What You Need to Do30C Form

If You've Had a Work-Related Injury or Been Diagnosed with an Occupational Disease or Illness


1 — Report your injury to your employer.

When you notify your employer of an accidental injury, your employer should send you for immediate medical treatment.

Your employer should also file an "Employer's First Report of Occupational Injury or Illness" (FRI) form - sometimes referred to as an "accident report" - with its workers’ compensation insurance carrier and with the Workers’ Compensation Commission.


Any delay by you in reporting your injury to your employer increases the chance that it may be disputed by your employer. An Administrative Law Judge can also reduce your benefits, to any extent he or she finds your delay adversely impacted your employer.



2 — Get prompt medical attention.

Your employer should send you to the company medical facility, a walk-in clinic, a hospital, or a designated physician for your initial medical treatment, as soon as possible after you are injured. If your employer has a designated medical provider, you must accept such initial treatment.


Your employer or your employer’s workers’ compensation insurance carrier may establish a medical care plan to provide medical treatment for its employees. If there is such a plan, you must accept your initial medical treatment from a provider who's part of your employer's plan, and any subsequent medical treatment must also be with a provider listed within your employer's plan.



3 — File a timely official claim.

Filing a “written notice of claim” puts your claim on record, and preserves any right to future benefits you may have. A Form 30C is best for this purpose and may be found in the Commission's free Information Packet, with complete instructions for filing the form correctly. You may also access the form, with filing instructions, in the Claim Forms section of our website.

The statute of limitations for filing a compensation claim for an accidental injury is one year from the date of the injury, while for an occupational disease or illness it is three years from the first manifestation of a symptom...so be sure to file in time!


The "Employer's First Report of Occupational Injury or Illness" (FRI) form, or "accident report", that your employer must file is not an official claim for workers' compensation benefits.

Only you as the injured party may file an official claim, using the Commission's Form 30C, so file your claim as early in the process as possible. This should reduce the likelihood your claim will be denied by your employer, and put your claim on record permanently to safeguard your eligibility for benefits.



4 — Contact your employer’s workers’ comp insurer.

If you don’t receive a benefit check within two weeks of becoming disabled, get in touch with your employer's workers' compensation insurance carrier to inquire about the status of your case.

To start payments the insurance carrier needs the "Employer's First Report of Occupational Injury or Illness" (FRI) form, a wage statement from your employer, and a medical report from your physician confirming that your injury is work-related and that you are disabled by it. The insurer also needs to know your federal tax filing status (single, head of household, married filing jointly, or married filing separately). If only the wage statement is missing, the carrier can usually send an advance payment until it arrives.


If your employer or its insurance carrier wants to dispute your claim, you must receive official written notice of a denial [describing the reason(s) for it] on a Form 43, or your employer must begin making workers’ compensation payments “without prejudice” within 28 calendar days.



5 — Learn more about workers' compensation:


Information Packet

Our free 41-page publication; approachable, yet comprehensive.

About the Workers' Compensation Commission

Read about Connecticut's workers' compensation agency.