Connecticut Workers’ Compensation Claims
Every workers’ comp case is unique, but they all must follow certain timelines and procedures as established in Connecticut law. See below for some of the most important steps involved in a workers’ compensation case in Connecticut, and contact Morizio Law Firm, P.C., if you’ve been injured on the job. Our board-certified worker’s compensation specialist will advise you, assist you and represent you every step of the way.
Steps to Take After a Workplace Accident to Secure Your Right to File a Workers’ Comp Claim
Immediately report the accident to your supervisor or the person designated at your company to receive accident reports.
Your employer files a First Report of Injury accident report with the carrier.
Get your initial medical treatment from a physician or facility designated by your employer.
Complete Form 30C, Notice of Claim for Compensation. Send the original to your employer by certified or registered mail, and send a copy to your Workers’ Compensation Commission District Office. Connecticut has eight district offices (Stratford and Bridgeport are in District Four). We can help you locate the appropriate district office to file your Form 30C. This is your official claim form. Make sure you are submitting the proper form and not your employer’s accident report.
Choose who will be your attending physician after your initial visit. You can continue with the same provider who initially saw you, or you can choose your own doctor. If the employer participates in a plan, you’ll need to select a doctor in the employer’s network to have your bills paid by workers’ compensation.
Continue to receive treatment until your doctor releases you. Don’t miss any appointments, or if you do miss an appointment, document why you missed it and try to make it up. Submit a record of your visits to your employer or their workers’ comp carrier to get mileage reimbursement for your trips to and from treatment.
Temporary Total Disability (TTD) benefit payments begin. The insurer pays your medical bills directly to the provider. You should not be billed personally for any medical treatment.
If authorized by your doctor, accept a light-duty assignment and receive Temporary Partial Disability (TPD) benefit payments, or apply for job retraining and placement if you have permanent restrictions on your ability to work. You can receive TPD during your job search.
If you are permanently disabled after reaching a point of Maximum Medical Improvement (MMI), begin receiving Permanent Partial Disability (PPD) benefits.
An Employer’s/Respondent’s Examination (formerly known as an IME) may be requested at any time. You must attend this exam when required by your employer or their insurance carrier. The exam is at the employer’s expense. You can request an informal hearing if you think their request is unreasonable. If you disagree with the outcome of the exam, you could be sent for a Commissioner’s Examination.
Denied Claims for Workers’ Compensation
Workers’ compensation is insurance that your employer carries to cover you in case you get injured on the job. You can’t sue your employer, even if they were negligent or otherwise at fault in causing the accident. Your only option is to file a workers’ compensation insurance claim after a workplace accident, so the insurance carrier will pay your medical bills and replace a portion of your lost wages while you are disabled.
If only life were that simple. Instead, employers and their insurers find numerous excuses to delay, deny or terminate a claim, keeping you from getting the medical care you need and wage replacement so you can manage your household while you are out of work. That’s why you need an attorney in your corner to fight for your rights and make sure you get the benefits you deserve. Morizio Law Firm in Stratford/Bridgeport offers a skilled and experienced workers’ compensation lawyer who is Board-Certified as a Specialist in Connecticut workers’ compensation law. Learn more below about why workers’ comp claims get denied, and call Morizio Law Firm at 475-338-3505 if you are having trouble getting the benefits to which you are entitled.
Why do Workers’ Comp Claims get Denied?
Workers’ compensation insurance carriers get more and more creative in the reasons they come up with to deny a claim. These are the most common excuses they give for why they shouldn’t pay you benefits after a workplace accident:
The accident was not work-related. Connecticut workers’ compensation law covers an accidental injury or occupational disease that arises out of and in the course of employment. The insurer might claim you were off-duty when the accident happened, it occurred off-site, or you were doing something other than your job when the injury occurred. The insurance company hopes you’ll take their word for it and drop your claim, but whether or not an accident was work-related is a complex matter. Their denial may seem formal and intimidating, but don’t give up without bringing your case to Morizio Law Firm. We’ll conduct our own analysis and let you know whether we think you have a claim.
Your injury or illness is a pre-existing condition. It’s common for carriers to try to get out of claims based on back injuries, heart disease, and knee and shoulder injuries, by claiming you had some pre-existing illness or degenerative disease that caused or contributed to your current injury. It’s important to know that Connecticut workers’ compensation law covers workplace accidents that aggravate pre-existing conditions and pays for the portion of the damage attributable to the job-related aggravation.
You failed to notify the employer promptly. The law requires you to report an injury to your employer “immediately.” This is not the same as filing a claim form, which does not have to be done immediately. If you don’t notify your employer immediately, your award can be reduced if the failure or delay somehow harmed the employer. They would have to prove your delay prejudiced them in some way. Also, reporting “immediately” can depend on the circumstances; if you are severely injured, your first concern needs to be with getting emergency medical care. Don’t let the insurance company bully you by saying you didn’t report the injury timely enough; call our office to discuss your case.
