Return to Work through the Workers’ Compensation

Return to Work through the Workers’ Compensation

Return to Work through the Workers’ Compensation Commission’s Rehabilitation Services
The Basic Idea of Rehabilitation Services
Most workers in the state of Connecticut are protected by workers’ compensation insurance. In addition to provisions covering the loss of earnings and medical care, the Workers’ Compensation Act provides for Vocational Rehabilitation. This service is designed to help you begin to overcome any permanent and substantial loss of earning power you may have suffered as a result of a compensable injury or occupational disease.

The main goal of Rehabilitation Services is to help the injured worker get back to work in a position that is physically appropriate. Prompt and well-planned vocational rehabilitation may help prevent future injuries. Early referral may help the injured worker return to the job market sooner than otherwise might be possible.

Who May Be Eligible?
You may be eligible, if your injury or occupational disease has resulted in permanent limitations which do not allow you to return to your regular job.

You must also have an accepted compensation claim or an approved stipulated agreement.

What Services are Provided?
Each person’s program will be individualized, based on their needs. Services may include:

  • Vocational Counseling
  • Evaluation
  • Aptitude/Interest Testing
  • Training/Education
  • Job Seeking Skills
  • Placement Assistance
Am I Guaranteed A Job?
No one can guarantee you a job. You are, however, guaranteed that your Rehabilitation Coordinator will do everything possible to assist you in your efforts to return to work. This will include advice as to how to best apply for work and where openings in your field may be available.
When Should I Apply?
Apply to Rehabilitation Services as soon as your doctor sees a problem with you returning to your regular work.

Fact: You can refer yourself.
Fact: You don’t have to wait until maximum medical improvement. 18
Fact: You do not need a high school diploma and you do not need to speak English.
Fact: THE SOONER YOU APPLY, THE GREATER YOUR CHANCES FOR SUCCESS!

How Do I Apply?
You can apply by calling the central Workers’ Compensation Commission office at (860) 493-1500 and asking for Rehabilitation Services. We will send you a brochure and an application.

When your application is received, your case will be assigned to a Rehabilitation Coordinator and you will be scheduled for an interview. At that time we will begin the eligibility process and answer any questions you may have. For a more detailed description of the program, please see the Client Handbook.

A Message to Employers
A company’s most valuable asset is its work force. The sooner an injured employee can be returned to work, the lower the cost for the work-related injury. Rehabilitation Services can work with you, if a job modification or new skills are necessary to return your injured employee back to work. Rehabilitation Services has contracted with a Rehabilitation Engineer to provide a one-time work-site consultation for possible job modifications. New skills may be learned through classroom training or from on-the job training. THERE IS NO COST TO YOU FOR THESE SERVICES.
On-The-Job Training
Rehabilitation Services offers financial incentives for employers to take the time to train injured workers to return to the work force with new skills and abilities. Rehabilitation Coordinators are available to discuss your needs. The length of time for training varies based on the skill level of that position.
Is It Worth the Effort?
Only you can decide this. The best outcome of a work-related injury is a successful return to work as quickly as possible. Rehabilitation Services and its staff of Counseling Coordinators are ready to help you help yourself.
Contact
Workers’ Compensation Commission Rehabilitation Services
21 Oak Street, 4th Floor
Hartford, CT 06106-8011
Telephone: (860) 493-1500

Other Benefits Provided by the Workers’ Compensation Act

Other Benefits Provided by the Workers’ Compensation Act

Vocational Rehabilitation [Sec. 31-283a]

If you cannot return to your usual work because of a significant permanent physical impairment, you may be entitled to vocational rehabilitation. If you are eligible, your rehabilitation program will be paid for by the Workers’ Compensation Commission’s Rehabilitation Services. (For more information, see page 18.)

Workers’ Compensation Fraud [Sec. 31-290c]

Workers’ compensation fraud is either a class C felony, if the amount of benefits claimed or received is less than $2,000, or a class B felony, if the amount of benefits claimed or received exceeds $2,000.

