Workers’ compensation benefits provide medical treatment, lost wages and more to someone who is injured while at work.
Anyone could become injured at work. Regardless of whether you’re in a high-risk occupation like roofing or construction, or if you think your job is pretty low-risk—office work, answering phones, or data processing, for instance—accidents happen.
The key to workers’ compensation is coverage of any injury that happens while you’re at work or engaged in work-related duties. That means your injury would qualify for benefits if you tripped over a phone cord in your office, dropped a heavy stapler on your foot, or even slipped on the stairs and were injured—even though the injury wasn’t directly related to performing your job.
If you’re injured outside of work, you can file a personal injury lawsuit if you were injured in a car accident, truck accident, slip and fall, by a defective product, as a result of medical malpractice, or in any other way if the other party was negligent.
Negligence means that the person or entity that caused the injury did not adhere to a reasonable standard of care to the plaintiff (injured person). The plaintiff must prove that the defendant’s negligence directly caused their injury.
Fortunately, this is not the standard to recover benefits for a workers’ compensation claim. Workers’ compensation is no-fault insurance.
Injuries that are eligible for Connecticut workers’ compensation benefits
You need to prove one of the following:
1. The injury resulted from an accident that happened at your workplace;
This is the most straightforward and easily proven scenario. It happened at work.
If you’re injured while at work, you need to prove (1) the existence of your injury, and (2) that it happened at work. Often, this is a matter of properly and timely notifying your manager or supervisor so that your employer is on notice that a claim will be filed.
2. The injury or illness resulted from a condition or environment in your workplace;
This could be more challenging to prove. This would include conditions like hearing loss from repeated exposure to loud noise, an illness that develops over time as a result of exposure to toxins or chemicals; or similar.
Your lawyer must show the workers’ compensation insurer that the condition at work caused your condition and that there is no other cause for the injury or illness.
This can be a variety of illnesses that include (but are not limited to):
- Chemical poisoning from exposure to harmful chemical elements without proper protection or training.
- Mesothelioma from exposure to asbestos.
- Industrial dermatitis, which is caused when an employee’s skin comes into direct contact with industrial irritants and can cause extreme cell damage.
- Industrial asthma from airborne toxins like Potassium Dichromate, which is common on construction sites.
- Neurological disorders from harmful contaminants.
- Stress-related injuries, which can be from many sources, such as being overworked, an abusive boss or dealing with difficult coworkers/employees.
3. The injury or illness developed from a particular task that’s part of your job;
There are several types of injuries that could develop because of repetitive motions or tasks at work.
These types of injuries often come from either strain (i.e. heavy lifting, turning or twisting) or repetitive motion (such as cutting food, computer work, etc.). People who perform the same or similar physical motion or positioning for many hours a day are susceptible to these kinds of injuries, which often don’t show symptoms for a long time.
If you’re suffering from this type of injury, you’d likely benefit from hiring a workers’ compensation lawyer because one reason why insurance companies deny a workers’ compensation claim is because the worker can’t prove that their job caused the injury. Your lawyer will know how to prove and negotiate a claim for an injury that might not immediately show a direct link to your job.
Here’s the scenario... you work for a small accounting firm as the assistant to one of the accountants. Your boss is late for a meeting, so she asks you to run out and pick up her drycleaning at a shop around the corner from your office.
You are on your way to the drycleaner when a driver exits a parking lot without looking and you get hit and injured.
Can you claim workers’ compensation benefits? YES. Even though picking up the cleaning isn’t necessarily in your job description, it is a task requested (required) of you by your employer and is therefore within the scope of work covered by workers’ comp, even though you were not physically present in your workplace at the time of the accident.
But let’s switch it around a little.
It’s 7:30am and you’re about to leave your home to head in to work. Your boss texts and says, “I am running late. Could you please stop at the drycleaner on Main Street and pick up my cleaning on your way in?” Certainly, this could be perceived as problematic for a number of reasons (healthy boundaries being one of them!), but it also becomes murky from a workers’ comp perspective if you’re injured.
So, you drive to work and park on the street in front of the drycleaner. You’re getting out of your car to pick up the cleaning when a driver who is texting swerves out of their lane and hits you.
If you’re injured while commuting to or from work, it is not covered by workers’ compensation insurance. But you enter the gray area when you make a stop that could be considered a work-related task.
It’s easier to determine that an injury is covered under Connecticut workers’ compensation insurance if you’re injured while doing your work at a client’s home or office, on a construction site, or anywhere else that your job requires you to be.
How to make a Connecticut workers’ compensation claim
Connecticut workers’ compensation is administered by the Department of Administrative Services (DAS) and is governed by laws of Chapter 568 of the General Statutes.
