WCC Revised Voluntary Agreement Form Memorandum

WCC Revised Voluntary Agreement Form Memorandum - July 22, 1999

MEMORANDUM NO. 99-13

TO:	Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, Medical Practitioners, and Advisory Board Members
FROM:	Jesse M. Frankl, Chairman
DATE:	July 22, 1999
RE:	VOLUNTARY AGREEMENT FORM REVISED 7/20/99

We are pleased to announce a revision of the Voluntary Agreement (Form WCC-1).

The enclosed BLUE form, effective July 20, 1999, reflects a change in the method of calculating concurrent employment for all injuries occurring on or after July 1, 1995.

PLEASE NOTE THAT THIS FORM WILL BE ACCEPTED ON BLUE STOCK ONLY.

With this revision, the Workers’ Compensation Commission will now be accepting the following voluntary agreement forms:

BLUE for all injuries occuring on or after July 1, 1995
GOLDENROD for all injuries between October 1, 1991 and June 30, 1995
GREEN for all injuries up to and including September 30, 1991

This form is available from our website or any district office.

State of Connecticut
Workers' Compensation Commission
Page last revised: July 22, 1999
Page URL: http://wcc.state.ct.us/memos/1999/99-13.htm

Workers' Compensation Commission Disclaimer, Privacy Policy and Website Accessibility