A: Not always. However, the rules and procedures of the workers’ compensation system are complicated. If your claim is denied or if certain aspects of your claim (medical treatment, lost wages) are denied, it is in your best interest to contact an attorney familiar with the ins and outs of the system.
Q: How do you file a workers’ compensation claim?
A: First, report the injury to your employer. The next step is to file a Form 30C, which is a notice of claim. This form can be found on the CT Workers’ Compensation website and needs to be sent certified mail or hand delivery, with proof of receipt to both your employer and the workers’ compensation commission.
Q: Where do you file a workers’ compensation claim?
A: The claim must be filed in the district you were injured or became ill. A map of the districts and the towns included in each district is available on the CT Workers’ Compensation website.
Q: What is the time frame for filing a workers’ compensation claim?
A: Generally, if your injury is the result of a specific event, you have one year from the date of the injury. If your injury is the result of the repetitive motion of your employment activities, you have one year from the date you last engaged in the repetitive activities. If your claim involves an occupational disease, you have three years from the first manifestation of the illness.
Q: What is the time frame for contesting a workers’ compensation claim?
A: The employer/insurer has twenty eight days from receipt of the Form 30C to either issue a denial of the claim (Form 43) or commence paying benefits, either by paying for medical treatment or paying lost wages (temporary total or temporary partial disability benefits). If the employer/insurer does start paying benefits within 28 days, they then have one year to issue a denial.
Q: What is preclusion in a workers’ compensation claim?
A: If the employer/insurer does not contest a claim in time, they may be precluded from contesting acceptance of the claim or the extent of disability in the future. If a workers’ compensation commissioner grants preclusion, the case is deemed accepted and the employer/insurer must pay for all medical treatment and wage benefits. With preclusion, the employer/insurer losses the right to have a doctor of their choosing examine the claimant or the right to even cross examine the claimant during a Formal Hearing.
Q: What is a voluntary agreement?
A: A voluntary agreement is a form completed by both the employee and the employer/insurer establishing acceptance of the case. If a rating for the injury has been assigned and agreed to by all parties, a voluntary agreement will be completed to acknowledge acceptance of that impairment rating. The voluntary agreement is filed with the workers’ compensation commission and approved by a commissioner.
Q: What is a Form 43?
A: A Form 43 is filed by the employer/insurer contesting acceptance of the case or some other aspect of your claim. If a Form 43 is filed and you require medical treatment, the Form 43 can be presented to your medical provider and/or insured. Your private health insurance is mandated by law to pay for medical treatment that is being denied by workers’ compensation.
Q: What is a Form 36?
A: A Form 36 is filed by the employer/insurer to seek to discontinue or switch benefits. If you disagree with a Form 36, an objection must be filed within 15 days. The filing of an objection will prompt an Informal Hearing before a Commissioner.
Q: What is an Informal Hearing?
A: An Informal Hearing is held before a Workers’ Compensation Commissioner and usually lasts fifteen minutes. Both parties are allowed the opportunity to present their claims/defenses and the Commissioner makes recommendations. The Commissioner’s recommendations are generally not binding on either party.
Q: What is a Pre-Formal Hearing?
A: A Pre-Formal Hearing is a step between an Informal Hearing and a Formal Hearing. The hearing usually lasts a half hour and the parties outline the basis for their claims/denials. Evidence and the names of witnesses that may be called at a Formal Hearing are generally disclosed at a Pre-Formal Hearing.
Q: What is a Formal Hearing?
A: A Formal Hearing is a trial in the workers’ compensation forum. Evidence is presented, testimony may be given, a record is made, and, at its conclusion, the Commissioner issues a Finding. If the Finding is not appealed, it becomes final and binding on the parties.
Q: What is a Finding & Award or Finding & Dismissal?
A: A Finding & Award or Finding & Dismissal is the order issued by the workers’ compensation commissioner following the conclusion of a Formal Hearing. The Finding outlines the facts found by the commissioner and the award/denial either grants or denies the benefits sought at the Formal Hearing.
Q: What is the CRB?
A: The Compensation Review Board is the appellate court for workers’ compensation claims. When a party disagrees with a decision of the trial commissioner, that party can appeal that decision to the CRB.
Q: Do workers’ compensation claims settle?
