Notice of Intention to Discontinue - Connecticut 2026

1. Click ‘Get Form’ to open the Notice of Intention to Discontinue in the editor.
2. Begin by filling in the employee information section. Enter the employee's name, date of injury, social security number, and contact details accurately.
3. In the injury information section, specify the part of the body affected, nature of the injury, cause of injury, and any relevant dates.
4. Complete the employer and insurance carrier information fields. Ensure that all addresses and contact numbers are correct for effective communication.
5. Indicate whether there will be a permanent loss or loss of use on the specified part of the body. This is crucial for clarity regarding compensation.
6. Finally, have a licensed physician complete their section by certifying the employee's ability to return to work. Attach any supporting medical documentation as required.

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