Continued Health Insurance Coverage [Sec. 31-284b]

Sec. 31-284b says that the injured workers’s employer must continue paying for their insurance(s) while the employee is receiving workers’ compensation benefits. In 1992 the U.S. Supreme Court determined that this law was unconstitutional as it relates to employees in the private sector. This is because private sector employees come under the protection of the Federal Government’s Employee’s Retirement Income Security Act, also known as ERISA. Therefore, the state of Connecticut could not enact legislation affecting these kinds of employee issues.

Since state and municipal employees do NOT come under the ERISA Act, 31-284b still applies and their employers must continue paying for their employees’ insurance(s) while they are receiving, or eligible to receive, workers’ compensation benefits.

Protection Against Discharge or Discrimination [Sec. 31-290
Section 31-290a of the Workers’ Compensation Act prohibits employers from discharging, or in any way discriminating against, any employee just because the employee has filed a claim for workers’ compensation benefits or otherwise exercised his or her rights under the Act.

Any employee who claims to have been so discharged or so discriminated against may either (1) bring a civil action in the superior court for the judicial district where the employer has its principal office or (2) file a complaint with the Workers’ Compensation Commission (WCC) Chairman alleging violation of section 31-290a. Upon receiving such a complaint, the WCC Chairman shall select an Administrative Law Judge to hear the complaint in the WCC District Office having jurisdiction over the location of the employer’s principal office. If an Administrative Law Judge finds that the employee was wrongfully discharged or discriminated against, he or she may award job reinstatement, payment of back wages, and any other employee benefits which the employee lost, as well as reasonable attorney’s fees.

To file a Discrimination Complaint under Section 31-290a, the employee should send their complaint to: Stephen M. Morelli, Chairman, Workers’ Compensation Commission, 21 Oak Street, Hartford, CT 06106. The complaint must include:

(1) the employee’s name and address, (2) the name and address of the employer, (3) the date of the injury or illness, and (4) the date and nature of the alleged discharge or discrimination. The WCC Chairman will see that a hearing is scheduled before an Administrative Law Judge in the
appropriate workers’ compensation district office.

Workers’ Compensation Fraud Unit [Sec. 31-290d]

The State of Connecticut’s Fraud Unit operates out of the Chief State’s Attorney’s Office, Division of Criminal Justice, and investigates complaints of all parties alleged to be engaging in any form of workers’ compensation fraud. The Unit makes arrests and prosecutes those it believes to be engaging in workers’ compensation fraud. For more information, or to report alleged cases of workers’ compensation fraud, call the Workers’ Compensation Fraud Unit at (860) 258-5800.
Benefits under Group Medical Policy [Sec. 31-299a]
If an employee’s claim is denied and that employee has other insurance that pays for their medical care or lost time (i.e., health or disability insurance), they should submit their claims for payment to those insurance companies,
while their workers’ compensation claim is pending. The workers’ compensation insurer should issue a Form 43 (see the Forms section beginning on page 21), if they are denying the claim.

This should then be submitted along with any medical bills, or claims for wage replacement, to the employee’s health insurer or short-term/long-term disability insurer, if they have one. Since the Form 43 attests to the fact that the workers’ compensation insurer has denied the claim, the “other” insurance companies must honor their contractual obligations pending the outcome of the workers’ compensation claim. If the workers’ compensation claim is eventually approved, then the “other” insurances will have to contact the workers’ compensation insurer about getting their money back.

Artificial Aids Covered [Sec. 31-311]
Employers are liable for payment of damages to artificial legs, feet, arms, or hands sustained by their employees in the course of employment (consisting of the cost of the artificial aid’s repair or replacement). Repair or replacement of eyeglasses, contact lenses, hearing aids, and artificial teeth is also covered, when damage to such aids is accompanied by bodily injury about the face or head.
Right of Transfer to Suitable Work [Sec. 31-313]
If the injured worker cannot return to their usual job because of their injury, the employer should transfer that employee to full-time suitable work, if it is available, provided this does not conflict with the terms of a labor contract.

