Injured Worker Benefits
All medical treatment, durable medical equipment and prescriptions directly related and medically necessary to your compensable injury/illness will be paid for or reimbursed with no out-of-pocket expense to you. If your employer has an approved Medical Care Plan, the following information applies.
Instructions for Employees Injured Under Connecticut Workers' Compensation Law
These instructions are part of the Medical Care Plan which has been submitted and approved by the State of Connecticut Workers' Compensation Commission for providing medical treatment to employees who have work-related injuries or occupational illnesses. It is our goal to provide injured employees with prompt and effective medical care through a network of plan providers, treatment centers and hospitals. The objective of the Plan is to ensure that you receive prompt and effective medical care consistent with your injury and that you have access to specialty medical care if the need arises.
|What You Should Do If You Are Injured
If you have a work related injury, you should report the injury immediately to your supervisor. Your supervisor will make certain that you receive prompt medical treatment for that injury through the designated First Treatment Center. After the initial visit to the first treatment center you may seek continued treatment from any of the providers listed in the Workers’ Compensation Trust (Trust) provider directory. The Trust’s provider directory is available on the home page under "Quick Links" or you can call the Trust at (203) 678-0100 to obtain a current list.
After your initial visit to the first treatment center, if you need to treat with a specialist, the Plan covers providers in the following specialties: Chiropractic, Neurology, Neurosurgery, Orthopedics, Physical Medicine & Rehab, Physical Therapy and Hand Surgery. If the physician you need to see is in a specialty that is not covered by the Plan, you have the right to choose and treat with any Connecticut physician in that particular specialty. Please contact the Trust and they will assist you in making arrangements to obtain treatment from a physician in that specialty. However, for all specialties covered by this Plan, you MUST seek treatment from one of the physicians listed in the directory.
If you seek medical treatment from a provider not listed in the directory for a specialty covered by the plan, we are not required to pay for that medical treatment and you risk losing your right to receive workers’ compensation benefits and payment for medical treatment, subject to the order of the Workers’ Compensation Commissioner.
In the case of an emergency, you should seek treatment from the nearest emergency facility or hospital. You or a family member must also contact your supervisor as soon as possible. If further treatment is required, you must follow up with the First Treatment Center or a specialist listed in the directory. If the physician at the emergency facility recommends treatment by a physician in a specialty not listed in the directory, you may choose any licensed Connecticut physician within that specialty. This plan does not restrict your treating physician from referring you for inpatient or outpatient treatment at any licensed hospital in Connecticut.
In some situations, requested medical procedures and treatment must be pre-certified by the Trust’s licensed Utilization Review agency. The Utilization Review Agency will issue a decision within two (2) days. Should the proposed treatment be denied, you, your physician, and employer have the right to appeal that decision in accordance with the appeals process, which will be sent with the denial letter to the provider or is available from the Trust.
If you have any questions about how this plan works or how to obtain medical treatment for a work-related injury, please contact your supervisor or your claims adjuster.
Wage Replacement Benefits
- Full Pay for Day of Injury - You should receive a full day's wage from your employer for the day the injury occurred, regardless whether or not you were able to return to work after the accident.
- Waiting Period – There is a three day waiting period. Benefits begin on the fourth day. If you remain disabled for more than seven calendar days, the three-day waiting period is eliminated and benefits are paid from the beginning of your disability. In counting days of disability from work, all calendar days are counted, even if you were not scheduled to work. (The day of the injury does NOT count as a day of disability from work.)
- Temporary Total Disability (TT) Benefits- Weekly TT benefits while totally disabled from ANY type of work are equal to 75% of your 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.
- Temporary Partial Disability (TP) Benefits during a Job Search – If you are released for “light duty” or “restricted” work and the employer does not have such work, you are entitled to Temporary Partial Disability (TP) benefits while performing a job search for suitable employment.
- Temporary Partial Disability (TP) Benefits involving wage loss – If, as a result of the injury, you return to work receiving less than your normal rate of pay, (described as either “light duty” or “restricted”), you may be entitled to Temporary Partial Disability (TP) wage differential benefits. These TP benefits are equal to 75% of the after-tax difference between the wages you are currently earning, and the wages currently being paid in your former job, subject to the legislated maximum and minimum amounts.
- Permanent Partial Disability (PPD) Benefits – if your attending physician determines that Maximum Medical Improvement (MMI) has been reached and you have sustained a permanent partial loss of function, the physician may issue a disability rating.
- Cost-of-Living Adjustment (COLA) to dependent Survivor Benefits – Dependents of employees who die as a result of their work-related injury or illness are entitied to an annual Cost-of –Living Adjustment every October. The amount of the adjustment is based upon the date of the injury.
- Cost-of-Living Adjustment (COLA) – 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.
- Disfigurement and Scarring Benefits – A Commissioner may award benefits for any permanent, significant disfigurement or scar due to a work-related injury if (1) on the face, head, or neck, or (2) on any other area of the body that handicaps you 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.
- Discretionary Wage Differential (308a) Benefits – A Workers’ Compensation Commissioner “may” grant additional benefits to an employee after he/she has been paid all of their Permanent Partial Disability, if the injury results in your inability to find employment, or the new employment pays less than the original job. It is your responsibility to request a hearing in the appropriate Workers’ Compensation district in order to request these benefits.
- Dependent Survivor (Fatality) Benefits- When an employee’s death is caused by a work-related injury or illness, a surviving spouse or eligible dependent may be entitled to weekly wage replacement benefits equal to 75% of the deceased employee’s after-tax average weekly wage subject to the legislated maximum and minimum amounts. In addition, a burial expense benefit is provided based on the prevailing rate.