Connecticut Workers' Compensation Acknowledgment Form

State:
Multi-State
Control #:
US-537EM
Format:
Word; 
Rich Text
Instant download

Description

This is an acknowledgement form regarding workers' compensation. The form states that the employee has read and understands the workers' compensation guidelines.

How to fill out Workers' Compensation Acknowledgment Form?

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FAQ

If the employee suffers an accidental injury during the course of their employment, then he or she has a time period of up to one year to file an official claim for workers' compensation.

Generally, the FMLA allows employees that are eligible to take leave up to 12 weeks in any 12-month period (Connecticut allows 16 weeks in any 24-month period) for situations that include the serious health condition of the employee.

DWC-1 Workers Compensation Claim Form. This is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within one working day from you becoming aware of a work-related injury or occupational disease.

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.

You will have one (1) year from the time of your injury and three years from your first signs of symptoms related to an occupational disease or illness to file your claim with the Workers' Compensation Commission.

Workers' comp is a two-way street. Your employer pays for insurance for medical and wage support if you are injured in the course of your work. In exchange for quick access to these benefits, you cannot sue your employer after you are injured, nor are you compensated for pain and suffering.

The Connecticut Workers Compensation Act guarantees medical care, protection against income loss, and survivor benefits for employees who suffer work-related injury, illness or death. The act grants benefits to an injured employee without regard to fault or negligence on the part of the employer or employee.

Workers' comp is a two-way street. Your employer pays for insurance for medical and wage support if you are injured in the course of your work. In exchange for quick access to these benefits, you cannot sue your employer after you are injured, nor are you compensated for pain and suffering.

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.

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Connecticut Workers' Compensation Acknowledgment Form