Workers Compensation Law
Workers’ Compensation Laws In Connecticut and How They Protect Both the Employer and Employee — A Win-Win Scenario
Author: Nathan Sperl
All 50 States, including Connecticut, offer Workers’ Compensation as the “exclusive remedy” for those who are hurt on the job. (NFIB) This means that the employee can receive “lost wages” and “medical benefits” through workers compensation while he or she is injured. (Connecticut General Statutes, (“C.G.S.”) Chapter 568, Sec. 31-275, et. seq.) In exchange for ongoing payment of benefits while the employee is injured, the employee is barred from suing his or her employer in any other forum, including Superior Court, for personal injuries. C.G.S. Sec. 31-284 Instead, the employee should file a “First Report of Injury” with the employer once he is injured (http://wcc.state.ct.us/download/acrobat/pocket-guide.pdf) and then file a “Form 30c” with the Connecticut Workers’ Compensation Commission, within the first year he is injured. (C.G.S. 31-294c) If the injury arises out of and in the course of employment, then the employer must pay for the injury, even if the employee was not being careful and it was partly his own fault. State of Connecticut Workers Compensation Commission Information Packet (2015)
This “exclusive remedy” under Compensation, essentially forms a balance of “statutory benefits” between the parties. Schilling v. New Departure Hyatt Div., CASE NO. 3290 CRB-6-96-3 (1997) The employer benefits by limiting their “liability.” In other words, the employer cannot be sued for pain and suffering that usually comes as part of a personal injury lawsuit in Superior Court. Duddy v. Filene’s, CASE NO. 4484 CRB-7-02-1 (2002) The employer is able to protect profits and minimizes risk by carrying workers compensation insurance to cover costs of workers compensation insurance. It is the law in Connecticut that every employer must carry workers compensation insurance. C.G.S. 31-284 This insurance coverage usually includes attorney representation and covers all legal and insurance company fees as well as the “indemnity” and “medical” costs paid to the injured worker. Connecticut Business and Industry Association, Inc. (CBIA) The hidden benefit of compensation insurance includes a claims adjuster that essentially removes the burden of paying each week of lost wages and each medical bill from the employer and this is done directly through the insurance carrier. (Id). On the other hand, if an employer fails to carry workers’ compensation insurance, then that employer might have no way to pay for a workplace injury. In this instance, the State of Connecticut offers a State Second Injury Fund that steps in and pays for the injuries but the State will seek repayment from the employer and may even impose jail time on the employer for failing to carry the insurance. 31-349 et seq.
While it looks like the employee may have an easy ride on workers’ compensation, the benefits paid are not paid in a huge one-time payment. CT Workers’ Compensation Packet, supra. Instead, the employee gets (1) lost wages and (2) medical benefits paid as the lost wages and medical bills are incurred on a weekly basis. Id. For example, an injured employee might get a reduced (tax free) weekly lost wage benefit while he is totally out of work. Once he is able to work “light duty,” then he either has to go back to work or search for a job that fits his doctor’s medical injury limitations. If he does this and either finds a job or submits a weekly job search, then he is allowed to continue to collect lost wages until he either returns to work full time with no restrictions or until his doctor says he is at his “Maximum Medical Improvement.” Id., see also American Medical Association, Guidelines to Permanent Impairment, 5th Ed. (2002) This is usually about one year after the injury (or one year after a surgery), whichever is later. (Id.) In total, the employee usually gets a tax free portion of his usual earnings to get him by while he injured and medical bills paid for if they are related to the injury. (Pocket Guide, supra.)
There is a third benefit that some permanently injured workers get called PPD(Permanent Partial Disability) Benefits. (C.G.S. Sec. 31-308a) After about one year, the insurance company will ask the doctor that treats the injured worker if the employee is at “Maximum Medical improvement” and if at that time there is a “Permanent Partial Disability.” AMA Guidelines, Section 2.4, p. 19 If the doctor feels that the injured worker is as good as he is going to get, then he give a percentage of impairment to the injured body part called a permanent impairment rating. Id. see also Pocket Guide, infra. For example, if a neck injury occurs, then the doctor says the neck is either all better or he gives a certain percentage of injury, such as 10% impairment to the neck. AMA Guidelines, Section 15.6 and Table 15.5 The insurance company or attorney then use this injury rating to determine if the injured worker, called a “claimant,” is then entitled to Permanent Partial Disability (“PPD”) benefits. Sec. 31-308a These benefits are paid after the claimant is recovered and he or she can work again while he is receiving these benefits. Pocket Guide, supra.
The claimant must follow a couple of key rules if he wants to receive benefits under the Connecticut Workers’ Compensation Statute. See Pocket Guide These rules are also designed to make sure the employer is treated fairly. C.G.S. Sec 31-284 Firstly, the claimant must file a “First Report of Injury” at most jobs in Connecticut. See Pocket Guide This report is an official way of the injured worker letting the employer know he is really injured and that he thinks it happened on the job. Id. For example, the worker may say that a back injury happened on the job but nobody witnessed it happen. The employer could think that this same injury might have happened at home while the claimant was stacking wood or cutting the lawn. The First Report of injury is designed to make sure that both parties fairly learn of the alleged injury and how it happened while the facts are still fresh. Id.
The other more important form is the Workers Compensation Commission, Form 30c. See CT Compensation Form 30C This form must be filed within one year of the injury, with a few exception if the employer is already paying for medical treatment or for lost wages after the injury. C.G.S. Sec 31-294c The one year period for filing the 30c is called Statute of Limitations and it is intended to keep the process fair for the employer. Id. If the employer learns of the injury within a year of the date of injury, then there is a better chance that all parties can fairly determine whether the injury happened, whether it happened at work, while working and whiter it should be covered by workers’ compensation insurance. See Pocket Guide, supra If a claimant fails to file a 30c and is not paid lost wages or medical benefits in that first year, then he is out of luck and cannot file a claim after that. Id. This is called being “barred by the statute of limitations.” CGS Sec 31-294c
Once a 30c is filed, the employer must make sure to get the 30c to the insurance company right away. See Form 30C (Warning) In response to the 30c, an employer, or the insurance company, only has 28 days to file a Form 43 denying the claim. Id. The language right on the 30c says that if the employer fails to file a Form 43 denying or contesting the claim within 28 days of the 30c, then the claim is accepted. Id. Obviously, an employer would want to protect his interests by filing the Form 43 until either the employer or the insurance company has tie to investigate the actual facts. CGS Sec 31-284, See also Form 43.
If the case is accepted, the benefits begin once the 30c is filed. However, if the case is denied with a Form 43, a hearing with the Workers Compensation Commission can be required. See Pocket Guide, supra The State of Connecticut has many workers compensation commissioners that work across the State in “Districts.” Bulletin No. 51, January 2015 (Listing of 8 districts across State) The District that hears a specific case is usually the one that is closest to the injury or to the employer’s place of business. Information Packet, supra
The workers compensation process can be very slow because it takes time for the body to heal after a serious injury. AMA Guidelines, Sec. 2.4, see also Information Packet It also takes time for an insurance company to figure out what is being claimed and if there is a doctor that agrees with the relationship between the injury and it happening in the workplace. Id. The greatest benefit to the employer is that almost all of this is covered through the insurance policy that the employer carries. CBIA, supra All a covered employer has to do is let his insurance company know that a claim has been filed. 31-284 At that point, the employer did his job and he can continue to focus on business as usual for the company.
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