State of Connecticut Workers' Compensation Commission, Stephen M. Morelli, Chairman
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What happens if I receive a Form 36?


The employer/insurer will seek to discontinue benefits for temporary total incapacity when a physician indicates that the claimant is capable of some type of work. In order to discontinue benefits, employers/insurers are required to file a Form 36, which should be signed by a Connecticut-licensed physician or attached to the physician’s report. This form must be sent by certified mail to the claimant and the Workers’ Compensation Commissioner in the proper District Office.

The Form 36 will automatically be approved by the Commissioner, unless contested by the claimant within fifteen (15) days. If the notice of discontinuation is properly contested, the employer/insurer must continue to pay workers’ compensation benefits until an Informal Hearing is held on the matter.

If you receive a Form 36 and contend that total incapacity continues, you should:

(1) Immediately notify the District Office for the city or town in which you were injured and request an Emergency Informal Hearing on the matter.

(2) Call the insurance carrier or self-insured employer and inform them that the discontinuance has been contested and that an Emergency Informal Hearing has been requested.

At the Informal Hearing be prepared to present medical reports that confirm continued total incapacity. If you fail to do this, the Commissioner may approve the discontinuation of benefits retroactively.

If you contest a Form 36 and the Commissioner at the Informal Hearing approves the Form 36 retroactively, any additional benefits you received prior to the hearing may be credited against any future compensation benefits to which you may be entitled for Permanent Partial Disability.

[NOTE: A Form 36 does NOT necessarily mean that ALL workers’ compensation benefits are being discontinued! For example, a claimant no longer eligible for Temporary Total Disability (TT) benefits may be entitled to further benefits for Temporary Partial Disability (TP) or Permanent Partial Disability (PPD).]


For More Information . . .

. . . please call your local Workers' Compensation Commission District Office or Education Services at 1-800-223-WORK (toll-free in Connecticut).

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State of Connecticut Workers' Compensation Commission, Stephen M. Morelli, Chairman
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State of Connecticut
Workers' Compensation Commission
Page last revised: August 23, 2018
Page URL: http://wcc.state.ct.us/gen-info/if-injured/form36.htm

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