Understanding Connecticut's Workers' Compensation Form 30C

What Is Form 30C?

In Connecticut, Form 30C is the Workers' Compensation Employer's Notice of Injury. It is the first official document an employer must file to report an employee's injury to the state's workers' compensation board. The form records the incident date, injury details, and employer information, triggering the claim process and ensuring the injured worker receives the benefits they are entitled to.

Who Must Submit Form 30C?

Any Connecticut employer who has an employee who sustains a work‑related injury is required to file Form 30C within 30 days of the incident. This includes sole proprietors, partnerships, and corporations. Failure to file on time can result in penalties and delays in the employee's benefits.

Key Information Required on the Form

The form asks for:

• Employer name, address, and employer identification number (EIN)
• Employee's full name, address, and Social Security number
• Date and location of the injury, and a detailed description of the event
• Whether the injury is a new or ongoing condition
• Medical provider's name and contact details
• Signature of the employer or authorized representative

Filing Process and Deadlines

Once the form is completed, employers should mail it to the Connecticut Department of Labor's Workers' Compensation Division or submit it electronically via the state's online portal if available. The 30‑day deadline starts from the day the injury occurs, not from the day the employer learns of it, so timely filing is essential.

Common Mistakes to Avoid

Errors that can delay or invalidate a claim include:

• Missing or incorrect employee identification numbers
• Inaccurate injury descriptions that fail to capture the severity
• Late signatures or missing signatures from the employer
• Failure to attach required medical documentation

Benefits of Prompt Filing

Submitting Form 30C quickly:

• Prevents administrative penalties
• Accelerates the workers' compensation claim review
• Provides the employee with timely access to medical treatment and wage replacement

Resources for Completing Form 30C

Employers can find a PDF version of the form on the Connecticut Department of Labor website. Instructional guides, sample entries, and a frequently asked questions section are also available to clarify common uncertainties.

When to Seek Legal Advice

If the injury involves a dispute over fault, significant medical expenses, or if the employer suspects the claim was filed incorrectly, consulting a workers' compensation attorney can help navigate the process and protect both parties' interests.