Connecticut Workers Comp Forms

Find Connecticut workers compensation forms and helpful coverage guides.

At Workers Compensation Shop.com we attempt to offer free access to Connecticut's workers' compensation forms, applications and guides. We strive to keep our library up to date with the latest versions of every form you may need.

As with all the information we provide, please verify the accuracy of this information with the Connecticut Workers' Compensation Commission.

If you have questions about a workers comp form feel free to contact a specialist at T888-611-7467. We want to be your source for workers compensation information, rates and quotes in Connecticut.

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Connecticut Workers Compensation Insurance Forms

CT Acord 130 Workers' Compensation Application.

The standard Acord 130 application form for workers comp coverage in Connecticut.

Connecticut First Report of Injury Form.

CT First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.

CT Workers Comp Notice to Employees

This form is to display contact information for the workers' compensation insurance carrier and the State of Connecticut Workers' Compensation Commission office.

Connecticut notice of Claim for Compensation.

Complete this form if you are seeking coverage election by an employee who is an officer of a corporation, manager of an LLC, or member of a multiple-member LLC. coverage.

CT Affidavit of Exemption for Work Comp Insurance for Sole Proprietor.

Complete this form if you are a sole-proprietor or with no employees and would like to be exempt from coverage.

Connecticut LLC Rejection of Workmans Compensation Coverage.

This form allows selection of Coverage Election by Employee who is an Officer of a Corporation, Manager of an LLC, or Member of a Multiple-Member LLC for the state of Connecticut.

CT Affidavit of Exemption for Workers' Compensation Insurance for a Partnership.

Complete this form if you are a partnership or with no employees and would like to be exempt from coverage.

Connecticut District Map.

A map of the Connecticut districts for use in workers' compensation claims.

CT Notice to Reduce or Discontinue Payments.

Form for the reduction or discontinuation of Workers Compensation in Connecticut.

Connecticut Voluntary Agreement Form.

FEmployer/Respondents form for confirmation of claim information and verification of the validity of the claim.

CT Standard Wage Rate Determination for Certain Service Workers.

Form to request the standard wage rate for certain service professionals.

Connecticut Filing Status and Exemption From.

Form for verification of filing status and dependencies.

State Resources for Connecticut

Connecticut Insurance Department

P.O. Box 816
Hartford, CT 06142-0816
800-203-3447
http://www.ct.gov/cid/site/default.asp

Connecticut Workers' Compensation Commission

Capitol Place
21 Oak Street, Fourth Floor
Hartford, Connecticut 06106
860-493-1500
http://wcc.state.ct.us/

Workers compensation insurance is required by law for Connecticut employers.

Connecticut forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers compensation form your need for Connecticut.

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Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.

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