Injuries on the job affect our members on an all too regular basis. Our jobs can be dangerous, and injuries can happen without warning. It's with this in mind that the Union has reinstated its workers’ compensation program.  The state employee workers’ compensation system can be difficult to navigate; and it is even more confusing when dealing with hazardous duty classifications.  

Thankfully, most injuries are not serious in nature, however even a relatively minor injury should still be reported. You never know when an injury you sustained months, or even years, ago may become aggravated again. If you failed to report it when you were initially injured, you run the risk of not being covered by workers' compensation. 

There are basic steps you should take if you are ever injured at work, and remember— no injury is too minor to report.  You may not have lost any time from the job due to the injury, but it still should be reported, regardless of whether or not you believe it merits filing. Please follow the three easy steps in the box below when documenting and reporting your injury/illness:

The statute of limitations for filing an injury report is ONE YEAR, however it is suggested that you file as soon as possible after the injury is sustained. The statute of limitations for an occupational illness is three years.

Just a word of caution to anyone who thinks that workers' compensation is an "Easy Street" to taking time off from work. Falsely reporting and collecting on a workers' comp. claim is either a Class B or Class C felony, depending on the monetary amount you’ve received. 

Any member who has been injured on the job and has not contacted the Union; please call so we may start a case. Our goal is to establish a database of workers’ compensation claims for use in hazardous duty evaluations and health and safety issues.

Finally, We have compiled some information to guide you as your claim goes forward in the workers compensation system.  First, the State requires that employees use a managed care system for treatment of workers compensation injuries. Physicians and pharmacies must participate in the system to provide coverage. Please check the links below to make sure your using the proper providers.

Lastly, We have compiled a guide for our members to help answer any questions that come up during your claim. This guide is available as a download below. I would suggest that all members read this guide regardless if you’re involved in a workers’ compensation claim or not.

Members Guide To Workers' Compensation

(Click article or title to view.)

I. Definition of Workers’ Compensation 

Workers’ Compensation is a type of insurance intended to provide wage replacement, medical bill coverage, and other benefits to employees and their families due to occupational injuries and illnesses. It is a mandated program governed primarily by laws found in the Connecticut General Statutes. All employees on state payrolls are eligible for workers’ compensation benefits in the event of accident or injury in the performance of their on- the-job duties. This includes all paid full-time and part-time employees.

The Workers’ Compensation program for state employees is managed by the Department of Administrative Services, but is administered through an outside contractor known as the Third Party Administrator (TPA).

This guide is adapted from the program guidelines issued to state agencies and is intended to give members information regarding procedures and some general information regarding workers’ compensation rules and benefits. Because each claim is different, please contact the Workers’ Compensation Representative at the Union office for assistance with your claim.

 II. Reporting an Injury 

An employee should immediately inform his/her supervisor about the injury, and call their Human Resources Department, or your agency’s designee to have the required W/C 207 Form – “Report of Occupational Injury or Disease to an Employee” completed. This form collects detailed information about a work related injury, and is the initial step for filing a workers’ compensation claim. If your agency requires additional reports you will need to complete these forms as required. As a state employee, if you do not file a WC-207, you will not be covered by Workers Compensation.

III. Seeking Medical Treatment 

Members injured on the job are required to seek treatment from a provider within the State of Connecticut’s Managed Medical Care Network.  A copy of this directory is available at the Union office. If you have a question as to whether or not a provider is in the network, contact the Union office at (860) 953-2626 and someone will assist you. If an employee receives medical care from a provider outside the network, he/she risks being ineligible for any workers’ compensation benefits, subject to the order of the Workers’ Compensation Commissioner.

• Initial Treatment: An injured employee should seek initial treatment for non-emergency injuries at the facility designated by your agency.
• Emergency Injuries: For emergency injuries (injuries that, if not treated immediately, would seriously jeopardize or impair health) a member may be treated at a provider outside the network if no network provider is immediately accessible.
• Subsequent Care: After initial treatment a member may select a physician from the network for on-going treatment, or may be referred to a physician within the network. Once the treating physician has been established, the TPA or the Workers' Compensation Commissioner must approve a subsequent change of provider.

Attending physicians are required to submit reports of the injured employee’s treatment and condition, and should use a “Worker Status Report” form for this purpose.

• The form contains information pertaining to diagnosis, treatment plan, and work capacity, which may include specific work restrictions.
• This form is generally completed immediately following an appointment and given to the employee.
• Employees should submit the form to Human Resources and to his/her supervisor as soon as possible.

IV. Covering the Cost of Medical Treatment 

The TPA will pay for medical treatment of a compensable claim.

