Rehabilitation Request {WCR-1} | Pdf Fpdf Doc Docx | Connecticut

 Connecticut   Workers Compensation 
Rehabilitation Request {WCR-1} | Pdf Fpdf Doc Docx | Connecticut

Last updated: 9/25/2024

Rehabilitation Request {WCR-1}

Start Your Free Trial $ 13.99
200 Ratings
What you get:
  • Instant access to fillable Microsoft Word or PDF forms.
  • Minimize the risk of using outdated forms and eliminate rejected fillings.
  • Largest forms database in the USA with more than 80,000 federal, state and agency forms.
  • Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
  • Trusted by 1,000s of Attorneys and Legal Professionals

Description

Form WCR-1 -- REHABILITATION REQUEST. This form is used in Connecticut to request rehabilitation services from the Department of Aging and Disability Services for individuals who have suffered a workplace injury. The form allows injured employees to apply for assistance in returning to work by providing details such as their name, date of birth, the injured body part, contact information, the date and location of the injury, and the employer at the time of the injury. The injured worker must sign the form to confirm their request for rehabilitation services. www.FormsWorkflow.com

Related forms

Our Products