This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
All employees, whether part-time or full-time, are covered under the Connecticut workers' compensation act starting the first day of employment. The Connecticut Workers' Compensation Commission outlines three steps to follow once you have suffered an injury or realize you are suffering from an occupational disease or illness:
- Report your injury to your employer immediately
- File a 30c form
- Ask your employer for information about your employer's insurance provider.
It is very important to notify your employer about your injury. Although you may do this orally, it is essential that you provide written notice to your employer about your injury. You can provide official written notice by completing the 30c form. Once completed, the 30c should be sent via certified mail to the employer and the state Workers' Compensation Commission.
You have one (1) year from the time of your injury and three (3) years from the first manifestation of symptoms related to an occupational disease to report your injury. Failing to do so may prevent you from filing a workers' compensation claim and/or receiving potential benefits related to your injury.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
All employers with one or more employees are required by law to have workers' compensation insurance. When you are injured at work, your employer must provide you with information about their insurance provider. Your employer must also complete a First Report of Injury form to notify the insurance provider about the injury. The insurer determines the compensability of your claim. The insurance provider is given twenty-eight (28) days to make this determination-either to begin payments or to deny coverage for the claim. If the insurance provider fails to make a decision or properly notify you of that determination within twenty- eight (28) days, the insurance provider loses its ability to contest and accepts responsibility for your claim (otherwise the insurance provider has one year to contest from the determination).
The Voluntary Agreement is a statement issued by the insurance provider when a claimant's injury persist more than three (3) working days and the insurance provider has yet to make a determination about whether they will accept responsibility for the claim. This Voluntary Agreement is a statement of acceptance that must be signed by the claimant, the employer, and the insurance company and should be approved by the Workers' Compensation Commission.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
Your benefits are largely contingent upon the promptness and thoroughness in which you file your claim. Make sure you contact your employer about any injuries or symptoms you have relating to your job and your workplace as soon as possible. Also, make sure to file the appropriate paper work and notify or send the documents to your employer, your employer's insurance provider, and/or the Workers' Compensation Commission if need be.
4. What benefits might I be eligible to receive?
Workers' compensation is an exclusive remedy of wage replacement benefits and medical treatments related to work related injuries and diseases. Under Connecticut workers' compensation law, an injured employee is capable of receiving benefits in regards to medical treatment, the degree of disability as a result of the injury, and job re-training.
- Medical Benefits: In most scenarios, the employer will have a pre-designated medical facility for you to receive treatments or physical evaluation should you be injured or suffer from an occupational disease as a result of your employment. After an initial medical evaluation, you may, in certain cased, designate your own physician to continue your treatment or rehabilitation.
- Benefits Relating to Degree of Injury: Wage replacement benefits are determined by the degree of disability caused by your injury, and the extent to which it prevents you from continuing or fulfilling work-related responsibilities. Depending on the degree of your injury, you may be qualified for temporary total disability benefits, temporary partial disability benefits, or permanent partial disability benefits.
- Temporary Total Disability: If you are totally disabled due to a work related injury or illness, you be entitled to wage replacement benefits. This calculation is usually based on a 75 percent benefit rate of your average weekly wages, after taxes and social security. Your average wages are based on what you have previously earned throughout a fifty-two (52) week period prior to your injury.
- Temporary Partial Disability: You are entitled to these benefits typically when you are capable of performing some work, but not as much work as you were able to prior to the injury or illness. This is calculated as 75 percent of the difference between the amount you are currently earning and what you would have earned were you not injured.
- Permanent Partial Disability: these benefits are calculated based on the amount of disability or disfigurement caused to a specific part of your body.
- Relapse or Recurrence Benefits: Depending on the nature and extent of your injury, you may be entitled to benefits for the probability of relapse or recurrence related to symptoms, pain, or future medical treatment.
- Discretionary Benefits: You may request an informal hearing with the Workers' Compensation Commission to evaluate whether you are entitled to additional benefits in regards to your claim. This determination is made on a case-by-case basis and is very circumstantial.
- Job Re-Benefits: These are benefits relating to vocational rehabilitation and job re-training to help you get back into the work force after dealing with your injury.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
It is very important that you notify your employer of your injury as soon as possible. It is the best way to insure that you will have the opportunity and the most access to potential benefits relating to your injury. You will have one (1) year from the time of your injury and three years from your first signs of symptoms related to an occupational disease or illness to file your claim with the Workers' Compensation Commission.
The Connecticut Workers' Compensation Commission has created an informational chart outlining the stages of the claims process.
6. If I am not happy with the determination, how do I appeal?
Cases that are undisputed may seek resolution through the appeals process. These are claims that carry some level of difference in opinion, disagreement, or misunderstanding among the claimant, employer or insurance provider. You or your employer may request an informal hearing to resolve a variety of issues. Informal hearings are held at the Workers' Compensation Commission office in the respective district that you reside in and presided over by a Workers' Compensation Commissioner. The purpose of these hearings is to resolve certain disputes arising from your claim or to determine whether additional benefits can be awarded. Before an informal hearing may be requested, you must attempt to resolve the dispute through your own efforts.
Disputes arising from your claim may also be resolved through a formal hearings process. These resemble formal legal proceedings, where the Workers' Compensation Commissioner acts as a judge and you and your employer are permitted to present a case, with evidence, witnesses, etc. Disputes submitted to a formal hearings process are subject to appeal should the Workers' Compensation Commissioner make a determination on the claim. These determinations may be appealed to the Compensation Review Board, which is also reviewable by the state appellate and State Supreme Court.
You are entitled to the representation of an attorney throughout the claims process.