Claims Kit

Physician Selection 31-294d

An employee may choose an attending physician AFTER the initial visit with an employer-designated medical practitioner. If the employer does not participate in an approved medical care plan, the employee may choose any medical practitioner who is licensed to practice in Connecticut, including practitioners of chiropractic, medicine, naturopathy, osteopathy, and podiatry. An employee whose employer does participate in an approved medical care plan must choose a physician from the list of doctors included in that plan. If the employee chooses a physician outside the plan, a Workers' Compensation Commissioner may suspend all rights to workers' compensation benefits. In either case, it is the injured worker who has the right to choose.

An employee may change their attending physician, if dissatisfied with the medical treatment being rendered. There are three ways in which an employee may effect a change of physician: (1) Get a referral from the present attending physician, (2) Obtain approval to change physicians from the workers' compensation insurance carrier involved (or the employer, if it is self-insured), OR (3) Write to the Workers' Compensation Commissioner in the District Office having jurisdiction. Indicate the name, address, and medical specialty of the present physician, as well as the name, address, and medical specialty of the new physician, and the reason(s) for requesting a change. In this case, the commissioner could reply by mail or set up an informal hearing.

[NOTE: If the employee is covered by an approved employer medical care plan, the new physician MUST also be a participating practitioner in the plan.] If an employee does not have an attending physician's referral to another medical practitioner, or permission to change physicians from the insurer, self-insured employer, or Commissioner, they will most likely be liable to pay for any unauthorized medical bills which may arise.

All necessary medical care for the injury or illness must be provided by a medical practitioners licensed to practice in Connecticut. If, for any number of reasons, the employee requires treatment with a doctor outside of the state, the employer/insurer could grant permission or the employee would have to request permission from a Workers' Compensation Commissioner who may or may not authorize out-of-state treatment. If the employee resides in another state, a Workers' Compensation Commissioner may authorize medical care by a physician in that state.

Medical care provided by a practitioner other than the attending physician or a specialist to whom the employee has been referred, is the employee's responsibility as these treatments and their charges are considered unauthorized.

Reporting of Claim by Employer Sec. 31-316

Every employer must keep a record of the injuries sustained by their employees in the course of their employment that result in incapacity for one day or more.

Every employer must send to the chairman of the Workers' Compensation Commission, in duplicate, each week, or more often if so directed, a report of all injuries that the rules prescribed by the chairman determine, including the time of each injury, together with notices of claims for compensation that have been served upon the employer, within one week of the receipt of the notices of claims.

 Upon determining that the employer or the employer's representative failed to report injuries as required, the workers' compensation commissioner may increase the award for compensation for the employee's injuries proportionate to the prejudice that the employee sustained due to the employer's failure to file.

Posting Requirements Statute 31-294c, Rules 31-279(b)-3   31-279 (b)-4

Each place of employment subject to Workers' Compensation must post a notice in a place readily accessible to all employees. 

The information in the notice will be kept current by each employer to whom a certificate of solvency has been issued, and will be revised by each insured employer each time a new policy of workers' compensation insurance is issued to it.

Effective October 1, 2017, an employer other than the state or a municipality may opt to post the location to which an employee must send a claim for workers' compensation benefits.

If an employer chooses to designate a location for employee claims, notice must be posted where other posters required by law are displayed in the workplace.
 
When an employer opts into this new provision, it is required to send the same address information it has posted in its workplace to the Workers' Compensation Commission.

When an employer opts into this new provision, it is the employer's sole responsibility to ensure that the information posted in the workplace, and that submitted to the Commission for posting on its website, is accurate, and consistent with each other.

Penalty

 Any employer who violates any of the posting requirements as prescribed will be assessed a civil penalty of up to one thousand dollars for each violation. 31-382

Penalties for Late Reporting  31-316 (b) 38a-1018

Upon determining that the employer or the employer’s representative failed to report injuries as required, the workers’ compensation commissioner may increase the award for compensation for the employee’s injuries proportionate to the prejudice that the employee sustained due to the employer’s failure to file.

After notice and opportunity for a hearing, the commissioner may impose a monetary penalty on any person or group found to be in violation of any provision of 31-316. The monetary penalty will not exceed $1,000 for each act or violation and must not exceed an aggregate o f$10,000.