Job Searches
1. Apply to your employer for the type of light or restricted work your attending physician says you can do. If no such work is offered, register with the Connecticut Job Service and initiate a job search for any type of suitable work in your geographical area, even if it is not your ordinary type of work.
2. Inform the insurance carrier of your change in status and make arrangements to send a list of your employment contacts on a weekly basis to the adjuster that is handling your case. (You can find a form you may use for this purpose in the Forms section beginning on page 24 of this Packet.)
3. Confirm that the adjuster will be sending you a weekly check for temporary partial benefits for every week that your list of job searches is received. Your TP benefit rate will be equal to your original weekly benefit rate subject to the maximum and minimum benefit amounts.
4. If you find work that pays you less than what you would usually earn in your regular work, notify the adjuster. You should receive wage differential benefits from the insurer, until your attending physician either says that you can return to your regular work or you have reached your maximum level of medical improvement. You will need to send copies of your pay stubs to the adjuster in order to receive this payment, which is 75% of the difference between what you are currently earning and what you would have been earning in your original job.
If you return to work, you may now collect your weekly pay and receive your PPD benefits. If you do not have a job at this time and the Unemployment Office deems you eligible, you may collect your PPD benefits while you are also collecting unemployment benefits. To determine whether you are eligible for these benefits, contact the nearest Department of Labor Unemployment Office (usually listed in the blue pages of your phone book).
Of all disputed cases, over 95% are settled in Informal Hearings. In a very small number of cases, usually involving very complex issues or matters of law, disputes are taken to Formal Hearings for resolution. Decisions rendered at Formal Hearings may be appealed to the Compensation Review Board (CRB). [Cases may also be appealed past the CRB to the Appellate Court and to the State Supreme Court, but this is very rare indeed.] Sec. 31-290a cases, involving Discharge and Discrimination, do not get appealed to the CRB, but directly to the Appellate Court.
Hearings may also be held for reasons other than disputes. For instance, a claimant must request an Informal Hearing before an Administrative Law Judge to request discretionary “308a” wage differential benefits or to have a scar or disfigurement evaluation.
Both the claimant and the employer or its workers’ compensation insurance carrier attend the Informal Hearing. (An Informal Hearing will not be postponed if one party fails to attend, unless both parties have agreed ahead of time to such a postponement.) A claimant may come alone to an Informal Hearing or may come with an interpreter (if needed) and may also be represented by an attorney, union official, or other workers’ compensation representative. Employers and insurers often have an insurance adjuster and/or attorney as their representative(s).
As a claimant, you have the right to attend hearings involving your case, including when represented by counsel.
The Informal Hearing is informal in nature, simply including a discussion of the issues and evidence, and most often a recommendation by an Administrative Law Judge as to how to resolve the dispute. There are no stenographic records of such hearings.
The party requesting the hearing should clearly explain to the Administrative Law Judge any issues that are in dispute. Evidence (such as medical reports, test results, evaluations, or any documents supporting the request) should have been attached to the Hearing Request so that the Administrative Law Judge will have them in the file. After reviewing evidence presented and discussing the issues, the Administrative Law Judge will usually make a recommendation to resolve the dispute. If both parties agree, the recommendation(s) will be binding upon the parties as an award made by the Administrative Law Judge.
When a resolution cannot be determined and agreed upon in one Informal Hearing, another one is usually scheduled for more discussion, presentation of evidence, or for whatever other reason(s) the Administrative Law Judge deems necessary. In cases where the parties cannot reach agreement after one or more Informal Hearing(s), it may be necessary to request a Formal Hearing.
The purpose of the Pre-Formal Hearing is to help the settlement of claims and to prepare a case for trial at a Formal Hearing by clarifying the issues in dispute. At the Pre-Formal Hearing, the parties should cover the issues to be decided at the Formal Hearing, the evidence that they expect to submit, the particular testimony to be addressed, and the names of persons being deposed. Once the hearing is concluded, the parties should know what the Administrative Law Judge expects of them for the Formal Hearing. They should not expect the Administrative Law Judge to consider issues or evidence, including testimony, that goes beyond the matters addressed at the Pre-Formal Hearing.
At the Pre-Formal Hearing, the parties should also agree to a timetable for preparing their respective cases. This timetable will be given to the Administrative Law Judge, who may either schedule a second Pre-Formal Hearing to confirm that the parties have followed the schedule, or proceed to schedule the Formal Hearing. The goal of a Pre-Formal Hearing is to streamline the overall process.
The purpose of Formal Hearings, like that of the Informal Hearings, is to resolve differences and disagreements. It is the second level of hearing available to adverse parties in a workers’ compensation case, although perhaps only about 3% or 4% of disputed cases ever reach this level. (NOTE: A Formal Hearing is scheduled ONLY when disputes are not resolved by an Administrative Law Judge at one or more Informal Hearings; they are NOT scheduled without previous attempts to reach agreement at the Informal Hearing level.)
Like the Informal Hearing, either party—claimant or respondent—may request a Formal Hearing, if earlier Informal Hearings have failed to produce an agreement between the adverse parties. Both the claimant and the respondent attend the hearing. Although a claimant may represent himself or herself (called “pro se”) at a Formal Hearing and they are not legally required to retain an attorney, it is almost always recommended that the claimant be represented at this level by legal counsel.
In Formal Hearings, which resemble court trials, evidence is submitted as exhibits, witnesses may be produced and provide testimony under oath, and a stenographic record of the proceedings is taken. Unlike regular court trials, however, an Administrative Law Judge is not as restricted by statutory rules of evidence or procedure. It is the Administrative Law Judge’s duty in a Formal Hearing to make inquiry (through oral testimony, deposition testimony, or through written or printed records) in a manner designed to ascertain each of the parties’ substantial rights and carry out the provisions of the Workers’ Compensation Act, as well as its intent.
Following a Formal Hearing the presiding Administrative Law Judge reviews the evidence presented, as well as any briefs filed with the Administrative Law Judge after the actual hearing, and renders a written decision called a “Finding and Award” or a “Finding and Dismissal” in which he or she issues any findings of fact and conclusions regarding the disputed issue(s) in the case. It must be delivered to both parties within 120 days after the conclusion of the hearing. This written decision is binding on all parties, unless appealed by either party to the Workers’ Compensation Commission’s Compensation Review Board (CRB).
After an Administrative Law Judge has rendered a Formal Hearing decision, either party to the claim has twenty (20) days in which to appeal the Administrative Law Judge’s decision to the CRB, which does NOT try the case again, but hears the appeal on the record of the earlier hearing. The CRB will not change an Administrative Law Judge’s decision from the earlier hearing, if that decision was based on the evidence presented. New evidence or testimony will be allowed ONLY if the CRB determines that such evidence or testimony is material and there were good reasons for failure to present it at the Formal Hearing.