WC 101

State of Connecticut
Workers’ Compensation 101

Preface

The following is selected and summarized information relating to the Workers’ Compensation Act of the Connecticut General Statutes. It is supplied here as a quick reference to the Connecticut Workers’ Compensation system. The Act provides medical treatment, “wage replacement” and other similar benefits to employees who suffer work related injury or illness.
For more information click on the link below to the Workers’ Compensation Information Packet at the Workers’ Compensation Commission website. It includes details and expanded text.

Click here for details http://wcc.state.ct.us/download/acrobat/Info-Packet.pdf

Introduction

It is every employee’s responsibility to work safely. Unfortunately, situations do arise where employees are injured or become ill while in the performance of their job duties.
The Connecticut Workers’ Compensation Act was first enacted in 1913. It has seen changes over the years, but has maintained its premise as a mandatory program that pays medical costs and lost wages to full-time and part-time employees in the event of work-related injuries and illnesses. Connecticut General Statutes regulate what benefits are due the injured employee. This system may also provide other benefits for those who qualify.

The agency created in the Act is the Connecticut Workers’ Compensation Commission, which administers the statutes of the Act. The Commission houses official forms and documents and performs hearings to settle disputes in individual cases. The Commission is headquartered in Hartford, with eight satellite district offices across the State. These district offices are in the following cities and towns:

Click here for a listing of CT Towns and their Workers’ Compensation District http://wcc.state.ct.us/download/acrobat/townlist.pdf

Claim Filing and Administration

The State contracts with a third party administrator(TPA) to process reported claims, using the administrator’s network of medical providers and managed care services. The TPA works with the agencies and the injured employee to manage the medical treatment of the injury, and assist in the return-to-work process.
If an employee is injured on the job or diagnosed as having a work-related disease, he or she should report the incident to his or her supervisor. A first report of injury will then be generated and sent to the State’s third party claims administrator. They will either approve or contest the claim. If medical treatment is necessary, it is important that the network providers be used. Receiving treatment outside the third party medical provider network may jeopardize the employee’s entitlement to workers’ compensation benefits, subject to the jurisdiction of the Workers’ Compensation Commission.

Benefits

Benefits paid by workers’ compensation include medical expenses and lost wages. For those who qualify, additional benefits may be available. These may include the following:

temporary total disability (when unable to perform ANY job)
temporary partial disability (when able to perform SOME type of work)
permanent partial disability (for suffering a disability to a specific body part) · disfigurement or scarring (depending on its bodily location)
“308a” benefits (living funds, etc, pursuant to Statute)
job retraining (vocational rehabilitation for those who qualify)
relapse or recurrence (referring to a previous injury)

Dispute Resolution

The third party administrator approves or contests claims. For contested claims, either party (the TPA or the employee) may request a Hearing with the Workers’ Compensation Commission. After a claimant receives a notice to contest, all related medical bills must be submitted to their health carrier for payment. If the claim is later approved, the health carrier has the right to pursue his/her reimbursement of medical expenditures.
There are five types of Hearings as follows:

Informal
Emergency
Pre-Formal
Formal
CRB Appeal

Ninety-five percent of disputed cases are settled at Informal Hearings. Certain situations necessitate a special form of Informal Hearing called an “Emergency Hearing”. These situations include emergency surgery, threat of loss of home or vehicle, lack of insurance, halting of benefits, etc. In cases where the parties cannot reach agreement after one or more Informal Hearing(s), either party can request a Pre-Formal Hearing. If the Pre-Formal Hearing does not resolve matters, it may be necessary to request a Formal Hearing. This is a formal legal proceeding. The Commissioner’s finding at a Formal Hearing is binding on all parties, unless appealed by either party to the Workers’ Compensation Commissioner’s Compensation Review Board (CRB). Such appeals are rare.

Definitions

See the Definitions section (page 6) in the Workers’ Compensation Information Packet at the link below for details, including the following terms and forms:

TTD – temporary total disability
TPD – temporary partial disability
PPD – permanent partial disability
MMI – maximum medical improvement
“308a” – wage differentials, etc pursuant to Statute
Form 36 – notice of discontinuation of benefits
Form 43 – notice of intent to contest liability of a claim WCC-1 – voluntary agreement

http://wcc.state.ct.us/glossary/glos-ful.htm