Monday, September 25, 2017
Connecticut Workers’ Compensation Claims: Eligibility, Filing, and Appeals Understand how workers' compensation works in the state of Connecticut. By Sachi Barreiro Virtually all employers in Connecticut are required to carry workers’ compensation insurance. As in the rest of the country, the workers’ compensation system in Connecticut is a no-fault system designed to compensate injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must take certain steps required by Connecticut law. Who Is Eligible for Workers’ Comp Benefits? Workers’ compensation covers all injuries or illnesses that happen in the course of employment. In general, injuries that happen while you are performing your work duties or running work errands are covered by workers’ comp. On the other hand, injuries that occur while you’re off-duty are generally not compensated through workers’ comp. For example, if you were injured during your lunch break or during your commute to and from work, you will typically not be covered by workers’ comp. For more information, see our article on what types of injuries are covered by workers’ comp. Workers’ comp covers both traumatic injuries and occupational illnesses. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos). What Should I Do if I’m Injured at Work? If you’re injured at work, you must report your injuries to your employer immediately. Your employer should complete an “Employer’s First Report of Injury” form and provide it to its insurer and to the state Workers’ Compensation Commission, along with a copy to you. In addition to giving notice, you will have to file an official workers’ comp claim by completing a Notice of Claim for Compensation (Form 30C). You must provide this form to your employer and the Workers’ Compensation Commission within one year of your accident or within three years of the onset of an occupational illness. You should do this in person or by sending the documents by certified mail with a return receipt requested. Once your employer receives your claim form, it has 28 days to accept your claim, deny your claim, or begin benefit payments “without prejudice” – meaning that your employer has agreed to pay your benefits while it continues to make a final decision about your claim. If the employer fails to do any of these within 28 days, your claim is deemed accepted. How Do I Get Medical Treatment? In an emergency, you can choose which doctor or hospital to seek treatment from. For all non-emergency care, your employer may choose which doctor you see for your initial treatment. After the initial treatment, you can select your own doctors, unless your employer has established a managed care program for treatment of work-related injuries. If your employer has established such a plan, you must select a doctor from a doctor within the plan’s network. In general, though, your employer must provide you with notice of the managed care plan prior to your injuries. What Benefits Can I Receive? All reasonable and necessary medical treatment related to your work injury will be covered through workers’ comp, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You’ll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive temporary disability payments and a permanent disability award. Temporary Disability You will be eligible to receive compensation for wage loss during the time you are temporarily disabled and unable to work. Temporary total disability payments are 75% of your average weekly wages, subject to a maximum of $1,292 per week (as of October 1, 2016). You can continue to receive temporary total disability until your doctor finds that you’ve reached maximum medical improvement (MMI), meaning that your condition has plateaued and is not expected to improve. If you’re able to return to part-time or light-duty work while you’re recovering, but earn less than your normal wages, you may eligible for temporary partial disability benefits. Temporary partial disability benefits are 75% of the difference in your average weekly wages, subject to the same maximum weekly amount. Permanent Disability If you are found to be totally and permanently disabled, you will receive the same weekly amount that you received in temporary total disability payments: 75% of your average weekly wages, subject to a maximum of $1,292 per week (as of October 1, 2016). Permanent total disability benefits are available for as long as the disability continues. These benefits are available only to workers with severely debilitating injuries, such as the loss of both hands, feet, arms, legs, or eyes. Workers are considered totally disabled only if they cannot earn any wages in the same job or another job. For most other workers, permanent partial disability benefits are available. You will receive 75% of your average weekly wage, up to $1,063 per week (as of October 1, 2016). How long you’ll receive these benefits depends on a state schedule and the disability rating assigned by your doctor. Connecticut’s state schedule is comprehensive and lists injuries to certain body parts, including extremities and organs. For each body part, the schedule identifies the maximum number of weeks for a total loss of use of that body part. For example, a worker with a 100% loss of use of a dominant arm will receive benefits for 208 weeks. However, if the worker had a 50% disability rating, he or she would receive benefits for 104 weeks. You may also receive benefits for significant scarring or disfigurement to the face, head, or neck, or to another body part if it will impede your ability to find new work. These benefits are equal to the total temporary disability rate, subject to the same maximum amounts. Benefits are available for up to 208 weeks. What if My Claim Is Denied? If your workers’ comp claim has been denied, or the insurance company is disputing any portion of your claim, you have the right to request a hearing before the Workers’ Compensation Commission. To do so, you must file a form called a “Hearing Request” with the Workers’ Compensation Commission. A hearing will be held before a workers’ comp judge, who will issue a written decision. If you disagree with the judge’s decision, you may file an appeal with the Compensation Review Board. For more information on the appeals process, see our article on appealing a denial of your Connecticut workers’ comp claim.