Memorandum No. 2019-04

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MEMORANDUM NO. 2019-04

Form 30C Revised

TO:	WCC Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, and Advisory Board Members
FROM:	Stephen M. Morelli, Chairman
DATE:	June 27, 2019
RE:	Form 30C Revised

In light of Public Act 19-17 which allows for police officers, parole officers, and firefighters to receive certain workers’ compensation benefits for post-traumatic stress disorder (PTSD) caused by their participation in specific events, the Commission’s Form 30C “Notice of Claim for Compensation” has been revised, with a revision date of July 1, 2019. Please use this newest revision of the Form 30C, which can be obtained below or from our Online Forms page.

Form 30C (PDF File: 4 pages; 1.3MB; Last revised July 1, 2019)

State of Connecticut Workers' Compensation Commission

MEMORANDUM NO. 2019-04

Form 30C Revised