Medical Treatment for Employees | Kerin Law Offices

Initial Medical Treatment [Sec. 31-294d]

When an injury occurs, a claimant is entitled to receive all necessary and appropriate medical treatment. The employer is responsible for furnishing the initial medical treatment at an employer-designated office or facility. After this initial treatment, the employee may choose an attending physician.

If the claimant refuses the initial employer-provided medical care and fails to obtain treatment, they may risk their entitlement to Workers’ Compensation benefits.

Choice of Physician [Sec. 31-294d]

A claimant may choose an attending physician AFTER the initial visit with an employer-designated medical practitioner. If the employer does not participate in an approved medical care plan, the claimant may choose any medical practitioner who is licensed to practice in Connecticut, including practitioners of chiropractic, medicine,
naturopathy, osteopathy, and podiatry.

A claimant whose employer does participate in an approved medical care plan must choose a physician from the list of doctors included in that plan. If the employee chooses a physician “outside” the plan, an Administrative Law Judge may suspend all rights to workers’ compensation benefits. In either case, it is the injured worker who has the right to choose.

Change of Physician [Sec. 31-294d]

A claimant may change their attending physician, if dissatisfied with the medical treatment being rendered. There are three ways in which a claimant may effect a change of physician:

(1) Get a referral from the present attending physician,
(2) Obtain approval to change physicians from the workers’ compensation insurance carrier involved (or the
employer, if it is self-insured),
OR

(3) Write to the Administrative Law Judge in the District Office having jurisdiction. Indicate the name,
address, and medical specialty of the present physician, as well as the name, address, and medical specialty
of the “new” physician, and the reason(s) for requesting a change. In this case, the Administrative Law
Judge could reply by mail or set up an informal hearing.

NOTE: If a claimant does not have an attending physician’s referral to another medical practitioner, or permission to change physicians from the insurer, self-insured employer, or Administrative Law Judge, they will most likely be liable to pay for any “unauthorized” medical bills which may arise.

Out-of-State Physicians [Sec. 31-294d]

A claimant MUST receive all necessary medical care for the injury or illness from medical practitioners licensed to practice in Connecticut. If, for any number of reasons, the employee requires treatment with a doctor outside of the state, the employer/insurer could grant permission or the claimant would have to request permission from an Administrative Law Judge who may or may not authorize out-of-state treatment.

If the claimant resides in another state, an Administrative Law Judge may authorize medical care by a physician in that state.

Employer’s/Respondent’s Examination (Formerly IME) [Sec. 31-294f]

At any time while claiming or receiving workers’ compensation benefits, an employee may be directed by an Administrative Law Judge, or requested by the employer or its workers’ compensation insurance carrier, to submit to an Employer/Respondent’s Examination (formerly known as IME), paid for by the employer/ respondent.

The purpose of the exam is to determine the nature and extent of the injury. The claimant may have their own attending physician present (at their own expense), but this is not a common practice. The claimant must submit to examination upon reasonable request, and refusal to do so may suspend any right to receive compensation. (A request may be considered unreasonable, if it involves lengthy or difficult travel.

The claimant should request an Informal Hearing before a Commissioners to make this determination.) The examining physician must furnish the employer’s/respondent’s medical report within 30 days of its completion, at the same time and in the same manner, to both the employer (or its insurer) and to the claimant (or their attorney, if represented).

Out-of-State Physicians [Sec. 31-294d]

A claimant MUST receive all necessary medical care for the injury or illness from medical practitioners licensed to practice in Connecticut. If, for any number of reasons, the employee requires treatment with a doctor outside of the state, the employer/insurer could grant permission or the claimant would have to request permission from an Administrative Law Judge who may or may not authorize out-of-state treatment.

If the claimant resides in another state, an Administrative Law Judge may authorize medical care by a physician in that state.

Unauthorized Medical Care [Sec. 31-294d]

Medical care provided by a practitioner other than the attending physician or a specialist to whom the claimant has been referred, is the claimant’s responsibility as these treatments and their charges are considered unauthorized.

The Commission Medical Exam [Sec. 31-294f]

Sometimes there is a significant difference in opinion between the attending physician and the employer’s/ respondent’s physician, and the parties are unable to reach an agreement. In these cases the Administrative Law Judge has the authority to send the claimant for a “Commission Medical Examination”.

The examiner is chosen on the basis that he/she is free of any bias or interest, not aligned with either of the parties, and therefore able to impart an independent medical opinion. The claimant must agree to be seen by this doctor or risk the chance of losing their workers’ compensation benefits.

Medical Bills [Sec. 31-279-9]

All medical bills for a compensable injury or illness should be paid by the workers’ compensation provider (workers’ compensation insurance carrier or self-insured employer). All medical bills for compensable claims must be sent directly to the workers’ compensation provider, NEVER to the claimant. It is also against Connecticut Regulations for any medical practitioner to ask a claimant for payment for medical treatment, or to refuse a claimant necessary medical care because the practitioner has not yet been paid by the workers’ compensation provider for previously-rendered services

Travel Expenses for Medical Services [Sec. 31-312]

The employer must furnish, or pay for, transportation for an injured employee to go to and from medical examination, treatment, or testing. If medically necessary, this includes transportation by ambulance or taxi. If the claimant uses a private vehicle to travel to and from medical services, they must be reimbursed for expenses at the federal mileage reimbursement rate, as determined by the U.S. General Services Administration (GSA).

In practice, most employees keep a record of their travel with each visit’s date, location, and mileage, and send a copy of this record to the workers’ compensation insurer or self-insured employer periodically or at the end of treatment. The insurer or employer should send the claimant a check for the expenses within a reasonable period of time. (See the Forms section beginning on page 24 for a mileage form you may use for this purpose.)

Lost Time Reimbursement for Medical Treatment [Sec. 31-312]

The claimant who needs medical attention should obtain such medical care during normal work hours, if this is possible, and should be paid by the employer at their normal rate of earnings (if the employee is not receiving or eligible to receive workers’ compensation wage replacement benefits). An employer CANNOT require the claimant to receive medical treatment outside of their regular work hours, if such treatment is available during regular work hours. If necessary care is not available during normal work hours, the claimant should receive care when it is available and should be reimbursed at the rate of their average hourly earnings by the employer, as if it were time lost from work. The employer may then seek reimbursement from their workers’ compensation insurer.

Prescription Reimbursement [Sec. 31-294d]

Prescriptions given by an attending physician as part of medical treatment for a work-related injury or illness are fully covered.

All expenses for prescriptions must be paid directly by the carrier or self-insured employer, and claimants should not have to pay for them or seek reimbursement. This relates to all employers whether they participate in a managed care plan or not.

Right to Medical Reports [Sec. 31-294f]

The claimant is entitled to a copy of every medical report by any medical practitioner providing care for the injury or illness, in the same manner and at the same time as reports provided to the employer or its workers’ compensation insurance carrier, at no additional charge. If the claimant retains legal counsel, the reports must be furnished to the attorney instead of the claimant.