Workers Compensation Forms for all 50 States | State Forms and Information | Claimwire: Workers' Compensation Resource for Forms and Information

Register Login

Connecticut Forms

58 State Forms found

name	number	revision	print or send online
STIPULATION AND WHAT IT MEANS	No Form Number	Rev. 10-01-2021
STIPULATION APPROVAL PROCEDURE	No Form Number	Rev. 10-01-2021
STIPULATION QUESTIONNAIRE	No Form Number	Rev. 8-25-2022
STIPULATION TO DATE AND WHAT IT MEANS	No Form Number	August 2022
Voluntary Agreement	VA	Rev. 6-14-2024
Information Packet	No Form Number	Rev. 06-01-2022
EMPLOYER MEDICAL CARE PLANS INFORMATION PACKET	No Form Number	Rev. 10-01-2021
Notice of Claim for Compensation	MPTN	Revised 2/8/24
Authorization for Release of Medical Records	MPTN	Revised 11/5/14
Notice to Chief Commissioner and Employee of Intention to Contest Liability to Pay Compensation	MPTN	Revised 11/5/14
Physician's Permanent Impairment Evaluation	MPTN	Revised 11/5/14
Voluntary Agreement	MPTN	Revised 11/5/14
Filing Status & Exemption Form	MPTN	Revised 2/8/24
STATEMENT OF CLAIM FOR WAGES - ONLINE ONLY	WCA-1	(Rev 6/16)
Election of Workers' Compensation Coverage for Certain Employees under the Workers' Compensation Act OR Revocation of Previous Election of Such Coverage	6B-6B-1-75 Directions	Rev. 12-15-2022

1
2
3
4

Disclaimer: These forms may not be the most recent version. Connecticut may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.

Loading results ...

Origami Risk

1379 N 1075 W, Suite 226,
Farmington, UT 84025
312.546.6515
info@origamirisk.com

© 2026 Origami Risk. All Rights Reserved.