In Connecticut, an attorney cannot lend money to his client or advance money while the case is pending. This is in violation of the Rules of Professional Conduct.

However, there are a number of financing companies which have arrived upon the scene of personal injury and workers’ compensation cases in the last several years. These companies charge interest rates that are significantly in excess of the interest rates allowed under the Connecticut state law for loans. However, the companies are able to avoid violating the lending statutes (usury laws) because in strict terms, they are not lending money since there is at least some chance they will not get this money paid back to them if the claimant does not prevail in his or her case.

A word of caution is needed here. The terms of these financing arrangements are very harsh, and very difficult to avoid once her contract has been signed and the money advanced. The injured claimant should avoid this type of treacherous financing arrangements at all costs if possible. While it may seem like an attractive alternative in order to get some immediate infusion of cash when an insurance company may be denying benefits, the amount that the claimant will have to pay back to the financing company upon resolution of the case must be carefully weighed in comparison to the much smaller amount of the initial payment by the financing company.

In Connecticut, an employer may have a workers’ compensation insurance policy that has a unitization review component. This is a procedure by which the workers’ compensation carrier can review a recommendation by a treating physician for a particular procedure such as a diagnostic test or a surgical procedure after the treating physician has ordered it.

A typical scenario is as follows: the claimant sustains a compensable lumbar spine injury which has not responded favorably to several months of physical therapy and anti-inflammatory medication. The treating physician requests authorization for an MRI. The workers’ compensation carrier will refer that request to the unitization review decision of its company and a nurse and/or doctor will review this request. Typically a “peer to peer” conference is requested with the doctor to get his or her feedback as to why this procedure is being requested.

Because of the time constraints placed upon the treating physician, it may be difficult or impossible for this physician to get back to the utilization review nurse or doctor. If two such attempts by utilization review are made without contacting the treating physician, the utilization review will summarily deny the procedure. This denial can be appealed, but ultimately, should the utilization review division stand on its denial throughout the various appeals of offices within the utilization review rules, there is nothing that can be done to overturn this decision by the workers’ compensation commissioner. However, the adjuster has the power to override the utilization review’s decision if he/she believes that the circumstances warrant it, or if a convincing argument can be made to the adjuster to do so.

One can check with the Chairman’s office in Hartford to determine whether a utilization review or division exists for a particular employer. This should be done by the claimant or the attorney once the spectre of utilization review has been raised.

Maybe. My general rule is that the more complex the injury, the more helpful a nurse case manager may be. For a simple rotator cuff injury or a back sprain that may only last a few months, a nurse case manager is probably not required. However, if there is a complicated surgery in which any claimant may need special accessories such as some type of a back brace, a hospital bed, or accommodations in the shower, then a nurse case manager may indeed facilitate the patient’s recovery.

If I allow a nurse case manager to participate in the care of a patient/claimant, I do so under very stringent guidelines which I make the nurse case manager agree to and sign before the nurse case manager can become involved in the case. If the nurse case manager will not adhere to these guidelines and sign, I will not allow him or her to participate in the case any further. For example, I do not allow the nurse case manager to be present in the examination room during the examination of the claimant. For one thing, this destroys the doctor/patient confidentiality. In addition, it is completely inappropriate.

If you decide allow the nurse case manager to participate in your case, you must always remember that the nurse case manager is a double agent. Anything that you relate to him or her is not confidential and you can assume that it will be conveyed to the adjuster. You should also remember that the nurse case manager’s ultimate allegiance is to the carrier since it is the carrier who pays the nurse case manager, not the claimant.

In Connecticut, the Voluntary Agreement is a form by which the respondent/employer accepts the compensability of an injury. This means that the employer/respondent is agreeing that an injury took place at work which arose out of and in the course of your employment. It does not mean that the injured employee can treat wherever she wishes or that the respondent employer will pay for all of the benefits that you request.

In deciding whether to sign this agreement, the employee must carefully review all of the information contained within the agreement. Specifically, you must scrutinize the date of the injury, the injured body parts listed, the average weekly wage and the compensation rate that are set forth. It is common for the employer/respondent to accept only some of the injuries that are being alleged to have happened at work. For example, a worker may have slipped and fallen on a slippery floor sustaining injuries to both her back and neck. The employer may indicate on the voluntary agreement that it is accepting a strain of the lumbar and cervical spine, even though it has been established by an MRI that there are herniated discs at both levels. The employer may do so in an attempt to limit the exposure when a final rating has been provided. By not accepting the herniations, the employer can later make the argument that while it was responsible for a short-term (self-limited) strain of the neck and back, it is not responsible for any permanent injury. Simply stated, the employer is hedging its bets by stating that an injury occurred at work, although it is only accepting responsibility for a sprain, rather than for the more serious herniation. However, with the help of a strong medical report and a good lawyer, the injured employee should be able to prove that the employer is responsible for the herniations, not just the sprain/strain.

The employer may also not include concurrent employment in calculating the compensation rate, which is the amount the carrier will pay you, tax free, each week. Under Connecticut statutes if the injured employee is prevented from working at a second job, then any earnings from the second job must be calculated in her total average weekly wages.

While the voluntary agreement states that this is not a “final agreement”, once the voluntary agreement has been signed by both parties and approved by the commissioner, then the only way to correct a mistake is by filing a Motion to Open the agreement. This will require a hearing before a commissioner, and the burden will be on the moving party. This is not necessarily an easy prospect, and, for that reason, it is strongly recommended that the claimant reviews the proposed voluntary agreement with an attorney prior to signing it.

There are generally two types of voluntary agreements. The first is the one that has been described above and is sometimes called a “jurisdictional” voluntary agreement. The other voluntary agreement is one in which the parties have agreed to the permanency rating that has been issued by either the treating physician, or is a compromise between the treating physician’s rating and an IME rating (and possibly, the commissioner’s examination as well).