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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.
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.
Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers' compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.
A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.
A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.
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State Resources for Connecticut
Connecticut Insurance Department
P.O. Box 816 Hartford, CT 06142-0816800-203-3447 http://www.ct.gov/cid/site/default.asp
Connecticut Workers' Compensation Commission
Capitol Place21 Oak Street, Fourth FloorHartford, Connecticut 06106860-493-1500 CT Insurance Dept
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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