State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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How do I claim my workers' compensation benefits?


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:

OR

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:

If you are injured on the job, follow the proper procedures to protect your rights!

First:

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.

Second:

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).


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State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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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

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