State of Connecticut Workers' Compensation Commission

The Seventh District Office located at 111 High Ridge Road in Stamford will have limited public access on Monday, May 19, 2025, and Tuesday, May 20, 2025, due to building maintenance.

MEMORANDUM NO. 2023-08

Form 42 Revised

 

TO: WCC Administrative Law Judges, District Administrators, Claimants, Self-Insureds, Insurance Carriers, Attorneys, Unions, and Advisory Board Members
FROM: Stephen M. Morelli, Chairperson
DATE: November 3, 2023
RE: Form 42 Revised

 

Form 42 has been revised to include a check box indicating "Check, if total impairment rating, inclusive of any prior ratings, for body part." The box should be checked when the rating is for the total impairment inclusive of any previous ratings for the body part. The box should not be checked when the rating is in addition to a previous rating. The revised form can be obtained from our Online Forms page.