• Prior approval must be sought for some treatment, such as physical therapy, and must be pre-certified by the TPA's medical case manager. The provider will request the treatment authorization.
• Medication is also provided under Workers’ Compensation Act.
• No payment will be required for pharmacies participating in the State’s pharmacy plan.
• If an employee goes to a non-participating pharmacy, he/she will pay out of pocket and request reimbursement from the Third Party Administrator.
• Employees can receive reimbursement from the TPA for mileage to and from medical appointments.

• If a claim is contested, all medical bills must be submitted to the health carrier for payment. If the claim is later approved, the TPA will reimburse the health carrier.
   

V. The Third Party Administrator’s Role 

Once an injury is reported, the Third Party Administrator (TPA) will review the claim and the Form 207 to determine compensability and:

• If the claim is accepted, will issue any appropriate workers’ compensation benefits.
• If they have determined that a disability benefit is due, the wage benefit will be calculated based on previous wage information provided by Human Resources.
• The TPA will mail wage benefits to the employee. Direct deposit is not available. Wages are paid on the same time schedule as State payroll.

The TPA may prepare a Form WCC-1- “Agreement as to Workers’ Compensation”, or “Voluntary Agreement”. This document contains identifying and payment information acknowledging the employee’s Workers’ Compensation benefits.

When a claim is voluntarily accepted under a voluntary agreement and/or payments have been made against the claim, written legal notice has been satisfied and no further reporting by the employee is necessary.  

VI. A Contested Claim 

The TPA may contest the compensability of a claim after appropriate investigation. Some reasons why a claim may be contested are as follows:

• The cause of the injury was due to the willful and serious misconduct of the employee.
• The cause of the injury was due to the employee’s use of alcohol or narcotic drugs.
• The cause of the injury involved voluntary participation in recreation and sports activities regardless if the employer sponsored the activity.
• The injury reported was purely a mental or emotional injury.
• There is evidence that shows the injury occurred outside the course or scope of employment.
• There is evidence that the employee intentionally falsified employment and/or health records.

The TPA will issue a Form 43, “Notice to Compensation Commissioner of Intention to Contest Liability to Pay Compensation” when a claim is contested.

• Employees may challenge the TPA’s contestment by scheduling an informal hearing with the Workers’ Compensation Commissioner.
• The TPA or an injured employee may request the Compensation Commissioner to schedule an informal hearing to resolve disputes over workers’ compensation benefits.
• Hearings are scheduled in the district where the injury occurred. The Compensation Commissioner evaluates the positions of both parties in the dispute and will make recommendations to reach resolution. The recommendations made by the Commissioner are not binding at an informal hearing.
• A formal hearing is generally scheduled when disputes cannot be resolved at the informal level.

Decisions made by the Commissioner at formal hearings are enforceable under law. They are binding unless an appeal is made, first to the Compensation Review Commission, and then to the Appellate Court.

VII. Workers’ Compensation Benefits for an Approved Claim 

The type of workers’ compensation benefit paid to an employee who has been injured at the workplace depends on the employee’s medical condition and their ability to return to work. 

Types of Benefits 

Temporary Total Disability 

An employee receives Temporary Total Disability (TTD) benefits when the treating physician determines that the employee cannot work in any capacity for a temporary period of time. Once the treating physician releases the employee to return to some form of work, TTD benefits cease.

• The TTD compensation rate is dependent upon the date of injury.
• Injuries that occurred on or after July 1, 1993 are paid at 75% of the employee’s average net pay over the 52-week period prior to the injury.
• Workers’ Compensation benefits shall not be paid until the employee has been incapacitated for more than 3 calendar days, excluding the day of the injury.
• Benefits begin on the fourth day of incapacity.
• If the incapacity continues for more than 6 calendar days, beginning on the seventh calendar day, workers’ compensation is paid retroactive to the first day of incapacity.
• The day of injury is never considered a day of incapacity.

Additional benefits are afforded to Hazardous Duty Classified employees. To qualify for this compensation disability benefit:

• The injury must be considered hazardous duty and arise out of the special hazard of the job (i.e., the direct assault by an inmate or patient to an employee).
• Benefits paid under this section are paid starting the first day of total incapacity.

• Benefits are paid calculated on your base wages only.

Temporary Partial 

Temporary Partial (TP) benefits will be paid to an employee at the discretion of a Compensation Commissioner. An employee may receive these benefits when he/she has been released to work with temporary restrictions prescribed by the treating physician.

• Benefits under this section for injuries occurring after July 1, 1993 are paid at 75% of the difference between the wages currently earned by an employee in a position comparable to the position held by the injured worker before his/her injury and the amount earned after the injury. The wages cannot exceed 100% of the average weekly earnings of production and manufacturing workers in the state. The Compensation Commission sets this amount each year.

