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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and Social Security number at the top of the form. This information is essential for identification purposes.
Select your filing status from the four options provided: A) Single, B) Head of Household, C) Married filing jointly, or D) Married filing separately. Choose based on your IRS filing status at the time of your injury.
Indicate the number of exemptions you claimed on your last Federal and State Tax Returns, including yourself.
Check any applicable boxes regarding age or blindness for yourself or your spouse to ensure all relevant benefits are considered.
List names, birth dates, and relationships for all exemptions claimed on your tax returns in the designated section.
If applicable, provide details about any other employment you had at the time of injury, including employer names, weekly hours, addresses, wages, and type of work performed. If none, simply write 'none'.
Finally, review all entries for accuracy before signing and dating the form to complete it.

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How long do I have to file a Workmans Comp claim in CT?

You generally have one year from the date of the injury to file CT workers compensation claims. However, you should report any work-related injuries or sicknesses to your supervisor or manager immediately. It is best not to wait to file your claim, and the sooner you file your claim the better.

What are the three main requirements to obtain workers compensation?

You must be an employee. Your employer must carry workers comp insurance. You must have a work-related injury or illness.

How to file for workers comp in CT?

Promptly file a Written Notice of Claim: In Connecticut, you must file Form 30C, which gives notice to the Workers Compensation Commission that you are claiming benefits. Although you notified your employer that you were injured, you must file the Written Notice, Form 30C, as well.

What is the Connecticut General statute for workers compensation?

Connecticuts Workers Compensation Act, or Chapter 568 of the Connecticut General Statutes, is the body of law that specifically addresses issues of workplace injury and disease, benefits for which injured or ill employees may be eligible, insurance requirements to provide for benefits, how benefits are best to be

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Filing Status and Exemption - Connecticut 2026

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Filing Status and Exemption - Connecticut 2026

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How to file for workers comp in CT?

What is the Connecticut General statute for workers compensation?

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