Get Ct 30c 2016

The CT 30C form, officially known as the Notice of Claim for Compensation, is an essential document for employees in Connecticut who wish to claim workers' compensation benefits following a work-related injury or illness. This guide provides a step-by-step approach to completing the form online, ensuring you navigate each section with confidence and clarity.

Follow the steps to successfully complete your CT 30C form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. In the 'Injured Worker' box, print the name of the injured worker and provide their date of birth. Also include the worker's address and contact information.
3. In the 'Employer' box, fill in the employer's name and address. Confirm if the injury occurred at the employer's location and provide an alternative address if it did not.
4. Detail the injury in the 'Injury' box by stating the date of the injury, the town where it occurred, and the specific body parts affected. Describe the injury clearly.
5. Sign the form in the 'Signature of Injured Worker or Representative' section, and date it accordingly.
6. Make two copies of the completed CT 30C form.
7. Send the original form to your employer via certified mail or deliver it personally, obtaining a written acknowledgment of receipt.
8. Submit a copy of the form to the appropriate Workers’ Compensation Commission District Office, also by certified mail or in person.
9. Keep the final copy of the form for your records.

Complete your CT 30C form online today to ensure your workers' compensation claim is filed promptly and correctly.