Claims Kit

Physician Selection 31-294d

An injured 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 injured 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, an Administrative Law Judge may suspend all rights to workers' compensation benefits.

In either case, it is the injured worker who has the right to choose.

An injured 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.

MEMORANDUM NO. 2021-04

Effective Thursday, May 20, 2021, Governor Lamont has extended Section 2 ofExecutive Order 7K, which suspends non-critical Workers' Compensation Commission operations and associated requirements, through June 1, 2021. Upon the expiration of Executive Order 7K, Section 2:

1. All statutory filing deadlines waived by Executive Order 7K shall begin anew effective June 2, 2021. For example, a 20-day deadline for payment of an awardpursuant to § 31-303dated prior to June 2, 2021 must commence on the 20th day following June 2, 2021.
   
2. Forms 36 received prior to the expiration of the EO 7K will not be automatically approved. Any Forms 36 received on or after June 2, 2021 will be automatically approved if no objection is filed within 15 days.
   
3. Job searches will continue to be waived for all existing temporary partial benefits and/or C.G.S. 31-308a orders in effect on or before June 2, 2021. Effective June 2, 2021, the Commissioners, at their discretion, can require job searches when appropriate for temporary partial and/or C.G.S. 31-308a benefits. No benefits shall be terminated for lack of job searches on any temporary partial and/or C.G.S. 31-308a benefits already being paid as of June 2, 2021.
   
4. Effective June 2, 2021, all other WCC policies, procedures and deadlines return to the same as existed prior to March 16, 2020.

March 25, 2020

Submission of WCC Forms During COVID-19 Pandemic

Given the directives and measures being taken to contain the spread of COVID-19, the requirements for certain forms to be sent via certified mail under the workers' compensation act is hereby suspended per Section 31-321, effective March 25, 2020.

The Commission will now accept forms via standard mail delivery services or facsimile. It may be advisable to maintain copies and take any other measures which would support proof of the delivery and receipt of any forms should subsequent substantiation be necessary.

Additionally, given the Governor's recent Executive Order allowing remote notarizations, the Commission will now be accepting documents notarized pursuant to Executive Order No. 7K.

Executive Order No. 7K can be found on the Governor's websitehere.

March 25, 2020

WCC Form 36 Procedure Under Governor's Executive Order

The Governor's recent Executive Order suspending Chapter 568 statutory, regulatory and administrative deadlines (including the 15-day deadline to object to a Form 36 pursuant to Section 31-296). As a result, WCC will no longer be automatically approving Forms 36 administratively.

Currently, and going forward, commissioners are receiving a daily list of all Forms 36 that would have otherwise been administratively approved. Commissioners are then reviewing these Forms 36 to determine if approval, denial or a hearing is warranted.

Further, as the result of the suspension of the 15-day deadline to object, a Form 36 approved in the above manner will require a hearing if WCC receives notice of an objection after the expiration of 15 days.

MEMORANDUM NO. 2020-14 August 12, 2020

Governor Lamont’s Executive Order 7JJJ (“EO”) tasks the Workers’ Compensation Commission (“WCC”) with collecting information from employers and insurers some of which information is not available to WCC in its data base. The pertinent section of the EO which pertains to such information includes the following language:

“to the extent reasonably practicable, information about the percent of non-litigated COVID-19 workers’ compensation claims filed by hospital, municipal, and other employees that are record-only claims, have been granted or denied by the employer or insurer, and are being paid, including paid without prejudice, by the employer or insurer.

Employers and insurers shall comply with any requests from the Workers’ Compensation Commission for information pertinent to said reports.”

WCC, per the EO language provided our first report to the Office of the Governor on August 1, 2020 and is required to do so monthly until such time as it is no longer required. We would request you please provide to us in advance of September 1, 2020, the information requested so that WCC may comply with the Governor’s request.

While the language in the EO seems self-explanatory, if you have any questions please feel free to reach out to Richard Eighme whose contact information is provided below. The requested information can be submitted to Richard Eighme via email, mail or fax.

Richard Eighme, Communications and Legislative Program Manager
Workers’ Compensation Commission, Office of the Chairman
24 Oak Street
Hartford, CT 06106-8011

(860) 493-1580
Fax: (860) 247-1361

Richard.Eighme@ct.gov

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 of $10,000.

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  31-284 (f)31-294c, Rules 31-279(b)-3  

 Each employer must post, in a conspicuous place, a notice of the availability of compensation

An employer, other than the state or a municipality, may opt to post a copy of where notice of a claim for compensation must be sent by an employee in the workplace location where other labor law posters required by the Labor Department are prominently displayed. In addition, an employer, opting to post where notice of a claim for compensation  will be sent, must forward the address of where the notice of a claim will be sent to the Workers’ Compensation Commission and the commission will post the address on its Internet web site. An employer is responsible for verifying that information posted at a workplace location is consistent with the information posted on the commission’s Internet web site

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

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