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How to fill out the CT 30C online
The CT 30C form is crucial for workers seeking compensation benefits after a work-related injury. This guide provides step-by-step instructions for filling out the form online, ensuring clarity and compliance with requirements.
Follow the steps to complete the CT 30C form with ease.
- Click the ‘Get Form’ button to download the form and open it in your preferred editor.
- In the 'INJURED WORKER' section, type or neatly print the name of the injured worker, indicating your date of birth, and check the box if the worker is a minor. Fill in the full address and telephone number of the injured worker.
- In the 'EMPLOYER' section, type or neatly print the name of the employer along with the address and telephone number. Indicate whether the injury occurred on the employer’s premises by answering 'YES' or 'NO,' and provide the actual location if different.
- In the 'INJURY' section, input the date of the injury and the town where it happened. Describe the nature of the injury and specify body parts affected, concluding with whether it is an occupational disease or repetitive trauma, marking the appropriate boxes.
- In the 'SIGNATURE OF INJURED WORKER OR REPRESENTATIVE' section, sign and date the form. If you are a representative, provide your details following the signature, including your firm's name, address, and contact number.
- For the 'WCC File #' area, enter the file number if known; otherwise, you may leave it blank.
- Make at least two copies of the completed form.
- Send the original form to the employer via certified or registered mail or delivered in person with a receipt acknowledgment.
- Mail a copy of the form to the appropriate Workers’ Compensation Commission District Office or deliver it personally.
- Keep the remaining copy for your records.
Start the process of filing your CT 30C form online today.
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In Connecticut, workers' compensation provides benefits to employees injured on the job. This program helps cover medical costs and lost wages, allowing you to focus on recovery. Filing involves submitting your Form 30C, which starts your claim. US Legal Forms can be a valuable tool in ensuring your claim aligns with Connecticut regulations.
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