If you are injured on the job or are diagnosed as having a work-related disease, you should file a written notice of claim for workers’ compensation as soon as possible. The Workers’ Compensation Commission provides an official form for workers’ compensation claims, a 30C Form. This form is also available from any Workers’ Compensation Commission District Office or from the Commission’s Education Services.
A 30C Claim Form should be filed promptly after a work-related injury takes place. There is a statute of limitation for filing workers’ compensation claims:
within ONE YEAR of the date of an injury
within THREE YEARS of the first manifestation of a symptom of an occupational disease.
All written notices of claim (30C Forms) for workers’ compensation benefits must be filed with both your employer and with the Workers’ Compensation Commission District Office which has jurisdiction over the city or town in which you were injured or became ill, NOT where you live.
[NOTE: If, within the applicable time period described above, (1) there has been a hearing or a written request for a hearing or an assignment for a hearing or (2) your employer’s insurance carrier has already signed a Voluntary Agreement, you do NOT need to file a 30C Form for the injury or illness it covers.]
You should file a 30C Claim Form because:
There will be no doubt that you are claiming that you have a work-related injury or occupational disease.
It is the best way to insure that you have met the statute of limitations for filing a workers’ compensation claim.
A simple “accident report” filed with your employer is NOT an official claim for workers’ compensation benefits.
Your claim will be more likely to receive prompt attention from your employer or insurance carrier.
Once your employer receives an official claim, it has only 28 calendar days in which to either deny your claim or to begin making workers’ compensation benefit payments “without prejudice.” If an official denial is not issued within 28 calendar days or if benefit payments are not initiated within 28 calendar days, your employer MUST accept the compensability of your claim.
If you are injured on the job, follow the proper procedures to protect your rights!
Report your injury immediately to your employer and get proper medical attention. Do not delay in reporting workplace injuries, since this can endanger your claim. Many injured workers are initially denied benefits because they did not report their injuries immediately.
File a proper written notice of claim — a 30C Form — as soon as possible! Send the form by Certified or Registered Mail (return receipt requested) or deliver it by personal presentation (obtaining a written receipt as proof of such personal delivery).
If you need assistance with filing a claim, please call your local Workers' Compensation Commission District Office or Education Services at 1-800-223-WORK (toll-free in Connecticut).
State of Connecticut
Workers' Compensation Commission
Page last revised: May 22, 2001
Page URL: http://wcc.state.ct.us/gen-info/if-injured/howtoclaim.htm