Voluntary Agreement

VOLUNTARY AGREEMENT. This form is used in Connecticut's Workers' Compensation system. It is intended for employees who are seeking benefits related to work-related injuries but does not finalize the case or close it out. The agreement outlines details such as the employee's information, the nature of the injury, and the computation of benefits based on average weekly wages. It also includes sections for the acknowledgment of both parties, ensuring that they accept the facts stated in the document. Additionally, it allows for the consideration of concurrent employment situations, detailing how benefits will be calculated and allocated when an employee has worked for multiple employers. The agreement must be signed by both the employee and the authorized representative of the employer for processing. www.FormsWorkflow.com