Workers comp walkthrough
Workers’ Compensation Commission (WCC) Offices
Office of the Chairman
Chairman Stephen M. Morelli
21 Oak Street, Hartford, CT 06106-8011
(860) 493-1500
wcc.chairmansoffice@po.state.ct.us
Chairman Stephen M. Morelli
21 Oak Street, Hartford, CT 06106-8011
(860) 493-1500
wcc.chairmansoffice@po.state.ct.us
Compensation Review Board (CRB)
Chairman Stephen M. Morelli
21 Oak Street, Hartford, CT 06106-8011
(860) 493-1500
Chairman Stephen M. Morelli
21 Oak Street, Hartford, CT 06106-8011
(860) 493-1500
Education and Safety & Health Services
21 Oak Street. Hartford, CT 06106-8011
1-800-223-WORK (9675) Toll-free in CT only
(860) 493-1500
21 Oak Street. Hartford, CT 06106-8011
1-800-223-WORK (9675) Toll-free in CT only
(860) 493-1500
An Introduction to the Workers’ Compensation Act
ALL EMPLOYEES, WHETHER PART-TIME OR FULL-TIME, ARE COVERED UNDER THE WORKERS’ COMPENSATION ACT FROM THE FIRST DAY OF THEIR EMPLOYMENT
What is Workers’ Compensation?
The basic purpose of the Workers’ Compensation Act is to provide wage replacement benefits and medical treatment for employees who have been injured or become ill due to a work-related injury or illness. It is the EXCLUSIVE REMEDY, which means that the employee may NOT sue their employer for any other benefits. Workers’ Compensation is a NO-FAULT system of insurance with the benefits paid by the employer’s workers’ compensation insurance coverage.
The Workers’ Compensation Commission
This is the administrative agency created by the Workers’ Compensation Act to administer the law. The Workers’ Compensation Commission performs Administrative Hearings, with Administrative Law Judges in eight (8) districts hearing disputed workers’ compensation claims. (To contact any of our offices, please see page 1.)
Workers’ Compensation Benefits
MEDICAL TREATMENT [Sec. 31-294d]
The most immediate concern in cases of occupational injury or illness is the health and physical well-being of the employee. While the employer is responsible for designating a medical facility for the initial treatment of an injury/illness, it is always the employee who chooses the “attending physician.” (If the employer has a Medical Care Plan which has been approved by the Chairman’s Office, then the employee’s choice is limited to the doctors in that plan.)
TEMPORARY TOTAL DISABILITY [Sec. 31-307]
This is the wage replacement benefit for which an employee may be eligible, if they are totally disabled from a work-related injury or illness. The benefit rate is 75% of the AFTER-TAX-AND-SOCIAL-SECURITY average weekly wage, based upon the wages earned by the injured worker (hereafter referred to as “claimant”) prior to the injury (up to 52 weeks)
TEMPORARY PARTIAL DISABILITY [Sec. 31-308(a)
When an employee is able to perform some type of work, but not the same kind of work or the same number of hours they worked at the time of the injury, he or she may receive this benefit. It is 75% of the AFTER-TAXAND-SOCIAL SECURITY difference between the amount they are currently earning, and the amount they would have been earning if they hadn’t been injured.
PERMANENT PARTIAL DISABILITY [Sec. 31-308(b)]
These benefits are paid to the claimant who has suffered a permanent, partial loss of use of a body part(s), due to their work-related injury. The exact amount is based upon the specific body part which was injured, the attending physician’s determination of the percentage of that body part which has been disabled, and the employee’s basic compensation rate.
RELAPSE OR RECURRENCE [Sec. 31-307b]
This is the wage replacement benefit for which an employee may be eligible, if they are totally disabled from a work-related injury or illness. The benefit rate is 75% of the AFTER-TAX-AND-SOCIAL-SECURITY average weekly wage, based upon the wages earned by the injured worker (hereafter referred to as “claimant”) prior to the injury (up to 52 weeks)
DISCRETIONARY BENEFITS [Sec. 31-308a]
An Administrative Law Judge “may” grant these additional benefits to an employee after he/she has been paid all of their Permanent Partial Disability. The employee must request an informal hearing at which the Administrative Law Judge may or may not grant these benefits, depending upon the specific circumstances of the case.
JOB RETRAINING [Sec. 31-283a]
The Workers’ Compensation Act also provides for vocational rehabilitation for those employees who are injured or become ill as a result of their work, and cannot return to the type of work which caused the injury or illness. These employees may be eligible for some kind of job re-training from the Workers’ Compensation Commission’s Rehabilitation Services.
The Flow of a “Typical” Workers’ Compensation Case
This is a simplified chart representing the basic steps through a “typical” undisputed workers’ compensation case, including the main events in the life of a claim and the corresponding actions taken by the injured/ill employee, the employer/insurer, and the employee’s attending physician.
