chairman's Office in Hartford.

[NOTE: For more information, see Section 31-316 of the Workers' Compensation Act.]

 


 

link opens in new browser tab    Notice to Employees

PDF File:  1 page; Last revised October 1, 2021
 

Notice to Employees

The Notice to Employees must be completed and posted in a conspicuous place in each place of employment in Connecticut.

If an employer chooses to designate a location for employee claims pursuant to Public Act 17-141, this notice must be posted where other posters required by law are displayed in the workplace.

[NOTE: For complete information regarding an employer-designated location for employee claims, refer to Memorandum No. 2017-08]

 


 

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The Workers' Compensation Commission's recommendation of Adobe's free Adobe Acrobat Reader software application is based solely on technical considerations inherent in the PDF files this agency produces, and does not constitute an endorsement of Adobe Software as a company or of its commercially-available products. There are a multitude of free and commercial software applications offered by various software makers that are capable of opening and displaying our PDF documents, but only the Adobe Acrobat Reader application makes full and accurate use of the capabilities we have built into our documents; the agency has found over a period of many years that the Adobe Acrobat Reader provides the best, most trouble-free experience using this Commission's PDF files.