Here’s what to do if you suffer a work-related injury or illness:
- Report your injury to your employer immediately.
- Provide your supervisor with a thorough account of the accident or incident.
- Use the approved provider directory to find a physician and receive an examination.
- Complete the claim packet (Form 30C). This is a Notice of Claim and must be completed and filed by the employee. It’s important to file the Notice of Claim as soon as possible after an injury, but you must file within one year of an accidental injury and within three years of the first manifestation of a symptom of occupational disease.
Seeking medical treatment for a Connecticut workplace injury
An injured employee must receive treatment from a provider within the Gallagher Bassett Services Inc./Prime Health Medical Provider Network. If you seek treatment outside the network, you might not be able to make a workers’ compensation claim for those costs.
All services are provided through a managed care program that complies with Connecticut General Statutes § 31-279-10. The program offers pre-certification treatment, nurse case management, prescription drugs and access to specialists outside of the network if necessary by referral from an in-network provider.
What if your employer contests your claim?
If your employer disputes or contests the claim, you may request an informal hearing from the DAS district office where you were injured. You may file for benefits from the group health insurance and disability program, and the group carrier should provide benefits under the group policy until your denial is resolved at a hearing.
Benefits under Connecticut workers’ compensation insurance
You can receive benefits to cover the cost of medical treatment including prescription drugs, doctor and hospital visits, surgery and more. You may choose your treating doctor or provider from an approved list.
If your injury leaves you unable to return to the job you had previously, you can receive benefits for retraining so you can perform a different job.
Temporary disability benefits
Connecticut workers’ compensation laws say that if you’re unable to work at all while you’re recovering from a work-related injury or illness, you may receive temporary total disability (TTD) benefits. This is 75% of your pre-injury average weekly wage, subject to a state-mandated maximum and minimum.
If you’re partially disabled, you can receive some benefits, or temporary partial disability. You can receive up to 75% of the difference between the current wage for the work you performed before your injury and your actual take-home pay after the injury (also subject to a state-imposed maximum amount).
Temporary disability benefits can begin after you’ve missed three days of work from the injury, unless you’re unable to work for more than seven days. These benefits continue until you are able to resume work at your regular wage or until the doctor determines that you’ve reached maximum medical improvement (MMI). That means you’re not expected to improve any further, even though you might continue to receive medical treatment.
Workers’ compensation benefits include transportation costs to medical appointments. This includes mileage reimbursement if you’re able to drive your own vehicle.
Permanent disability benefits
If you’ve reached MMI, your doctor can determine whether you have a permanent disability. If so, you might be able to receive permanent partial disability (PPD) benefits. This would be if the work-related injury caused you to lose part of your body as included on a specific list under Connecticut law. This could include organs and sensory functions (like sight and hearing).
You can receive benefits based on the amount or extent of function lost. It would be 75% of your pre-injury wage up to the state-specified maximum and with a $50 minimum.
The state schedule of functional losses lists the number of weeks you can receive benefits depending on the amount of function or body part lost. If there is a partial loss, the benefits can continue to a proportional amount based on your percentage of disability.
If you’ve reached MMI and remain unable to do any type of work, you could receive permanent total disability benefits. These would continue at the same rate as your temporary total disability benefits and would last for the length of time you remain disabled, even if it’s a lifetime, which includes annual cost of living adjustments.
If someone dies in a work-related accident or from a work-related illness, their surviving dependent family members may receive death benefits. This is paid at the same rate as TTD benefits and includes burial expenses up to $4,000.
When to call a Connecticut workers’ compensation lawyer
The workers’ compensation is intended for the injured worker to be able to receive benefits quickly after an injury without requiring a lawyer’s assistance.
But it doesn’t always work that way.
If you are injured at work and the workers’ compensation system provides you with the full amount of coverage for your injuries, and if you’re recovered, back to work and won’t require additional treatment, then you likely don’t need a lawyer.
However, if you believe you’ll need additional or future treatment for the injury or condition, or if you think that the amount you’re being offered isn’t sufficient to cover your anticipated costs, you need to call a Connecticut workers’ compensation lawyer.
Your lawyer will negotiate with the insurer to ensure that you’re receiving the full amount to which you’re entitled. In addition, your lawyer will consult with medical experts, actuaries and others to calculate the exact amount of future expenses you’d be likely to face related to your work injury.
The basis for personal injury law is fairly straightforward:
If you're injured because of someone's negligence, then you're entitled to recover for your financial losses related to the injury.
The premise for the workers' compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you're injured at work.