Memorandum No. 1999-18

Warning!

It seems that JavaScript is not working in your browser. It could be because it is not supported, or that JavaScript is intentionally disabled. Some of the features on CT.gov will not function properly with out javascript enabled.

Settings Menu

Language
High Contrast
High Contrast Mode On or Off switch
Font Size
Disclaimer

A period of extremely frigid temperatures is forecast to impact Connecticut between the afternoon of Saturday, December 21, through Tuesday, December 24. Governor Lamont is activating the state's severe cold weather protocol during this period. To locate a shelter or warming center in Connecticut, call 2-1-1 or visit 211ct.org.

MEMORANDUM NO. 1999-18

VOLUNTARY AGREEMENT FORMS

TO:	Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, Medical Practitioners, and Advisory Board Members
FROM:	John A. Mastropietro, Chairman
DATE:	November 17, 1999
RE:	VOLUNTARY AGREEMENT FORMS

The Workers' Compensation Commission will accept the following voluntary agreement forms:

GREEN for all injuries up to and including September 30, 1991
ORANGE for all injuries between October 1, 1991 and June 30, 1993*
GOLDENROD for all injuries between July 1, 1993 and June 30, 1995*
BLUE for all injuries occurring on or after July 1, 1995

* Please note that Memorandum No. 1999-13, dated July 22, 1999, incorrectly omitted the orange form.

[NOTE: This form is available from our website or any district office.]