How to Fill Out a 30c Form

When you get hurt at work, you may feel several emotions: pain, fear, sadness, loss, and confusion. It’s important to know what your options are for you and your loved ones who depend on you, not just for your income, but to get back to being the person you were before the injury.

Under Connecticut law, an injured worker has options. One option is to exercise the rights under the Worker’s Compensation Act, and that starts by completing a Notice of Claim for Compensation, more commonly known as a 30C form.

This form is easily accessible online here.

It is important to timely and accurately complete this form. After writing down the injured worker’s name and your employer’s name, the worker needs to identify the date of the injury and in which town the injury occurred. Please be careful, the place where the worker got hurt may not be the same as the business address of the employer. Be sure to describe any injury truthfully and simply and indicate how the injury happened.

Don’t worry if the information necessary to complete the WCC File # is unavailable. Most of the time, the Workers’ Compensation Commission will provide a number at the 30C form is completed.

Visit any copy center to make extra copies of a completed 30C Form. The original form must be submitted to the worker’s employer by certified mail, return receipt requested. This is to ensure that the employer is on notice of a potential claim arising out of the scope or course of employment, and businesses are required to report injuries themselves on a Report of Occupational Injury or Disease to an Employer.

A copy of the 30C must be sent to the appropriate Workers’ Compensation Commission District Office, also by certified mail, return receipt requested. Note that the District Office corresponds with the town where the worker was injured, which may not be the same place as the business address of the employer. Refer to the Workers’ Compensation Commission District Offices information sheet attached to the 30C to locate the correct address.

It is important to complete a 30C Notice of Claim for Compensation in order to protect an injured worker’s rights for proper reimbursement. Failure to timely do so result in a waiver of a claim or delay payment from the employer.

For more information, or if you've been injured in a workplace accident contact the attorneys at Carter Mario. The experts at Carter Mario are trained to handle any personal or workplace injury case and will fight for your settlement.