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How to Fill Out a 30C Form – Carter Mario Law Firm

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.

Client Victories

We’ve Recovered Over $1 Billion for Clients
Just Like You


$17M

Rear-End Collision

Our client sustained a significant injury to his cervical spine after a rear-end crash. After receiving a low initial offer from the insurance company, we fought hard for our client to get him the settlement he deserved.

$4M

Medical Misdiagnosis

Our client’s doctor misread an x-ray causing a delayed diagnosis of sarcoma, which resulted in our client’s death.

$3.9M

Failure to Treat

Gastroenterologist and primary care doctor failed to treat or transfer our client who was hospitalized for GI bleeding, which resulted in our client’s death.

$3.4M

Failure to Diagnose

Our client’s doctors failed to diagnose him with abdominal cancer, resulting in his death.

$3.4M

Medical Malpractice

Our client suffered brain damage, paralysis, and speech deficits after undergoing a bedside procedure.

$3.3M

Brain Damage

Our client suffered brain damage after their breathing tube was misplaced.

$3M

Failure to Diagnose

Our client’s doctor failed to diagnose Fournier’s Gangrene, resulting in necrotizing fasciitis, sterility, abnormal gait, and muscle loss.

$2.6M

Personal Injury Resulting in Death

Our client, an innocent bystander to a bar room brawl, required surgery for a ruptured Achilles tendon. After the surgery, our client developed a pulmonary embolism, resulting in his death.

$2.5M

Gas Poisoning

Our client suffered from carbon monoxide poisoning with cognitive loss after an on-site contractor ran gas engines during business hours.

Why choose Carter Mario?

We want justice and what’s best for you and your case. Here’s our promise:

  • A Team That Puts You First!

    Our clients are our #1 priority and everything we do is focused on getting you the best result! You are the reason we became lawyers. To the insurance company, you are no more than a claim number but to us, it’s personal. We’re here for you 24/7, 365 days a year. We communicate often and call you back the same day or lunch is on us. We believe an informed client is a happy client. You are the reason we fight!

  • Over $1 Billion Recovered!

    For over 30 years, we’ve fought fiercely and tirelessly against Big Insurance and won countless victories for our clients. You were already hurt physically when you came to us, but we make sure you aren’t hurt financially when you leave. Our goal is to give you a better tomorrow.

  • Experience On Your Side!

    No obstacle is too big. Our seasoned attorneys were handpicked and know how to hold the insurance companies accountable. We have experience in and out of the courtroom. Our attention to detail and in-depth investigation helps identify key evidence we use to prepare your case. Our attorneys have the knowledge, the dedication, and the passion it takes to win. They love what they do.

  • We Have a Large War Chest!

    When we go to trial, we are battle ready, but taking a case to trial takes more than confidence, experience, and commitment. It takes cutting edge technology and a War Chest to support the costs of zealous representation. Many firms aren’t willing or don’t have the resources and financial stability to front your costs and maximize your case. We’ll spend whatever it takes to get you every penny you deserve!

  • Making the Law Make Sense!

    At Carter Mario Law Firm, our mission is to make the law make sense. You’ve been injured and it wasn’t your fault. Life is suddenly overwhelming and confusing, and you don’t know where to turn. You need help, but it matters who you get. Let us come to your rescue. We’ll do the work, so you don’t have to. You can focus on you!

You Pay Us Nothing Until
We Win Your Case

Call (203) 876-2711 or Contact Us For a No-Obligation Case Evaluation. Our attorneys are standing by to evaluate your case, answer any questions, or discuss your next steps. Getting the compensation you deserve starts here!



    Client Testimonials

    Such a great experience

    "I had such a great experience with Carter Mario Law Firm. Everyone was amazing, helpful and comforting during this stressful time."

    - Michelle P.

    It felt really good to have someone

    "My son suffered an injury after being hurt in a car accident, and it felt really good to have someone fighting for the person you love."

    - Alex M.

    Tough and fearless

    "Look no further, you have found the best personal injury law firm in Connecticut. Tough and fearless, and I cannot think of anyone better to represent me."

    - Phillip Y.

    Attention to detail

    "Look no further, you have found the best personal injury law firm in Connecticut. Tough and fearless, and I cannot think of anyone better to represent me."

    - John L.

    Took so much stress off of me

    "When I had my work-related injury, Carter Mario took on the workers’ comp insurance company that tried to belittle me and dealt with them, which took so much stress off of me. Thank you so much."

    - Ruth H.