What injuries are covered by workers' compensation?
Injuries that "arise out of and in the course of employment" are covered.
"Arising out of and in the course of employment" generally means an accidental injury happening to an employee or an occupational disease of an employee originating while the employee has been engaged in the line of the employee's duty in the business or affairs of the employer upon the employer's premises, or while engaged elsewhere upon the employer's business or affairs by the direction, express or implied, of the employer" [See Section 3 1-275(1) of the Connecticut General Statutes.
An injury may be caused by a single trauma located as to time and place; performance of repetitive acts that are done over time; or an occupational disease, i.e., "...any disease peculiar to the occupation in which the employee was engaged and due to causes in excess of the ordinary hazards of employment....".
Who decides if I have a covered injury?
Connecticut's workers' compensation system is an administrative law system. Your case is presented to a workers' compensation commissioner. He would first hear your case at one or more informal Hearings. If he cannot resolve the issues at these hearings, your case would be assigned for a Pre-Formal hearing. The Commissioner would review the outstanding issues and try to resolve them. If he cannot, he will schedule the case for a Formal Hearing. He will also review with the parties what issues they will litigate, the witnesses and procedure that will be followed, and determine approximately how much time the parties need to try the case. A Formal Hearing is an administrative trial. A jury is not used. A Commissioner would hear the case and make all rulings as to fact and law. A court reporter is present and a record of the proceeding will be created. Once the record is closed, a Commissioner has 120 days within which to render his decision.
What if a party doesn't agree with a Commissioner's decision?
Any party aggrieved by a Formal decision may appeal that decision. The first step is to appeal to the Compensation Review Board. This Board consists of a panel of three workers' compensation commissioners. If a party doesn't agree with the decision of the Compensation Review Board, they may appeal to the Appellate Court. Finally, if a pasty doesn't agree with the ruling of the Appellate Court, they may ask the Supreme Court to hear their case.
One must remember that an appeal is not a trial de novo or "new trial". Findings of Fact by the initial Trial Commissioner are generally not reviewable on appeal. Appeals are largely limited to questions of law.
Where are the hearings held?
Connecticut has eight workers' compensation districts. Each district holds hearings for injuries within its jurisdiction. The eight districts are as follows:
First District-Hartford (860) 566-4154;
Second District-Norwich (860) 823-3900;
Third District-New Haven (203) 789-7512;
Fourth District-Bridgeport (203) 382-5600;
Fifth District-Waterbury (203) 596-4207;
Sixth District-New Britain (860) 827-7180;
Seventh District-Stamford (203) 325-3811;
Eighth District-Middletown (860) 344-7453.
Some of the Districts also hear cases in satellite offices.
What benefits can an injured worker receive?
An injured worker is entitled to have 100% of the medical costs, including prescriptions, covered. The injured worker should not have any co-pays.
The injured worker is also entitled to be paid a workers' compensation benefit in lieu of wages. If the injury causes the individual to miss three days or less from work, no benefit is paid. If the injury causes the individual to miss four to seven days, the worker will get a benefit for days four through seven. If more than seven days are missed, the worker will receive benefits from day one forward.
The benefits fall into four basic types depending on how the injured worked is recovering from his or her injury.
What benefits can an injured worker can receive while recovering from injury?
Temporary Total Disability (TTD) - This benefit is paid to an individual when the injury
prevents the individual from performing any work at all.
Temporary Partial Disability (TPD) - Here, a physician advises the individual that the
individual should not return to regular work but may perform some type of restricted, light, or sedentary duty. In order to receive this benefit, the injured worker must have a physician who certifies he is unable to perform his usual work but can perform other work; the employee is ready and willing to perform other work in the same locality; and no other work is available.
What benefits can an injure worker receive after he or she is fully recovered?
Permanent Partial Disability (PPD) - A doctor will determine when the injured worker
reaches a point of maximum medical improvement, i.e. - when the individual has, in terms of healing, reached a plateau and will not improve with further treatment. The doctor will provide a rating, a percentage, of loss of use of the injured body part. This percentage is translated into a number of weeks of benefits. [See Section 31-308(b) of the Connecticut General Statutes.]
