Memorandum No. 1998-06

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MEMORANDUM NO. 1998-06

Form 43

TO:	Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, Medical Practitioners, and Advisory Board Members
FROM:	Jesse M. Frankl, Chairman
DATE:	May 6, 1998
RE:	Form 43

Attached please find a revised copy of the Form 43. We have made changes requiring that three (3) copies of the notice be made. One is to be filed with the Workers’ Compensation Commission, the second to be served on the employee, and the third to be served on the medical provider or providers.

[NOTE: Copies of the revised Form 43 may be obtained from the Commission's District Offices, Education Services and here on our Web Site.]

State of Connecticut Workers' Compensation Commission

MEMORANDUM NO. 1998-06

Form 43