Workers' Compensation Rights, Responsibilities, and Claims

Overview

The State of Connecticut Workers’ Compensation Program is centrally administered through the Department of Administrative Services (DAS), under authority of C.G.S. 31-284a.

Our Mission

DAS is committed to administering the State of Connecticut Workers’ Compensation Program to be current with the standards of an ever-changing industry. The main objective is to achieve the delicate balance between cost effectiveness for our organization and the delivery of a responsive program to our injured employees. The goal is to empower and support state agencies to meet the established operational procedures within the program as well as assisting them to promote a culture of safety within their respective workforces.

Note the following:

  • The State of Connecticut is self-insured for liabilities associated with work related injuries and illnesses.
  • All workers’ compensation claims are reported and internally processed through individual state agencies.
  • DAS contracts with a third party claim administration company for all claim adjusting services, the physician provider directory, and all supporting managed care services to the program.

 
Biznet

If you are a workers’ compensation liaison for your State agency, and you are seeking access to additional content on the DAS Business Network (BizNet), then you will need to create an account. BizNet access roles are available to all state agency workers’ compensation liaisons through the DAS Workers’ Compensation Division.

State of Connecticut Workers’ Compensation
Claim Reporting

Policy

The State of Connecticut Workers’ Compensation Program requires that an employee report a work-related injury or illness to his/her employer immediately. For injuries prohibiting the employee from immediately notifying his/her supervisor, the supervisor, on behalf of the injured employee, can directly report the claim.

Employing state agencies must accept all reports of injury from an employee. The employing state agency cannot deny the employee from filing a claim. The Third Party Administrator (TPA) determines issues of compensability and causation, based in part on the information facilitated through the claim reporting process.

Preface

The following is selected and summarized information relating to the Workers’ Compensation Act of the Connecticut General Statutes. It is supplied here as a quick reference to the Connecticut Workers’ Compensation system. The Act provides medical treatment, “wage replacement” and other similar benefits to employees who suffer work related injury or illness.

See the Workers’ Compensation Information Packet at the Workers’ Compensation Commission (WCC) Websitefor more detailed information and expanded text.

Introduction

It is every employee’s responsibility to work safely. Unfortunately, situations do arise where employees are injured or become ill while in the performance of their job duties. The Connecticut Workers’ Compensation Act was first enacted in 1913. Note the following:

  • The Act has seen changes over the years, but has maintained its premise as a mandatory program that pays medical costs and lost wages to full-time and part-time employees in the event of work-related injuries and illnesses.
  • Connecticut General Statutes regulate what benefits are due the injured employee.
  • This system may also provide other benefits for those who qualify.

 
The agency created in the Act is the Connecticut Workers’ Compensation Commission (WCC), which administers the statutes of the Act. The Commission does the following:

  • Houses official forms and documents and
  • Performs hearings to settle disputes in individual cases.

 
The Commission is headquartered in Hartford, with eight satellite district offices across the State. These district offices are in the following cities and towns:

See the following listing for Connecticut Towns and WCC Districts.

Claim Filing and Administration

The State contracts with a third party administrator (TPA) for workers’ compensation. The TPA does the following:

  • Processes reported claims, using the administrator’s network of medical providers and managed care services
  • Works with the agencies and the injured employee to manage the medical treatment of the injury
  • Assists in the return-to-work process

 
The Reporting Process goes as follows:

  1. If an employee is injured on the job or diagnosed as having a work-related disease, he or she should report the incident to his or her supervisor.
  2. A first report of injury will then be generated and sent to the State’s third party claims administrator (Gallagher Bassett Services).
  3. They will either approve or contest the claim.
  4. If medical treatment is necessary, it is important that the network providers be used. NOTE: Receiving treatment outside the third party medical provider network may jeopardize the employee’s entitlement to workers’ compensation benefits, subject to the jurisdiction of the Workers’ Compensation Commission.

 
Benefits

Benefits paid by workers’ compensation include medical expenses and lost wages. For those who qualify, additional benefits may be available. These may include the following:

  • temporary total disability (when unable to perform ANY job)
  • temporary partial disability (when able to perform SOME type of work)
  • permanent partial disability (for suffering a disability to a specific body part)
  • disfigurement or scarring (depending on its bodily location)
  • “308a” benefits (living funds, etc, pursuant to Statute)
  • job retraining (vocational rehabilitation for those who qualify)
  • relapse or recurrence (referring to a previous injury)

 
Dispute Resolution

The third party administrator approves or contests claims. For contested claims, either party (the TPA or the employee) may request a Hearing with the Workers’ Compensation Commission. After a claimant receives a notice to contest, all related medical bills must be submitted to their health carrier for payment. If the claim is later approved, the health carrier has the right to pursue his/her reimbursement of medical expenditures.

There are five types of Hearings, as follows:

  • Informal - Ninety-five percent of disputed cases are settled at Informal Hearings.
  • Emergency - Certain situations necessitate a special form of Informal Hearing called an “Emergency Hearing”. These situations include emergency surgery, threat of loss of home or vehicle, lack of insurance, halting of benefits, etc.
  • Pre-Formal - In cases where the parties cannot reach agreement after one or more Informal Hearing(s), either party can request a Pre-Formal Hearing.
  • Formal - If the Pre-Formal Hearing does not resolve matters, it may be necessary to request a Formal Hearing. This is a formal legal proceeding.
  • CRB Appeal - The Commissioner’s finding at a Formal Hearing is binding on all parties, unless appealed by either party to the Workers’ Compensation Commissioner’s Compensation Review Board (CRB). Such appeals are rare.

 
Definitions

See page 2 in the Workers’ Compensation Information Packet or in the WCC Glossary for a description of benefits, including the following terms and forms:

  • TTD – temporary total disability
  • TPD – temporary partial disability
  • PPD – permanent partial disability
  • MMI – maximum medical improvement
  • “308a” – wage differentials, etc pursuant to Statute
  • Form 36 – notice of discontinuation of benefits
  • Form 43 – notice of intent to contest liability of a claim WCC-1 – voluntary agreement