When an employee is released by the treating physician with work restrictions, one of the following situations may occur:

• employee returns to light duty work at their Agency.
• employee returns to work outside of their Agency
• employee conducts “job searches”

If an employee returns to light duty work at their Agency, he/she receives regular wages for the hours worked.

• If the employee is working reduced hours, the pay stub for that pay period is submitted to the TPA for calculation and payment of the TP benefit.
• If the Agency cannot accommodate an injured employee's work restrictions, the employee must seek suitable work outside of the Agency when released by the treating physician to restrictive work.
• If work is found outside of the Agency, the employee is obligated to inform the TPA of such work and report wages earned.
• If an employee is unable to find work within his/her restrictions, TP benefit payments will continue to be received from the TPA as long as the employee submits evidence or “job searches” showing that he/she has attempted to find work. In this situation, the Workers’ Compensation Commissioner determines how long the employee can receive this benefit.

After an employee receives workers’ compensation benefits, and the TPA makes the determination that employee’s medical status has changed, (such as returning to work on light duty) they may file a Form 36 “Notice to Compensation Commissioner and Employee of Intention to Discontinue or Reduce Payments”.

This form is required anytime there is a change in the level of compensation payments.

• An employee has 10 days to schedule a hearing with the Workers’ Compensation Commission if he/she wishes to contest a change in benefits.

Permanent Partial Disability 

Permanent Partial Disability (PPD) benefits are paid to an employee when the treating physician determines that the injured employee has reached Maximum Medical Improvement (MMI) and there is a permanent percentage loss of function to a body part.

• The treating physician files a narrative report or a Form 42- “Physician’s Report of Medical Evaluation Permanent Medical Impairment” with the Compensation Commissioner.
• The percentage impairment issued by the physician is then applied to a chart of values for the given body part(s) and the calculated number of benefit weeks owed is paid to the employee at the base compensation rate calculated at the time of the injury.

Disfigurement or Scarring 

For injuries occurring after July 1, 1993 a Compensation Commissioner may award disfigurement workers’ compensation benefits for any permanent disfigurement or scar on the face, head or neck, or any other area of the body, which hinders an employee in obtaining or continuing to work.

• The employee must request a hearing before the Workers’ Compensation Commissioner one year from the date of injury or from the surgical procedure, whichever is later, to be considered for this benefit.
• The filing of a claim for scarring benefits is prohibited after two years from the injury or the surgery.

 Permanent Total Disability 

Permanent Total Disability is a benefit provided expressly for persons who have suffered a severe injury that has caused a total and permanent physical or mental

disability, such as the total and permanent loss of sight in both eyes.

• The Workers’ Compensation Commissioner awards the permanent total benefit. Compensation is based on a rate established by law without regard to the time actually lost from work.
• This type of workers’ compensation benefit continues during the employee’s lifetime.

Stipulated Settlements 

Stipulated Agreement to Date 

A Stipulated Agreement to Date is typically used to settle a dispute where a compromise has been reached regarding a certain aspect of the claim that has been disputed. They represent the closing of only that aspect of the claim to the agreement of both parties. Your claim remains open and you are afforded all benefits available to you with respect to the agreement.

• The stipulated agreement requires approval by the Compensation Commissioner at an informal hearing.

Stipulated Agreement 

A stipulated settlement, in most cases, is a full and final agreement between the injured party and the State of Connecticut, which is intended to bring finality to a Workers’ Compensation claim.

• This benefit is paid based on the severity of the injury, the medical needs of the injured employee, and prospective future disability.
• The stipulated agreement requires approval by the Compensation Commissioner at an informal hearing.

Fatalities 

Compensation for a fatality resulting from an injury arising out of or in the course

of employment, or from an occupational disease is mandated by the Workers Compensation Act.

• The surviving spouse receives compensation until death or remarriage.
• Minor dependants receive an allowance until the age of eighteen or until they reach the age of twenty-two if a full-time student.
   

VIII. Returning to Work 

The goal is to return employees to work from work related injuries as quickly as possible.

• Temporary restricted work duties will be accommodated by the Agencies when available.
• When an employee reaches maximum medical improvement and it is determined by the treating physician that an employee has permanent restrictions, the Agency will evaluate whether the restrictions can be accommodated.
• If the restrictions cannot be accommodated, the Agency will assist the employee in pursuing other employment options.
• If no work is available, the Agencies will assist with other options through the Department of Administrative Services and the Workers’ Compensation Commission, such as vocational rehabilitation, a less arduous duty search for another state position, or disability retirement.
• If another position cannot be found in state service, an employee can be separated in good standing from state service in accordance with Section 5-244 of the Connecticut General Statutes.
   

