Memorandum No. 2023-08

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. 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.

State of Connecticut Workers' Compensation Commission

MEMORANDUM NO. 2023-08

Form 42 Revised