State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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WCC Form 30D Memorandum - September 24, 2007


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:

http://wcc.state.ct.us/download/acrobat/30d.pdf


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

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