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Hartford workers compensation claim form 2026
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- Click ‘Get Form’ to open the Hartford Workers Compensation Claim Form in our platform.
- Begin with Section I, where the employer's authorized representative must provide details about the employee, including their name, Social Security Number, and employment information.
- In Section II, the employee should complete their statement by filling in personal details such as date of birth, address, and condition causing disability. Ensure all questions are answered to avoid delays.
- Section III requires the employee's authorization to obtain necessary medical information. Make sure to sign this section for processing.
- In Section IV, the attending physician must complete their statement regarding the patient's condition. This includes diagnosis and treatment details.
- Review all sections for completeness and accuracy before submitting. Attach any required documents as specified in Section K.
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Complete, sign and date this form electronically or in paper copy. For assistance with completing this form, please call (866)547-4205.
HARTFORD CASUALTY INSURANCE COMPANY. ONE HARTFORD PLAZA, HO-1-09. HARTFORD, CT 06115. 800-243-5860. Workers Compensation Complaint and Requests for ActionRead more