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Please TYPE or PRINT IN INK 6B-1 Rev. 7-15-2013 State of Connecticut Workers Compensation Commission Date filed with WCC Coverage Election by Employees who are Members of a Partnership DO NOT SEND THIS FORM TO A DISTRICT OFFICE Send to WORKERS COMPENSATION COMMISSION 21 OAK STREET 4th FLOOR HARTFORD CT 06106 IF YOU WISH TO RECEIVE A DATE-STAMPED COPY OF THIS FORM SEND 2 COPIES of each form Pursuant to C.

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The Connecticut Workers' Compensation Act states that an employer may not discharge or discriminate against an employee because they have filed a workers' compensation claim or are exercising their rights under the act.

The Form 6B is to be completed by an Officer of a Corporation or a Manager of a Limited Liability Company (LLC) who wishes to be excluded from workers' compensation insurance coverage.

For a total disability, you can collect benefits for the full duration of the disability. Your medical benefits will continue as long as you need treatment. And, for partial disability, you can collect wage differential benefits for as long as 520 weeks.

The Form 36 is to be completed by the respondent (employer/workers' compensation insurance carrier) to notify the Workers' Compensation Commissioner, the claimant (employee/decedent), and all parties to the claim of its intention to reduce or discontinue payment of the claimant's workers' compensation benefits.

The Form 6B is to be completed by an Officer of a Corporation or a Manager of a Limited Liability Company (LLC) who wishes to be excluded from workers' compensation insurance coverage.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232