State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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Hearing Cancellation Request Form for Informal and Pre-Formal Hearings

October 27, 2005

Effective November 1, 2005, the Workers’ Compensation Commission will begin using the new Hearing Cancellation Request form. To allow everyone the ability to get acclimated to the new system, we will have a two-month trial run from November 1, 2005 through December 31, 2005. Beginning January 1, 2006, this form will be the only form accepted for cancellations of Informal and Pre-Formal hearings. We realize that this may not be possible for all pro se claimants and, therefore, leniency will be given in those instances.

The purpose of this form is:

  1. to ensure that parties are communicating prior to any hearing being cancelled
  2. to enable the Commission to fill cancelled hearing time slots with other hearings
  3. to track cancellation data for future use

Important features of this form include:

  1. The form itself can be filled out on the computer and printed. For those who have downloaded previous Workers’ Compensation forms and saved them, you will be able to do the same with this form. We will accept faxed or mailed copies.
  2. All parties will be required to appear for the scheduled hearing unless we receive the hearing cancellation request form more than three (3) business days in advance (except for unforeseen emergencies).
  3. Form 36s where benefits are being paid MUST BE AGREED TO IN WRITING by the respondent; otherwise parties will be required to attend the scheduled hearing.
  4. All parts of the form are to be filled out completely and a list of names and addresses of all parties notified should be attached.

Based on hearing cancellation information that we have obtained in reports, we are confident that this change will improve communication between the parties. Receipt of cancellation requests in a timely manner will also enable the Commission to schedule other hearings in their place. Please contact any district office, if you have questions regarding the form.

The new Hearing Cancellation Request form is available on this site in Adobe’s PDF format and requires the use of Adobe’s free Adobe Reader. If you need to obtain the free Adobe Reader, follow the link below to Adobe Software’s website, download and install the Reader on your computer, then return to this page to view, print, or save the Hearing Cancellation Request form. This new form is also available on our Forms page.

Hearing Cancellation Request (PDF File: 1 page; 316K; Last revised December 22, 2005)

Hearing Cancellation Request

(PDF File: 1 page; 316K; Last revised December 22, 2005)

Click here for the FREE Adobe Reader from Adobe Software.

Click here for the FREE Adobe Reader from Adobe Software.

Workers’ Compensation Commission

Page last revised: December 23, 2005

Page URL: http://wcc.state.ct.us/news/new-273.htm

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