Employer Forms
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.
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.
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.]
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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