DI 52120.040: Connecticut Workers' Compensation (WC)

changes
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~~Effective Dates: 11/12/2010 - Present~~
Effective Dates: 05/09/2018 - Present
BASIC (09-08)
DI 52120.040 Connecticut Workers' Compensation (WC)
Connecticut’s Workers' Compensation Commission administers their WC. WC is provided through private carriers but employers may self-insure.
A. Types of Connecticut WC payments
Connecticut’s 137 WC statutes are known collectively as the WC Act, or Chapter 568. Section 31 covers indemnity payments. No Connecticut WC case may be closed without mutual agreement between the claimant and the carrier/employer.
1. Temporary Total (TT) Benefits – Compensation for Total Incapacity [Sec. 31-307].
Weekly TT benefits are based on 75 percent of the worker’s after-tax average weekly wage, subject to the State legislated maximum and minimum amounts. WC is paid for the duration of the disability.
2. Temporary Total (TT) Benefits for a Recurrence or Relapse from Recovery [Sec. 31-307b].
If the worker returns to work from an injury, but then has a recurrence or relapse from recovery, he will again be eligible to receive WC. This weekly compensation rate is based on the original TT benefit rate (plus cost-of-living adjustments) OR the TT rate based on the worker’s earnings at the time of the recurrence or relapse, whichever is higher.
3. Temporary Partial (TP) Benefits during a Job Search (Partial Incapacity) [Sec. 31-308(a)].
If the worker is released for “light duty” or “restricted” work and the employer does not have such work, he is entitled to TP benefits while performing a job search for suitable employment. TP benefits are paid at the basic weekly TT compensation rate, subject to the State maximum and minimum amounts.
4. Temporary Partial (TP) Benefits while in a Lower-Paying Job (Partial Incapacity) [Sec. 31-308(a)].
If, as a result of the injury, the worker returns to a lower-paying job (described as either “light duty” or “restricted”), he is entitled to TP wage differential benefits. These TP benefits are based on 75 percent of the after-tax difference between the wages the worker is currently earning and the wages currently being paid in his former job, subject to the State maximum and minimum amounts.
5. Permanent Total (PT) Benefits – Compensation for Total Incapacity [Sec. 31-307] –
PT is the same as TT except that it is paid for permanent disability and is increased by COLAs. Some injuries are deemed permanent, such as an injury resulting in permanent and complete paralysis of the legs or arms.
6. Permanent Partial (PP) Benefits – Compensation for Partial Incapacity [Sec. 31-308(b)].
When Maximum Medical Improvement (MMI) is reached, a percentage disability rating is issued (usually on a Form 42 or in the form of a medical report). This marks the end of other workers’ compensation benefits (TT or TP) and makes the worker eligible to receive weekly PP benefits for a specific number of weeks. The rate of weekly PP paid is determined by the specific body part that was injured and the basic compensation that the worker was receiving at the time of his original injury. It is subject to the State maximum and minimum amounts. Payment of this benefit does not close out the claimant’s case.
If the employer/insurer accepts the evaluation, a Voluntary Agreement form is issued. The claim remains open and the employer/insurer is still liable for future medical expenses and other compensation benefits.
* If the degree of disability is disputed, the worker and the employer/insurer can either work out a compromise or request an Informal Hearing on the matter. In most cases claimants will receive undisputed PP benefits without the need for legal representation.
7. Disfigurement and Scarring Benefits [Sec. 31-308(c)] –
WC may be awarded for permanent, significant disfigurement or scars due to a work-related injury. These awards cannot be requested any earlier than 1 year or later than 2 years after the injury or surgery causing the disfigurement or scar. The weekly Disfigurement and Scarring benefit rate is equal to the worker’s weekly TT benefit rate, subject to the State maximum and minimum amounts, and may be paid for a period of up to 208 weeks.
8. Discretionary Wage Differential ‘308a’ Benefits [Sec. 31-308(a)] –
This additional WC may be granted to an worker after he has been paid all of his PP WC, if the injury results in his inability to find employment, or the new employment pays less than the original job. The worker must request a hearing in order to receive these benefits. If they are granted, it will be for a specific number of weeks, which cannot exceed the number of weeks PP was paid.
9. Second Injury Fund payments [Sec. 31-349] –
When a worker with a previous WC disability incurred a second disability that, in combination with the first injury, resulted in permanent disability, the second employer used to be able to transfer liability to the State’s Secondary Injury Fund. That fund has now been closed to new claims. For injuries on or after 07/01/1995, employers and their insurers remain liable for the WC due.
10. Lump Sum Commutation Awards [Sec. 31-302] –
Periodic WC can be commuted into a lump sum payment. An award commuted into a lump sum becomes a final judgment, and no additional WC will be due on that claim.
11. Lump Sum Settlements [Sec. 31-355] –
