Notice Of Claim For Compensation {30C}

Form 30C -- NOTICE OF CLAIM FOR COMPENSATION (Employee to Administrative Law Judge and to Employer). This should be filed promptly after a work-related injury or illness takes place. There is a statute of limitation for filing workers’ compensation claims: within one year of the date of an accidental injury or within three years from the first manifestation of a symptom of an occupational disease. [NOTE: If, within the applicable time period described above, (1) there has been a hearing or a written request for a hearing or an assignment for a hearing or (2) your employer’s insurance carrier has already signed a Voluntary Agreement, you do NOT need to file a 30C Form for the injury or illness it covers.] You should file this form because: • There will be no doubt that you are claiming that you have a work-related injury or occupational disease. • It is the best way to insure that you have met the statute of limitations for filing a workers’ compensation claim. • A simple “accident report” filed with the employer is not an official claim for workers’ compensation. • Your claim will be more likely to receive prompt attention from your employer or insurance carrier. • Once your employer receives an official claim, they have only 28 calendar days in which to either deny your claim or to begin making workers’ compensation benefit payments “without prejudice.” If an official denial is not issued within 28 calendar days or if benefit payments are not initiated within 28 calendar days, your employer must accept the compensability of your claim. (If your employer has opted to post a location where you must file your claim, this 28-day period begins when your employer has received your claim at the location posted per statute.) www.FormsWorkflow.com