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Connecticut workers compensation commission form 2026

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The document is a notice from the State of Connecticut Workers' Compensation Commission informing an employee and the Commissioner of the employer's intention to contest the employee's right to compensation benefits. It includes sections for employee details, injury information, attorney representation, reasons for contesting liability, and contact information for the employer and insurer. The notice must be served personally or via registered mail.

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Click ‘Get Form’ to open the Connecticut Workers Compensation Commission form in our editor.
Begin by filling in the employee's name, date of injury, and date of birth in the designated fields. Ensure all information is accurate as it is crucial for processing.
Provide the address, city/town of injury, and zip code. This helps in identifying the location related to the claim.
Indicate the body part(s) affected and describe the nature of the injury. If applicable, check the box for Occupational Disease or Repetitive Trauma.
Complete the attorney or representative section if applicable, including their name and contact details.
In the reason(s) for contest section, provide a specific explanation for contesting liability. This is essential for clarity.
Fill out employer and insurer details accurately, including names, addresses, and contact numbers.
Finally, ensure that all signatures are completed before submitting. You can easily sign directly within our platform.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (47 Votes)
2009	4.4 Satisfied (338 Votes)

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What is form 43 in Connecticut?

The Form 43 is to be completed by the respondent (employer/workers compensation insurance carrier) to notify the Administrative Law Judge, the claimant (employee/decedent), and all parties to the claim of its intention to deny the compensability of all or part of the claimants claim to workers compensation benefits.

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.

Is workers comp required in Connecticut?

The Connecticut Workers Compensation Act was first enacted in 1913. Note the following: The Act has seen changes over the years but has maintained its premise as a mandatory program that pays medical costs and lost wages to full-time and part-time employees in the event of work-related injuries and illnesses.

What is a form 30C in CT?

Notice of Claim for Compensation (Employee to Administrative Law Judge and to Employer) The Form 30C is to be completed and filed by a claimant (employee) or claimants attorney/representative for making a claim for workers compensation benefits.

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How to file a workers comp claim in Connecticut?

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.