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MEMORANDUM NO. 2007-06
| TO: | Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, Legal Advisory Panel and Advisory Board Members |
| FROM: | John A. Mastropietro, Chairman |
| DATE: | September 24, 2007 |
| RE: | Form 30D |
For the convenience of the parties, a "Dependent's Notice of Claim" form has now been established and designated as Form 30D, which is to be utilized by a dependent survivor who wishes to file a claim.
For your convenience, this form can be filled out and downloaded from our website at:
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State of Connecticut
Workers' Compensation Commission
Page last revised: September 24, 2007
Page URL: http://wcc.state.ct.us/memos/2007/2007-06.htm
Workers' Compensation Commission Disclaimer, Privacy Policy and Website Accessibility