You aren’t really injured. It seems like unless you have a broken bone sticking out of your body, some employers refuse to believe you are truly hurt. Muscle strains, sprains and repetitive stress injuries like carpal tunnel syndrome and tendinitis are all covered by workers’ compensation. Employers and their insurers may rightly demand proof of your injury, but sometimes they go too far, requiring unrealistic verification or excessive documentation. They might also send you to an Employer’s/Respondent’s Examination (IME) to evaluate you by a doctor they pay for. We’ll stand beside you throughout the process, protecting your rights and helping you get benefits in a timely manner.
You’re not a covered employee. Connecticut workers’ compensation covers every employee – full-time or part-time – from day one. Still, the carriers find ways to dispute your employment status, saying you are an independent contractor and not an employee. Don’t just take their word for it. People all the time are misclassified as independent contractors when they are really employees. Also, if you work for a construction contractor hired by another company, that company should cover you the same as if you worked for them directly. Attorney Lawrence Morizio is an expert in complicated employment issues, including state-to-state representation issues.
Another law covers you instead. Some workers are covered under specialized federal workers’ compensation laws, such as FELA, the Jones Act or LHWCA, or the Defense Base Act. These laws cover railroad workers, merchant seamen and dockworkers, U.S. defense contractors, and others. Morizio Law Firm can help determine which workers’ compensation laws apply to your injury and pursue your claim accordingly.
Steps to Take if Your Claim is Denied
You can fight a denied claim by resolving the dispute directly with the carrier and your employer, requesting an Informal Hearing or Formal Hearing with the Workers’ Compensation Commission, and appealing a denial to the Compensation Review Board or appellate court. Morizio Law Firm can help you at any stage with strong advocacy that makes a compelling case for your claim.
You have one year from the date of the injury or three years from the first manifestation of an occupational disease symptom to file a claim. However, the sooner you file a claim, the better it is for your case, generally speaking.
Your employer or their insurer has 28 days to begin payment or deny your claim. If they pay within 28 days, they will have up to a year to contest the claim. On the other hand, if they fail to either pay or deny the claim in 28 days, they lose the right to challenge the claim.
If the insurer does not deny the claim, they issue a Voluntary Agreement accepting responsibility for the claim. Call the insurer if you don’t receive a Voluntary Agreement within a month after filing your claim.
Most disputes are settled at an Informal Hearing. This hearing takes place at the WCC District Office. It is a short conference presided over by a WCC Commissioner, who serves as fact finder and mediator. Either party can request an Informal Hearing after attempts to resolve the dispute without a hearing have failed. The employer or insurer will have an attorney represent them at this hearing, and you can too. If the parties agree on a resolution, the Commissioner will make it binding. You can also request another Informal Hearing or request a Formal Hearing.
Before a Formal Hearing, the Commissioner may call for a Pre-Formal Hearing. The purpose of this hearing is to settle the case or prepare it for trial by clarifying the issues in dispute. You should include all the evidence, testimony, and issues that you want to address at the Formal Hearing.
A WCC Commissioner holds a Formal Hearing. This hearing could last for several hours and could involve more than one session. The purpose of the hearing is to resolve differences and disagreements. The WCC recommends that you have legal counsel represent you. A Formal Hearing is like a court trial. There is evidence, exhibits, witnesses providing testimony under oath, a court stenographer, etc. However, the Commissioner is not bound by traditional court rules of evidence or procedure, so it’s important to have an attorney skilled and experienced in workers’ compensation hearings who understands the process.
The Commissioner issues a Finding and Award or Finding and Dismissal within 120 days of the hearing. This decision is binding unless either party appeals it. You have 20 days to appeal.
Appeals go to the Compensation Review Board (CRB). A panel of two Commissioners and the Chairperson hears the appeal. The CRB can affirm, reverse or modify the lower decision. An appeal is not another hearing or trial of the issues; it is based on the record made at the Formal Hearing. The CRB doesn’t hear any new evidence or testimony unless the CRB determines it is material, and there are good reasons why the matter wasn’t presented at the Formal Hearing.
It is possible to appeal a CRB decision to Appellate Court and even the Connecticut Supreme Court. A dispute alleging illegal discharge and discrimination goes straight to the Appellate Court, bypassing the CRB. You could also file a civil action in Superior Court or a complaint with the WCC. The WCC could reinstate you to your job, order your employer to pay you back wages and benefits, and make the other side pay your attorney’s fees.
Call Morizio Law Firm for Help with Your Connecticut Workers’ Compensation Claim
A workers’ compensation claim can involve many steps, several of which require the assistance of a skilled and knowledgeable lawyer. For expert advice and representation at every stage of your workers’ compensation claim, call Morizio Law Firm at 475-338-3505 for help from a Board-Certified Connecticut Workers’ Compensation Specialist.