Discretionary Benefits (308a) - After the permanency is paid, the injured worker may be entitled to additional benefits. If the injury caused a permanent loss of earning capacity, a claim maybe made for benefits pursuant to Section 31-308a of the Connecticut General Statutes. If as a result of the work injury the worker is not earning or capable of earning the same wages now as could be earned before the injury, a Commissioner may award additional weeks of benefits.
How is the weekly benefit rate calculated?
The weekly benefit rate is referred to as the compensation rate. Compensation rates
change depending upon your date of accident and your tax filing status. Please see your attorney to check your compensation rate.
First, an average weekly wage must be determined. Wages earned the week of the injury are not included. All wages earned prior to the week of the injury, not to exceed 52 weeks of wages are combined and divided by the number of weeks worked. This will provide an average weekly wage. [Note: if you work for more than one employer at the time of injury you must add all earnings from all employers.] Second, the tax filing status of the injured worker must be determined.
A weekly compensation amount is equal to 75% of the after tax average weekly wage.
What is a voluntary agreement?
If the employer accepts a lost time case as compensable, the employer is required to issue a voluntary agreement. This agreement is a Connecticut workers' compensation form and will have all of the jurisdictional elements of your case, i.e., names and addresses of employee, employer, and insurer. The authorized treating physician's name will appear on the agreement. The injured workers' average weekly wage and compensation rate will be placed on the agreement. If the voluntary agreement deals with permanent partial disability, the agreement will also provide a date of maximum medical improvement, a percentage of loss of use, and a calculation of the number of weeks and weekly rate to be paid.
Can the injured worker choose a physician?
Yes. The choice of a treating physician belongs to the injured worker. While an employer may not select the treating physician, some employers have planned provider organizations [or PPO]. The Chairman of the Workers' Compensation Commission approves these. If the employer has a PPO, the injured worker still has the right to choose a treating physician but must make the selection from the list of physicians in the PPO.
Once a treating doctor is selected, only treatment by that physician or treatment by medical providers in a chain of referral from that physician will be considered
compensable. If the injured worker wants to change doctors, the worker must get either the approval of the insurer or employer or the approval of the workers' compensation commissioner.
Does the injured worker have a right to a second opinion?
Generally, no. A Commissioner usually will not require an employer or insurer pay for a second opinion.
The employer or insurer, however, is entitled to an independent medical examination. If the employer or insurer disagrees with an opinion from the treating doctor, they may send the injured worker to a doctor they select. The injured worker must attend an independent medical examination [IME]. Failure to attend the IME could result in suspension of rights to receive compensation during the period of refusal.
Can an injured worker be discharged or otherwise discriminated against?
Having a work related injury does not prevent a worker from being discharged. An employer may not, however, fire or otherwise discriminate against an employee because the employee "...has filed a claim for workers' compensation benefits or otherwise exercised the rights afforded to him pursuant to the provisions..." of the Connecticut Workers' Compensation Act [Chapter 568 of the Connecticut General Statutes]. [See Section 31-290a of the Connecticut General Statutes.]
Action for wrongful discharge or discrimination may be brought against the employer either in the workers' compensation forum or Superior Court. While the remedies in each forum are similar, some differences exist. Advantages and. disadvantages to proceeding in each forum should be discussed with your attorney.
Can the employer refuse to take the employee back to work?
An employer does not have an obligation to hold open an employee's job. The employer has no obligation to create a job for the injured worker. The employer has no obligation to provide an employee with vocational retraining.
However, where an employee has "...suffered a compensable injury which disables him from performing his customary or most recent work, his employer at the time of such injury shall transfer him to full-time work suitable to his physical condition where such work is available..."[See Section 31-313 of the Connecticut General Statutes.]
How are attorney's fees calculated?
In some cases, the attorney will be paid an hourly rate plus costs.
In cases where the attorney represents the injured worker, the fee is a contingency fee. The normal rate is 20% of any contested payments, permanency, 3 1-308a benefits, or stipulated settlements. Costs are in addition to attorney's fees.
A cost is a sum the attorney paid to a third party in order to properly handle your case. Examples of costs: payment to doctors for their time or reports; payment to court reporters for deposition transcripts; subpoena costs; etc.
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