All workers’ compensation benefits are non-taxable (except for benefits obtained under Section 7-433c, Heart & Hypertension Benefits for Police and Firefighters). For more information on taxability of benefits, contact the Internal Revenue Service (for federal guidelines) or the State Department of Revenue Services (for state guidelines).

Benefits for Permanent Partial Disability

Benefits for Permanent Partial Disability

Benefits for Permanent Partial Disability resulting from a Work-Related
Injury or Illness
Many employees with work-related injuries or illnesses end up with a “Permanent Partial Disability” (PPD), meaning that they have lost some body part, or some use of a body part or function, and are usually eligible for PPD benefits. When the attending physician determines that the injured employee has reached “maximum medical improvement” (MMI), he/she should issue an opinion about whether a permanent partial disability resulted from the injury or illness by assigning the disability rating to the specific body part involved.

Section 31-308 provides a list (see page 15) of body parts with the total number of weeks of compensation provided by law for each. For example, the master arm is scheduled for 208 weeks, so a “20% loss of use of the master arm” equals 20% of 208 weeks which equals 41.6 weeks of benefits. An employee eligible for a $200 per week benefit rate would receive 41.6 weekly payments of $200 for a total PPD benefit payment of $8,320.

The PPD weekly benefit rate is determined by the employee’s basic compensation rate at the time of the original injury or illness. As in everything else, it is subject to the legislated maximum and minimum amounts. After completing the disability evaluation, Form 42 (see the Forms section beginning on page 24), the attending physician giving the PPD rating should forward it to the employee, the employer/insurer, and the WCC District Office. PPD benefits should then begin within 30 days of the MMI date, or interest penalties may be applied. If the employer/insurer accepts the evaluation, a Voluntary Agreement (see the Forms section beginning on page 21) should be issued promptly for an Administrative Law Judge’s approval. This does not close out the case.

The claim remains open and the employer/insurer is still liable for future medical expenses and other compensation benefits. No workers’ compensation case may be closed without mutual agreement on the part of the claimant and the employer/insurer.

If there are two different opinions as to the degree of disability, the employee and the employer/insurer can either attempt to work out a compromise or request an Informal Hearing on the matter, where an Administrative Law Judge will review all medical information presented and may suggest a resolution to the dispute. (See Hearings and Appeals on page 12.)

In most cases, claimants will receive undisputed PPD benefits without the need for legal representation.

Maximum PPD Benefit Schedule [31-308]
(for injuries/illnesses ON OR AFTER July 1, 1993)
Arm (master)………………………………………….208 Weeks
Arm (other) ……………………………………………194
Back ………………………………………………………374
Brain……………………………………………………..520
Carotid Artery ……………………………………….520
Cervical Spine ……………………………………….117
Coccyx (actual removal)…………………………35
Eye ……………………………………………………….157
Finger (first) ** ……………………………………..36
Finger (second) **………………………………….29
Finger (third) **……………………………………..21
Finger (fourth) **…………………………………..17
Foot ………………………………………………………125
Gall Bladder…………………………………………..13
Hand (master) ……………………………………….168
Hand (other)…………………………………………..155
Hearing (both ears) ………………………………..104
Hearing (one ear)……………………………………35
Heart………………………………………………………520
Jaw (mastication) ……………………………………35
Kidney…………………………………………………….117
Leg …………………………………………………………155
Liver………………………………………………………..347
Loss of Bladder………………………………………..233
Loss of Drainage Duct of Eye …………………..17 each
(if corrected or uncorrected by prosthesis)
Lung………………………………………………………117
Mammary ……………………………………………..35
Nose (sense and respiratory function)……35
Ovary …………………………………………………….35
Pancreas…………………………………………………416
Pelvis………………………………………………………% of Back
Penis ………………………………………………………35-104
Rib Cage (bilateral) ………………………………….69
Sense of Smell ………………………………………..17
Sense of Taste…………………………………………17
Speech ……………………………………………………163
Spleen …………………………………………………….13
Stomach ………………………………………………….260
Testis ……………………………………………………….35
Thumb (master Hand) * ……………………………63
Thumb (other Hand) * ………………………………54
Toe (great) ***…………………………………………..28
Toe (any other) *** ……………………………………9
Uterus ……………………………………………………….35-104
Vagina ……………………………………………………….35-104
Notes
* The loss or loss of use of one phalanx of a thumb shall be construed as 75% of the loss of the thumb.
** The loss or loss of use of one phalanx of a finger shall be construed as 50% of the loss of the finger.
The loss of or loss of use of two phalanges of a finger shall be construed as 90% of the loss of the finger.
*** The loss or loss of use of one phalanx of a great toe shall be construed as 66-2/3% of the loss of the great toe.
The loss of the greater part of any phalanx shall be construed as the loss of a phalanx and shall be compensated accordingly

