Get Connecticut Dwc 1 Form

Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor (it's also known as a DWC 1 form). Your employer must give or mail you a claim form within one working day after learning about your injury or illness.

Workers' comp insurance provides five basic benefits: Medical care: Paid for by your employer to help you recover from an injury or illness caused by work. Temporary disability benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering.

The LES Form DWC-1, or First Report of Injury or Illness, is the form used to report workers' compensation accidents or work-related illnesses to your insurance carrier or designated claims office. Delays and errors may increase costs related to processing the claim.

Duration of provisional payments Provisional payments can include weekly payments for up to 12 weeks, and payment of medical expenses up to $10,000. It also extends the time allowed for the insurer to make a decision on liability.

The weekly Disfigurement and Scarring benefit rate is equal to the employee's weekly TT benefit rate, subject to the legislated maximum and minimum amounts, and may be paid for a period of up to 208 weeks.

You must be an employee. Your employer must carry workers' comp insurance. You must have a work-related injury or illness. You must meet your state's deadlines for reporting the injury and filing a workers' comp claim.

Some states limit the length of time an injured worker can receive temporary benefits. This range can be three to seven years. That said, there is not usually a limit on permanent disability benefits. However, some states do stop weekly benefits when employees reach the age of 65.

A Connecticut worker is paid 75% of worker's after tax average weekly wage. Weekly payments are calculated as 20% of the State Average Weekly Wage not to exceed 75% of their average wage. The minimum is $228.20 and the maximum is $1,141 or 100% of State Average Weekly Wage.

If you need assistance with filing a claim, please call your local Workers' Compensation Commission District Office or Education Services at 1-800-223-WORK (toll-free in Connecticut).