Understanding Your Benefits under Workers’ Compensation

The basic purpose of the Workers' Compensation Act is to protect and provide for employees who have sustained work-related injuries or illnesses. The Connecticut Worker's Compensation Act covers almost all employees, including non-citizens, minors, and part-time employees, regardless of the occupation.

Worker's compensation is a no-fault system of insurance, in which the cause of the accident, whether it is the worker's negligence or another cause, does not affect the employee's coverage. The design of the program is intended to assist workers who have become injured on the job or who have acquired an occupational disease.

Verdicts

The following are the types of benefits you, as an injured worker, can receive:

1. Day of Injury Covered - you should receive your full pay for the day of occurrence of your injury.

2. Temporary Total Disability - Temporary Total (TT) Disability benefits are essentially "wage replacement" benefits which are paid by your employer's workers' compensation insurance carrier while you are unable to perform any type of work due to your work-related injury or illness. TT benefits begin on the fourth calendar day of the disability from work, but if the disability lasts for seven or more calendar days, payment will be made retroactively to cover all the days of disability from work. For injuries/illnesses occurring on or after July 1, 1993, weekly TT benefits are equal to 75% of your after-tax earnings.

3. Cost-of-Living Adjustment (COLA) - For injuries/illnesses occurring on or after July 1, 1993, all claimants receiving Survivors' benefits are entitled to COLAs. In addition, claimants who have been totally disabled for at least five years, or who have been declared permanently totally disabled either by judgment or by statute, are also entitled to COLAs.

4. Right of Transfer Suitable Work - If you cannot work in your usual job because of your injury, your employer should transfer you to a full-time suitable work, if available, provided this does not conflict with the terms of a labor contract.

5. Benefits During a Job Search - If you are released for light or restricted work and your employer does not have such work, you can receive Temporary Partial (TP) benefits while performing a job search for suitable employment.

6. Wage Differential payments - If your injury results in your employment in a lower-paying job, you may be entitled to wage differential benefits for part of the difference between your actual present earnings in your "new" job and the wages being currently paid in your former job. For injuries/illnesses occurring on or after July 2, 1993, all wage differential benefits are 75% of the difference between the employee's after-tax earnings following the injury and the after-tax earnings in the employee's usual work.

7. Recurrence or Relapse from Recovery - If you return to work from an injury, but then have a recurrence or relapse from recovery, you will again be eligible to receive workers' compensation benefits and your compensation rate at that time will be based on your original TT benefit rate or the TT rate based on your earnings at the time of recurrence or relapse, whichever is higher.

8. Disfigurement & Scarring - For injuries/illnesses occurring on or after July 1, 1993, only scars or disfigurements (1) on the face, head or back; or (2) on any other area of the body that handicaps the claimant in obtaining or continuing to work will be considered for awards. Also, awards for scarring/disfigurement can no longer be requested more than two (2) years after the injury or surgery causing the scar or disfigurement.

9. Permanent Partial Disability - If your attending physician finds at the time he determines you have reached "maximum medical improvement" that you have sustained a permanent partial loss, or loss of use of, a body part, he should issue a percentage disability rating, usually on a Form 42 or in the form of a medical report. A disability rating marks the end of other workers' compensation benefits and makes you eligible to receive weekly Permanent partial Disability (PPD) benefits for a specific number of weeks.

10. Vocational Rehabilitation - If you cannot return to your usual work because of a significant permanent impairment, you may be entitled to vocational rehabilitation.

11. Notification of Benefit Discontinuation - Your employer or workers' compensation insurance carrier must notify you, by certified mail, of its intent to discontinue benefits, usually with a Form 36. You have ten (10) days in which to contest such a notice by calling the District Office for the town in which you were injured and requesting an "Emergency" Informal Hearing.

12. Choice of Physician/Right to Medical Reports - You have the right to select your own attending physician immediately after receiving your initial treatment from an employer-designed physician, if your employer has one. However, only Connecticut-licensed physicians may provide medical treatment in Connecticut workers' compensation cases. If your employer has such a medical care plan which is approved by the Chairman of the Workers' Compensation Commission, you MUST seek appropriate care from a medical provider who is part of your employer's managed care program.

13. Payment of All Medical Bills - All medical bills should be paid by the workers' compensation insurance carrier or self-insured employer. Any out-of-pocket expenses for prescriptions should also be fully reimbursed to you by the carrier or self-insured employer.

14. Travel Expenses for Medical Treatment - In most cases you will be entitled to mileage reimbursement for travel to and from any necessary medical treatment. Effective January 1, 2009, payment will be at the federal mileage reimbursement rate, currently 55.0 cents per mile.

15. Lost Time Reimbursement for Medical Treatment - If your injury does not totally disable you from work, but does require continued medical treatment, you should receive such treatment during work hours, if it is available. If the medical treatment is not available during your work hours, then you should be reimbursed for your own time as if it were lost work time.

16. Protection Against Discharge or Discrimination - Employers are prohibited from discharging or discriminating against employees who exercise their rights under the Workers' Compensation Act. A Commissioner can award job reinstatement, lose wages, and attorney's fees, and can also assess civil penalties for violations.

17. Continuation of Group Medical & Life Insurance - A requirement that private sector employers continue their portion of insurance coverage(s) for workers' compensation recipients was declared unconstitutional by the U.S. Supreme Court on December 14, 1992 in the case of District of Columbia vs. Greater Washington Board of Trade and also on April 28, 1993 in three similar cases in the Connecticut Supreme Court.

* This information is adapted from "An Employee's Packet Guide to Connecticut Workers' Compensation and this version may not be copied without the author's permission.