The 30C Form: Notice of Claim for Compensation

The 30C Form: Notice of Claim for Compensation

The 30C Form: Notice of Claim for Compensation
When an employee is injured or becomes ill as a result of their employment, the Workers’ Compensation Act (Sec. 31-294c) requires that he/she notify their employer of their intention to file a workers’ compensation claim. The law allows the employee 1 year from the date of injury or 3 years from the 1st manifestation of a symptom of an occupational disease in which to do this. Although the employer files a First Report of Injury to notify the insurer, it is the Form 30C, which is filed by the injured worker and served upon the employer, which satisfies this statutory requirement. (You can find copies of these forms in the Forms section beginning on page 24 of this Packet.)

As soon as the employer receives this notice of claim, they should forward it to the insurer in order to allow them time to make a determination as to the compensability of the claim. The employer/insurer then has 28 days in which to commence payment for lost time (if any), or deny the claim. If they do neither within that period of time, they lose their right to contest the claim, thereby accepting responsibility. If payments are begun within the 28 days, the employer/insurer then has up to ONE YEAR in which to contest the claim, should circumstances warrant.

Voluntary Agreement [Sec. 31-296]
If the injury/illness disables the claimant for more than 3 days and the insurance company does not deny the claim, they must issue a Voluntary Agreement (VA), which is a statement of acceptance of responsibility for the claim. The VA must be signed by all parties and approved by an Administrative Law Judge.

The law requires the insurance company to issue this Voluntary Agreement. If you do not receive a VA within a month from the date of your disability, you should call the insurance company and request that they issue one to you. It is your right and their responsibility under the law.

The official State of Connecticut Workers’ Compensation Voluntary Agreement form is green. (We have included a COPY of the Voluntary Agreement in the Forms section of this Packet beginning on page 24, so you will know what it looks like.)

To the Claimant: Filing an Official Workers’ Compensation Claim (30C Form)
If you are injured on the job or are diagnosed as having a work-related disease, you should file a written notice of claim for workers’ compensation as soon as possible. The 30C is the official form which the Workers’ Compensation Commission provides for this purpose. (There is a 30C form which you may use, as well as line-byline directions for completing it, in the Forms section on page 24 of this Packet.)

A Form 30C should be filed promptly after a work-related injury takes place. There is a statute of limitation for filing workers’ compensation claims: within ONE YEAR of the date of an injury or within THREE YEARS of the first manifestation of a symptom of an occupational disease. Neither the First Report of Injury nor the employer’s accident report satisfies this statutory requirement.

The 30C Form must be sent by registered or certified mail to both your employer and the Workers’ Compensation Commission District Office which has jurisdiction over the city or town in which you were injured or became ill; NOT the town in which you live. You must ask for a return receipt from the Post Office as proof of the date that it was received. You may also deliver it in person. If you do, you must have your employer sign and date the form as proof of their receipt.

