Where can attorneys find forms and request claim file documents and First Report of Injuries (FRIs)?
Attorneys can find important forms here.
The Connecticut Workers’ Compensation Commission recommends you use these forms to make sure your paperwork is:
- Up to date
- Correct
- Follow the State’s laws
Most forms are PDFs you can fill out online, print, and save. Others, you can send electronically.
Learn which forms to send with our Electronic Form Submission Service
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30C: Notice of Claim for Compensation (PDF) - For when your client wants to file a workers’ compensation claim.
30D: Dependent's Notice of Claim for Compensation (PDF) - To file for workers’ comp death benefits according to Section 31-306 of the Workers' Compensation Act.
Authorization for Release of Medical Records (PDF) - To ask for medical records for a workers’ comp claim.
Hearing Cancellation Request (PDF) - Ask to cancel a meeting about a workers’ compensation claim.
Hearing Request (PDF) - Ask for an Informal, Pre-Formal, Formal, Stipulation Approval, or Disfigurement/Scar hearing. It will happen before an administrative law judge in one of the Commission's eight district offices.
Indemnity Only Stipulation and What it Means (PDF) - For the claimant to sign. It is a full, final settlement for the case.
Notice of Appearance (PDF) - Tells WCC who will represent whom before the Commission.
Petition for Review (PDF) - File an appeal with the WCC Compensation Review Board (CRB).
Stipulation Approval Procedure (PDF) - An information document that explains the steps to follow before and during a Stipulation Hearing.
Stipulation and What It Means (English) (PDF) - Says the claimant agrees to end their case for good and must be signed before asking for a Stipulation Hearing.
La Estipulacion y lo que Significa (Español) (PDF).
Stipulation To Date and What it Means (PDF) - To settle benefit claims up to the date of approval. The claimant must sign it before asking for a Stipulation Hearing.
Stipulation Questionnaire (PDF) - Asks important questions and must be filled out before asking for a Stipulation Hearing.
WCR-1: Rehabilitation Request (PDF) - For the injured worker to ask for help with job training or recovery.
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