Settlement agreements to finally or partially settle WC claims are allowed, subject to the approval of the WC commissioner.
12. Connecticut Firefighters & Police Officers Benefits [Sec. 7.433c] –
These are benefits for police officers or firefighters disabled as a result of hypertension or heart disease only. They are offsettable WC if the disability is work-related. Develop if there is reason to suspect that the payments are not work-related. If the disabled worker was employed as a police officer or firefighter:
* Determine whether he is receiving, has filed, or intends to file for benefits under the Connecticut General Statutes, section 7.433c.
* Explain the effect of these payments on SSA DIB benefits, i.e., they are considered to be work-related and therefore are offsettable WC.
NOTE: Connecticut has businesses operated by Native American tribes. These tribes have created their own workers’ compensation systems separate from the State of Connecticut. Payment made under a law or plan enacted by an American Indian Tribal Government is NOT offsettable WC. For more information regarding this, see DI 52105.015 - Payments Not Considered Workers’ Compensation.
B. Cost-of-living Adjustments (COLA) [Sec. 31-307a]
COLAs apply ONLY to total WC and are effective October 1st. For injuries occurring on or after 07/01/1993, they apply only to workers who are permanently totally disabled (or who have been totally disabled for a period of 5 years or more). There are NO COLAs for the other types of WC. See the link for ‘State WC maximums and COLAs’ under References below for COLA charts. COLAs are calculated differently depending on the worker’s date of injury
C. Attorney fees
Attorney fees are determined on an individual case basis.
D. Retirement insurance benefit (RIB) considerations
Previously Connecticut WC payments were reduced by the amount of concurrent RIB benefits, but only WC for total incapacity, and only from 07/01/1993 through 05/29/2006.
E. Time limits for filing
A worker injured or ill as a result of his employment is required to notify the employer of his intention to file a WC claim. This must be done within:
* 1 year from the date of injury, or
* 3 years from the first manifestation of a symptom of an occupational disease.
F. Verifying WC
1. Carriers
Carriers are usually the best source of WC payment information.
2. State Contact
Workers’ Compensation Commission
Capitol Place
21 Oak Street, Fourth Floor
Hartford, Connecticut 06106
Phone: (800) 223-9675 (toll-free in Connecticut), or (860) 493-1500
Fax: (860) 247-1361
Early State records may not be available. Some records were lost due to flooding in the early 1990’s in Hartford.
When sending a request for WC information, make sure to provide the beneficiary’s date of birth (DOB). If you are using Form SSA-1709, provide the DOB in the Remarks section (field #12). The Connecticut Workers’ Compensation Commission is now using DOB information (as opposed to Social Security numbers) to identify claimants.
G. Connecticut WC forms
1. Form 30C (Notice of Claim for Compensation)
The employer sends the Form 30C to the insurer, who then has 28 days in which to commence payment for lost time or deny the claim. If they do neither within that period of time, they lose their right to contest the claim. If payments are begun within the 28 days, the employer/insurer then has up to one year in which to contest the claim.
2. Voluntary Agreement [Sec. 31-296]
If the injury/illness disables the worker for more than 3 days and the insurance company does not deny the claim, they must issue a Voluntary Agreement (VA), which is a statement of acceptance of responsibility for the claim. The VA must be signed by all parties and approved by a Workers’ Compensation Commissioner. The official State of Connecticut Workers’ Compensation Voluntary Agreement form is green.
3. Form 36 (Notice of Intention to Reduce or Discontinue Payments)
When the claimant is no longer totally disabled, the employers/insurers are required to file a Form 36 in order to discontinue TT WC payments. This form must be sent to the claimant and the WC Commissioner. The Commissioner will automatically approve the Form 36 within 15 days of receipt, unless contested by the claimant. If the notice of discontinuation is properly contested, the employer/insurer must continue to pay workers’ compensation benefits until an Informal Hearing is held on the matter.
NOTE: A Form 36 does not necessarily mean that ALL workers’ compensation benefits are being discontinued. A claimant no longer eligible for TT payments may be entitled to TP or PP WC.
H. Exhibits
* Form 30C http://wcc.state.ct.us/download/acrobat/30c.pdf
* Voluntary Agreement http://wcc.state.ct.us/download/acrobat/va.pdf
* Form 36 http://wcc.state.ct.us/download/acrobat/36.pdf
I. References
* State of Connecticut Workers’ Compensation Commission site: http://wcc.state.ct.us/index.html
* State of Connecticut - General Information on Workers’ Compensation (includes the WC law and a glossary of WC terms): http://wcc.state.ct.us/gen-info/gen-info.htm
* PR 02505.008 - Title II Regional Chief Counsel Precedent: PR 01-006 (Proration of Workers' Compensation Lump-Sum Award in Connecticut) http://policynet.ba.ssa.gov/poms.nsf/lnx/1502505008!opendocument
* Connecticut State WC maximums and COLAs http://wcc.state.ct.us/memos/2010/2010-05.htm

POMS Reference

DI 52120.040: Connecticut Workers' Compensation (WC)