(See pages 21-23 of this Packet for a complete list of Connecticut cities and towns and the District Offices which have jurisdiction over them for workers’ compensation claims.)

You should file a 30C Claim Form because:
1. It is the best way to insure that you have met the statute of limitations for filing a workers’ compensation claim.
2. A simple “accident report” filed with your employer is NOT an official claim for workers’ compensation benefits.
3. Your claim will be more likely to receive prompt attention from your employer or insurance carrier.
4. Once your employer receives an official claim, it has only 28 calendar days in which to either deny your claim or to begin making workers’ compensation benefit payments “without prejudice.” If an official denial is not issued within 28 calendar days or if benefit payments are not initiated within 28 calendar days, your employer MUST accept the compensability of your claim. (If your employer has opted to post a location where you must file your claim, this 28-day period begins when your employer has received your claim at the location posted.)
If you are injured on the job, follow the proper procedures to protect your rights!
First Report your injury immediately to your employer, who must then provide you with proper medical attention. Do not delay in reporting workplace injuries. Many claimants are initially denied benefits because they did not report their injuries immediately.

Second File a proper written notice of claim—a 30C Form—as soon as possible! This is YOUR RESPONSIBILITY! A 30C Form has been included in this packet for your convenience.

Third Ask your employer for the name of their workers’ compensation insurance company. Follow the directions and, if you need assistance, call our toll-free number in Connecticut at 1-800-223-WORK (9675) or call 860-493-1500 and ask to speak to an Education Coordinator.

Wage Replacement Benefits for Employees

Wage Replacement Benefits for Employees

Wage Replacement Benefits for Employees Disabled from Work-Related Injuries and Illnesses

Full Pay for Day of Injury [Sec. 31-295]
The employee should receive his/her full day’s wages for the day the injury occurred, whether or not he/she was able to return to work after the accident
Temporary Total Disability (TT) Benefits [Sec. 31-307]
Weekly TT benefits while totally disabled from ANY type of work are equal to 75% of the employee’s after-tax average weekly wage (after federal and state taxes and FICA deductions) for the 52-week period prior to the injury or illness, subject to the legislated maximum and minimum amounts.
Waiting Period [Sec. 31-295
No compensation benefits for Temporary Total Disability or Temporary Partial Disability (below) are paid until an injured or ill employee is incapacitated from work for MORE than three calendar days. Benefits begin on the fourth day of incapacity from work and if the employee remains incapacitated for seven or more calendar days, the three-day waiting period is eliminated and benefits are paid from the beginning of the employee’s incapacity.

In counting days of incapacity from work, all calendar days are counted, even if the employee was not scheduled to work during any or all of them. (The day of the injury itself does NOT count as a day of incapacity from work.)

Temporary Partial Disability (TP) Benefits during a Job Search [Sec. 31-308(a)]
If the employee is released for “light duty” or “restricted” work and the employer does not have such work, he/she is entitled to Temporary Partial Disability (TP) benefits while performing a job search for suitable employment. TP benefits are paid at the basic weekly TT compensation rate, subject to the legislated maximum and minimum amounts.
Temporary Partial Disability (TP) Benefits in a Lower-Paying Job [Sec. 31-308(a)]
If, as a result of the injury, the employee returns to a lower-paying job (described as either “light duty” or “restricted”), he/she is entitled to Temporary Partial Disability (TP) wage differential benefits. These TP benefits are equal to 75% of the after-tax difference between the wages they are currently earning, and the wages currently being paid in their former job, subject to the legislated maximum and minimum amounts.
Permanent Partial Disability (PPD) Benefits [Sec. 31-308(b)]
If the employee’s attending physician determines that Maximum Medical Improvement (MMI) has been reached and that the employee has sustained a permanent, but only partial loss, or loss of use of, a body part, that physician should issue a percentage disability rating, usually on a Form 42 or in the form of a medical report. Such a disability rating marks the end of other workers’ compensation benefits (TT and/or TP) and makes the employee eligible to receive weekly PPD benefits for a specific number of weeks.

