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NOTICE TO EMPLOYEESState of Connecticut Workers Compensation CommissionRevised 10012021The Workers Compensation Act (Connecticut General Statutes Chapter 568) requires your employer, Visiting Nurse

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How to fill out connecticut workers compensation claim

01

To fill out a Connecticut workers compensation claim, follow these steps:

02

Notify your employer: Inform your employer about the workplace injury or illness as soon as possible. Make sure to provide details about the incident and any witnesses.

03

Seek medical attention: Get medical treatment for your injury or illness. It's important to visit a healthcare provider authorized by the Workers' Compensation Commission (WCC).

04

File a written notice: Within one year of the injury or illness, complete a Form 30C, Notice of Claim for Compensation. This form should be sent to the WCC and a copy given to your employer.

05

Obtain medical reports: Request medical records from the healthcare provider treating your injury or illness. These reports will be necessary to support your claim.

06

Complete Form 30D: Fill out Form 30D, Notice to Employees of their Rights and Duties under the Workers' Compensation Law. This form should be provided to you by your employer.

07

Keep records: Maintain copies of all documents related to your workers compensation claim, including medical bills, correspondence, and any other relevant records.

08

Proceed with the claim: The WCC will review your claim and determine if you are eligible for benefits. It is advisable to seek legal advice to navigate the claim process effectively.

Who needs connecticut workers compensation claim?

01

Connecticut workers compensation claim is needed by employees who suffer a work-related injury or illness. If you are employed in Connecticut and experience an injury or illness due to your job, you may be eligible to file a workers compensation claim.

02

It covers various types of employees, such as full-time and part-time workers, temporary and seasonal workers, and even some independent contractors. Regardless of your occupation or industry, if you meet the criteria for a work-related injury or illness, you may need to file a Connecticut workers compensation claim.

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What is connecticut workers compensation claim?

Connecticut workers compensation claim is a form of insurance that provides wage replacement and medical benefits to employees who are injured while on the job in Connecticut.

Who is required to file connecticut workers compensation claim?

Employers in Connecticut are required to file a workers compensation claim on behalf of their employees who are injured on the job.

How to fill out connecticut workers compensation claim?

Connecticut workers compensation claims can be filled out by the injured employee or by their employer on their behalf. The form typically requires information about the injury, the employee's job role, and details of the incident.

What is the purpose of connecticut workers compensation claim?

The purpose of connecticut workers compensation claim is to provide benefits to employees who are injured on the job, including medical treatment, wage replacement, and disability benefits.

What information must be reported on connecticut workers compensation claim?

Information that must be reported on a connecticut workers compensation claim includes details of the injury, how it occurred, the employee's job role, and any medical treatment received.

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