Medical Care Plan
In Connecticut, an employee who has a work related injury or occupational illness has the right to choose his or her treating physician. If the employer has a Medical Care Plan (MCP), the employee's choice is restricted to the Provider Directory for specialties covered by the Plan. All members of the Trust must participate in the Medical Care Plan.
The Medical Care Plan establishes a network of approved providers who treat employees with work-related injuries or occupational illnesses. These providers are selected for their clinical excellence and their understanding of the workers' compensation system. The focus is to provide quality care to facilitate injured workers to return to their jobs as quickly as possible.
The specialties in the Medical Care Plan Provider Directory are:
- First Treatment/Occupational Medicine Centers
- Hand Surgeons
- Pain Management
- Physical Medicine & Rehabilitation Physicians
- Physical Therapists
If clinically appropriate and approved treatment is required from a specialist not listed above, an employee may treat with a provider of their choice in Connecticut.
The Provider Directory can be found on our home page under "Quick Links". The form for applying for a Medical Care Plan can be viewed and/or downloaded below:
Subject to the order of the Workers' Compensation Commission, if an employee seeks medical treatment from a physician or other provider not listed in the network for a specialty covered by the Plan, the employer is not required to pay for that medical treatment and the employee risks losing the right to receive workers' compensation benefits and payment for medical treatments.
Participation in the MCP also requires that the employer establishes and maintains a Safety & Health Committee and implements a Return-To-Work Program. A Return-To-Work Program is designed to facilitate an injured employee's return to the workplace as soon as medically feasible. Providing modified work until the employee is able to return to full duty reduces workers' compensation costs.
Employer Responsibility Once a Medical Care Plan is Established
As the employer, you have the responsibility to inform your employees that--if they are injured--they must seek treatment from the network or risk losing entitlement to workers compensation benefits.
The first step is to select a First Treatment Center for employees to receive prompt and effective medical treatment. A good working relationship between the employer and the First Treatment Center goes a long way in facilitating the return-to-work process. Do not hesitate to communicate regularly with your First Treatment Center. You should expect a call and a mailing of the employee's work capacity status every time the employee is seen.
All members must educate their employees on the rights and obligation under the MCP, by distributing the Employee Instructions to all current employees and new hires as well as posting it on the official company bulletin board. Customized copies of the Employee Instructions can be found on the website's home page under the Report Center. A copy of the Employee Instructions MUST be posted in the workplace. You are encouraged to have your employees sign that they have received and understand the instructions.
What to do if an employee chooses not to go to the recommended First Treatment Center
- Provide Provider Directory in order for the employee to choose another first treatment provider.
- Advise the employee that if he/she doesn't choose someone from this network, workers' compensation benefits may be denied as well as payment of medical bills.
If you have any questions regarding the Medical Care Plan, please contact Brian Downs, Vice President, Quality & Provider Relations at (203) 678-0103