The weekly PPD benefit rate is determined by the specific body part that was injured and the basic compensation that the employee was receiving at the time of their original injury. This also is subject to the legislated maximum and minimum amounts. Payment of this benefit does not close out the claimant’s case. (See pages 14-15 of this Packet for more information.)

Cost-of-Living Adjustment (COLA) to Dependent Survivor Benefits [Sec. 31-307a]
Dependents of employees who died as a result of their work-related injury or illness are entitled to an annual Cost of Living Adjustment every October 1st beginning with the October 1st after their death. The amount of the increase is based upon the date of the injury pursuant to section 31-309 of the Workers’ Compensation Act.
Cost-of-Living Adjustment (COLA) [Sec. 31-307a]
Effective July 1, 1993, only claimants who are judged to be Permanently Totally disabled or claimants who have been Temporarily Totally disabled for five (5) years or more are entitled to receive Cost-of-Living Adjustments, in accordance with the provisions set out in section 31-309 of the Workers’ Compensation Act.
Benefits for a Recurrence or Relapse from Recovery [Sec. 31-307b]
If the employee returns to work from an injury, but then has a recurrence or relapse from recovery, he/she will again be eligible to receive workers’ compensation wage replacement benefits. This weekly compensation rate is based on the original TT benefit rate (plus cost-of-living adjustments) OR the TT rate based on the employee’s earnings at the time of the recurrence or relapse, whichever is higher.
Disfigurement and Scarring Benefits [Sec. 31-308(c)]
An Administrative Law Judge may award benefits for any permanent, significant disfigurement or scar due to a work-related injury (1) on the face, head, or neck, or (2) on any other area of the body that handicaps the claimant in obtaining or continuing to work.

These awards cannot be requested any earlier than one (1) year after nor any later than two (2) years after the injury or surgery causing the disfigurement or scar. Scarring is not allowed for spinal surgery of the neck.

The weekly Disfigurement and Scarring benefit rate is equal to the employee’s weekly TT benefit rate, subject to the legislated maximum and minimum amounts, and may be paid for a period of up to 208 weeks.

Discretionary Wage Differential “308a” Benefits [Sec. 31-308a]
An Administrative Law Judge “may” grant additional benefits to an employee after he/she has been paid all of their Permanent Partial Disability, if the injury results in their inability to find employment, or the new employment pays less than the original job. The employee must request a hearing in the appropriate Workers’ Compensation district in order to request these benefits.

“308a”/Discretionary benefits are equal to 75% of the employee’s after-tax loss in earnings, subject to the legislated maximum and minimum amounts. This is the NET difference between the amount the employee is currently earning and the amount they would have been earning, if they hadn’t been injured. The employee “may” be granted this benefit for a specific number of weeks, which may be less than but cannot exceed the number of weeks he/she received their Permanent Partial payments

Dependent Survivor (“Fatality”) Benefits [Sec. 31-306]
When an employee’s death is caused by a work-related injury or illness, a surviving spouse or other eligible dependent may be entitled to burial expenses of $4,000 and weekly wage replacement benefits equal to 75% of the deceased employee’s after-tax average weekly wage (after federal and state taxes and FICA deductions), subject to the legislated maximum and minimum amounts.

(Also see the Dependent Survivors’ COLA information above.) There are other benefits provided by the Workers’ Compensation Act and other State laws for which you may also be eligible. For a description of some of these, see Medical Treatment for Employees with Work-Related Injuries or Illnesses (page 5) and Other Benefits Provided by the Workers’ Compensation Act (page 16).

Medical Treatment for Employees

Medical Treatment for Employees

Medical Treatment for Employees
with Work-Related Injuries or Illnesses

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.