IX. Use of Accrued Time 

Employees who are losing time from work due to a work related injury have the option to use accrued sick, vacation, personal, or other earned time to cover the interim period before the TPA makes a payment.

• The employee completes form CO-715- “Request for Use of Accrued Leave with Workers’ Compensation” for this purpose. Human Resources will provide the form to the employee.

Employees may also elect to supplement their workers’ compensation benefit to bring them up to 100% pay by using accrued leave.

Employees are able to accrue sick and vacation credits for up to twelve months when out due to a work related injury.

• Personal leave days are not included in the accrual.
   

X. Coding Your Timecard

Accurate timecard coding is essential to avoid underpayments or overpayments of

salary or benefits to employees when time is lost due to a work related injury.

• The day of the injury is always coded as full day of regular pay, regardless of the number of hours actually worked that day.
   

XI. Maintaining Health and Life Insurance Benefits

The State continues health insurance and other employer-paid benefits while an employee collects workers’ compensation benefits, but co-payments must still be made. Your Agency’s Human Resources Dept. will contact employees to make arrangements.

• Union dues are suspended.
• Payroll deductions for employee paid elections (credit union, short-term disability insurance, etc.) stop. Employees must make arrangements with the individual creditors or benefit providers for payment.
• Contributions to retirement plans are not made; however retirement credit is received for the period of time receiving workers’ compensation benefits up to one year.
• Workers’ Compensation benefits are not taxable.
   

XII. Forms Used to Calculate the Workers’ Compensation Benefit 

Two forms are required from an employee to be able to calculate the workers’ compensation benefit (WCC-211 & WCC-1A). These forms are sent directly to employees by Human Resources. Delay or failure to return the completed forms to Human Resources will result in a delay in receiving workers’ compensation benefits. 

Form PER-WCC 211 “Concurrent Employment/Third party Liability”

This form is required to provide information regarding concurrent employment. If there is concurrent employment prior to the injury, benefit rates may increase when these wages are considered.

• The third party liability section provides pertinent information regarding the potential liability of another party for the claim.
• Other employment after the injury may decrease benefits if an employee fails to report that he/she is working while receiving workers’ compensation benefits.
• Employees are required to report all earnings after completing Form PER-WC 211. Failure to inform may result in civil and/or criminal liability.
   

Form WCC-1A “Filing Status and Exemption Form”

This form is used to indicate the number of exemptions as reported on the W-4, and will determine if an employee is eligible for an increased benefit.

• Failure to return this form will result in the status reverting to single-one exemption.

XIII. Contact Information 

GAB Robins (Third Party Administrator)

(860) 256-3400
 

Workers’ Compensation District Offices

1st District- Hartford- (860) 566-4154

2nd District- Norwich- (860) 823-3900

3rd District- New Haven- (203) 789-7512

4th District- Bridgeport- (203) 382-5600

5th District- Waterbury- (203) 596-4207

6th District- New Britain- (860) 827-7180

7th District- Stamford- (203) 325-3881

8th District- Middletown- (860) 344-7453

Website: http://wcc.state.ct.us/index.html

XIV.  If You Need to Hire an Attorney (from the Connecticut Bar Assoc. website)

The Workers’ Compensation Section of the Connecticut Bar Association created the Workers’ Compensation Certification Program to help the public to identify attorneys who are competent, experienced, and skilled in the area of workers’ compensation law and to raise the level of practice in this area of the law.

The Legal Specialization Screening Committee and the Rules Committee of the Superior Court have approved the CBA’s certification program. This approval process insures that our program has met the court’s strict standards.

Attorneys who have attained the designation "Board Certified Workers’ Compensation Specialist" have satisfied the following requirements:

• Demonstrated that no less than twenty-five percent of their total practice has been in the area of workers’ compensation law;
• Engaged in the practice of law in Connecticut for at least five years and been a member in good standing of each bar in which the attorney is admitted;
• Maintained a malpractice policy with minimum limits of $300,000 per occurrence;
• Have a satisfactory disciplinary and malpractice history;
• Participated in a minimum of thirty-six hours of continuing legal education activities in the area of workers’ compensation law in the three years prior to filing the application;
• Have a minimum of five references from other attorneys knowledgeable regarding the applicant’s practice and competence; and
• Have passed a one-day written examination.

Only attorneys who have been formally certified may use the designation "Board Certified Workers’ Compensation Specialist" on business cards, letterhead, and other printed advertisements.

Click below for a list of Board Certified Workers’ Compensation Attorneys

http://www.ctbar.org/article/articleview/66