A: Yes, but it is not mandatory. Neither side can compel the other side to settle.
Q: What is a Full and Final Settlement?
A: A full and final settlement closes out all aspects of the claim – both entitlement to wage loss benefits and medical treatment in the future.
Q: What is a Stipulation to Date?
A: A Stipulation to Date, generally, settles an aspect of the claim, i.e. a claim for wage loss benefits or medical benefits, up to the date of approval of the Stipulation to Date. The claim remains open and the claimant may seek benefits in the future.
Q: Medical treatment: what is it?
A: If you sustain an injury during the course of your employment, you are entitled to reasonable and necessary medical treatment to cure that injury and for which the employer/insurer is obligated to pay.
Q: Medical treatment: where is it provided and with whom?
A: In general, once you report an injury to your employer, you may be directed to a specific medical facility to obtain care for your injury. With some exceptions, you are entitled to select a provider/doctor of your own choosing after you have been evaluated by the employer designated provider.
Q: Medical treatment: when does it end?
A: In general, medical treatment ends when a medical provider places you at maximum medical improvement. This means there is no other medical treatment that will improve your condition. Being placed at maximum medical improvement does not mean you may not require occasional medical treatment in the future. Further, if pain management, such as medication, is allowing you to work, that medical treatment will generally be approved, even if you have been placed at maximum medical improvement.
Q: Medical treatment: do I get paid while receiving treatment?
A: It depends. If you are receiving a wage loss benefit (temporary total or temporary partial) then you are not entitled to payment for time attending medical treatment. If you are not receiving a wage loss benefit and are working, you are entitled to your hourly wage for your time at medical appointments. This time does include reasonable travel to and from medical treatment.
Q: What is a Respondent’s Medical Examination?
A: A Respondent’s Medical Examination (RME) is an examination by a medical provider of the employer/insurer’s choosing.
Q: What is a Commissioner’s Medical Examination?
A: A Commissioner’s Medical Examination (CME) is an examination by a medical provider of the Commissioner’s choosing. A CME is generally performed when there is a dispute between your treating physician and the RME.
Q: Wage loss benefits: what are they?
A: If your injury prevents you from working, you may be entitled to a weekly benefit, the amount determined on the average amount of money you made in the fifty two weeks before your injury/disability. The weekly amount you receive is known as your base compensation rate.
Q: Wage loss benefits: what are temporary total disability benefits (TT)?
A: If you are totally disabled – unable to engage in any work – you are entitled to temporary total disability benefits.
Q: Wage loss benefits: what are temporary partial disability benefits (TP)?
A: If your injury impairs your ability to work at your usual employment, but you are still able to perform some level of employment, you are entitled to temporary partial disability benefits. If you are able to return to employment, but working reduced hours or at a reduced wage because of your injury, the temporary partial benefit is the difference between your base compensation rate and your earnings. If you are unable to return to employment, you may be required to look for employment within your restrictions.
Q: Wage loss benefits: what are permanent partial disability benefits (PPD)?
A: Once you have reached maximum medical improvement, your doctor may say you have a permanent disability. Each body part is assigned a specific number of weeks in the Workers’ Compensation Act. The number of weeks you may be entitled to for a permanent disability is calculated by the percentage of your disability (i.e. 10%) multiplied by the number of weeks for the injured body part (i.e. 374 weeks for a back). A 10% impairment of the back is 37.4 weeks. The benefits you receive for a permanent disability are called permanent partial disability benefits (PPD) or specific benefits. In general, PPD benefits are paid on a weekly basis for the number of weeks of the assigned rating at the base compensation rate.
Q: Wage loss benefits: what are 308a benefits?
A: Once permanent partial disability benefits have been paid, you may be entitled to 31-308a benefits. 308a benefits are ordered by a Commissioner at her discretion and designed to compensate a claimant for a continuing reduced earning capacity. You may be required to show that you are looking for employment within the State of Connecticut to be entitled to benefits.
Q: What are job searches and when are they required:
A: A job search form is completed to show you have been looking for employment. The form includes the date, the name, address and telephone number of the employer contacted, the person contacted, and the result of the contact. Job searches, usually five a week, may be required to be entitled to either temporary partial or 308a benefits.