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 MCP for specialties covered by the Plan.
The Managed Care Plan establishes a network of workers' compensation specific providers who treat employees who suffer work-related injuries or occupational illnesses.
These providers are selected for their clinical excellence and their understanding of and cooperation with the workers' compensation process. The focus is to return an injured worker to work at his/her appropriate level of capability as quickly as possible.
The specialties in the Medical Care Plan Directory of Network Providers include:
- 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.
One of the benefits of having a MCP is a reduction in medical provider costs, since employees must use the services of network providers--whose role is to assist employees with appropriate and timely treatment, so they may return to work. 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.
You then need to educate your employees of their rights and responsibilities under a Medical Care Plan through distribution of the Employee Instructions. This can be done via one-on-one discussions, meetings where the instructions are part of the written agenda and attendance is kept, or payroll stuffers. You should also incorporate the instructions into you new employee orientation. You are encouraged to have your employees sign that they have received and understand the instructions (click here to see a sample Employee Rights & Responsibilities Form).
A copy of the Employee Instructions MUST be posted in the workplace.
What to do if an employee chooses not to go to the recommended First Treatment Center
- Provide Medical Care Plan Directory of Network Providers 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