[NOTE: Any given workers’ compensation case may or may not include any or all of the following steps (e.g., an employee may completely bypass Temporary Total Disability benefits and begin receiving Temporary Partial Disability benefits, if his or her injury only partially incapacitates him or her from work). Also, if an employee’s employer operates an approved Preferred Provider Organization, or PPO, then the appropriate statutes and regulations are in effect.]
1 — Employee Has Work-Related Injury or Illness
Employee:
- Immediately reports injury/illness to employer
- Accepts initial medical treatment from employer-designated physician
- Files 30C Claim Form (Notice of Claim for Compensation)
Employer/Insurer
- Provides employee with initial medical treatment
- Files “First Report of Injury” Form (Accident Report)
Attending Physician:
- Renders initial medical treatment
- Submits initial medical report to employer/insurer and to injured/ill employee at same time
2 — Continued Medical Treatment and Total Incapacity from Work
Employee:
- Chooses attending physician,
after initial medical treatment - Accepts appropriate medical
treatment from attending physician - Furnishes employer/insurer with record of
physician/treatment visits
for mileage reimbursement
Employer/Insurer
- Provides wage statement to insurer, who
initiates payment of Temporary Total
Disability (TT) benefits upon confirmation
of total incapacity from work - Insurer provides Cost-of-Living
Adjustment(s) and/or Dependency
Allowance(s), if applicable - Pays medical bills
Attending Physician:
- Renders appropriate medical treatment
- Confirms Temporary Total Disability
- Provides medical reports as needed to
employer/insurer and to injured/ill
employee at same time - Sends medical bills to employer/insurer
3 — Continuing Period of Total Incapacity while under Treatment by Attending Physician
Employee:
- Continues to accept medical treatment
from attending physician - Signs Voluntary Agreement for TT benefits
- Calls employer/insurer and/or Workers’
Compensation Commission with any
questions
Employer/Insurer
- Continues paying weekly TT benefits
- Issues Voluntary Agreement for TT
benefits - Continues paying medical bills
Attending Physician:
- Renders appropriate medical treatment
- Provides periodic medical reports on
injured/ill employe’s medical status to
employer/insurer and to injured/ill
employee at same time - Sends medical bills to employer/insurer
4 — Medical Status Improves & Employee Becomes Capable of “Light Duty” or “Restricted” Work
Employee:
- Requests light duty/restricted work
from employer - If unavailable from employer, performs a
job search and contacts insurer to request
Temporary Partial Disability (TP) benefits - If attending physician indicates that
restrictions are permanent, may apply to
WCC’s Rehabilitation Services for help
with job retraining and/or placement
Employer/Insurer
- Sends a Form 36 (Discontinuation Notice)
to Workers’ Compensation Commission
and to injured/ill employee for
discontinuation of TT benefits - Begins payment of TP benefits
- Continues paying medical bills
Attending Physician:
- Reports injured/ill employee’s medical
status and work restrictions to
employer/insurer and to employee at same
time - Renders appropriate medical treatment
- Provides periodic medical reports, as earlier
- Sends medical bills to employer/insurer
5 — Injured/Ill Employee Reaches Maximum Medical Improvement (MM
Employee:
- Contacts insurer to reach agreement on
Permanent Partial Disability (PPD) benefits
for any permanent physical impairment - Signs Voluntary Agreement for PPD
benefits
Employer/Insurer
- Begins payment of PPD benefits
- May request an Employer’s/Respondent’s
Examination (formerly IME) - Issues Voluntary Agreement for PPD
benefits for any permanent physical
impairment
Attending Physician:
- Reports injured/ill employee’s medical
status and work restrictions to
employer/insurer and to employee at same
time - Renders appropriate medical treatment
- Provides periodic medical reports, as earlier
- Sends medical bills to employer/insurer
6 — Employee Exhausts Period in which PPD Benefits are Paid (Specific Award)
Employee:
- May request an Informal Hearing with an
Administrative Law Judge in a District
Office to apply for additional discretionary
wage differential “308a” benefits, just prior
to the end of the period for which PPD
benefits are paid
Employer/Insurer
- Pays additional wage differential “308a”
benefits, if directed by an Administrative
Law Judge at an Informal Hearing - Continues paying medical bills
Attending Physician:
- Renders further medical treatment, if
necessary - Sends medical bills to employer/insurer
7 — Injury or Surgery Causes Disfigurement and/or Scarring (except for inguinal hernia or spinal surgery)
Employee:
- Just prior to a year after the date of the
injury or surgery which caused the
disfigurement or scar, contacts the Workers’
Compensation Commission District Office
to request scar/disfigurement evaluation by
an Administrative Law Judge (see page 9
for details on which disfigurements and
scars are eligible for statutory benefits)
Employer/Insurer
- Makes payment for scar or disfigurement
award, if eligible under the Workers’
Compensation Act and if directed by
an Administrative Law Judge
Attending Physician:
- NONE