State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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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:

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


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

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