Dependents Notice Of Claim {30D}

Forms 30D -- DEPENDENT'S NOTICE OF CLAIM (To Administrative Law Judge and to Employer). This form from the Connecticut Workers' Compensation Commission is used by the dependent or legal representative of a deceased employee to file a claim for workers' compensation death benefits following the employee's work-related death. The form requires information about the deceased employee's injury, relationship to the dependent, and details of the employer. A death certificate should be attached if available. The form must be filed with both the employer and the Workers' Compensation Commission, either by certified mail or in person, to initiate the claim process. There are instructions for filing depending on the employer type (state, municipal, or other). If the employer does not contest liability or begin payments within 28 days, the claim is presumed compensable. There are also statutes of limitations related to when the claim must be filed based on the timing of the injury, illness, or death. www.FormsWorkflow.com