This is the first in a series of blog entries addressing workers’ compensation claims in Connecticut. It is important to note at the outset that this blog is not a substitute for seeking advice from a licensed attorney to discuss your personal situation. Compensation claims by definition are dependent upon the specific facts and circumstances of each case. The workers’ compensation statutes are codified at Chapter 568, Section 31-275 et seq. of the Connecticut General Statutes. These statutes are referred to as the Workers’ Compensation Act (“Act”). The Act sets forth the framework within which a claim should be filed, prosecuted, defended, settled, etc. The Act also defines key terms vital to an understanding of the Act. The Act was written by the legislature to be form intensive but “user friendly.” In other words, a claimant is not required to retain an attorney to represent his interests before the Workers’ Compensation Commission (“WCC”) because the claimant should be able to utilize the statutory forms and represent himself. However, in my opinion, a claimant who attempts to represent himself before the WCC has a fool for a client. Most attorneys will represent claimants on a contingency fee basis, which means the attorney would only receive a legal fee if the attorney is successful in procuring benefits for the claimant.
The Act in its present form is designed to compensate an injured worker who is injured in the course and within the scope of his employment. There are two main categories of benefits. An injured employee is entitled to indemnity and medical benefits if he is injured at work. The Act governs how compensation is calculated and how medical treatment should be administered.
Indemnity benefits are payment to an injured worker for lost time from work because of an injury, and medical benefits refer to the actual treatment by a medical professional of a work injury or occupational illness. For example, an employee who sustains a lifting injury while working on the loading dock is entitled to receive medical treatment at no cost to him, and if the injury is significant enough that the employee misses more than a week from work then the worker would generally be entitled to indemnity payments too. The indemnity payments are based upon the injured worker’s average weekly salary.
Average weekly salary is calculated pursuant to the Act as the total wages of the employee for the previous 52-weeks from the date of injury divided by the amount of weeks used to reach the total. The Act provides that 75% of the average weekly wage (with deductions for taxes) is the employees workers’ compensation rate. Candidly, attempting to ensure that an insurance company has properly calculated an employee’s compensation rate is one of the most important tasks I as a claimant’s attorney perform. Obviously, an employee should receive all compensation that the Act mandates, but a claimant also wants to ensure that he is not overpaid because an employer or its insurance company can demand that the overpayment be refunded.
Medical benefits tend to be a more difficult aspect of a workers’ compensation claim. There is a requirement that an employer provide medical attention to an employee injured on the job. Sometimes, however, it becomes clear to a claimant that the employer’s interests don’t always conform with the claimant’s interests when it comes to medical treatment. Sometimes problems arise out of the claimant’s freedom to choose her own doctors, and sometimes the problem could be a disagreement between the employer and the claimant as to whether the claimant is medically cleared to return to work.
The most common dispute I am involved with in my workers’ compensation practice is the inevitable difference of opinion between a treating physician and an insurance company physician about whether a claimant is cleared to return to unrestricted full duty employment. Obviously, it is in the employer and insurance company’s best interests to return an injured worker to his job as soon as possible because injured employees are expensive; expensive from the perspective of the employer due to a lack of production and expensive from the perspective of the insurance company that is paying medical and indemnity benefits while the injured claimant is out of work.
The attorneys at Sullivan Heiser, LLC are well-versed in the prosecution (and defense) of workers’ compensation claims. We have represented many claimants and have been successful in procuring benefits for injured workers both before the WCC and also in Superior Court when there is third party liability, i.e., an employee injured in a car crash can seek compensation from his employer if the claimant can allege and prove that his injury is work related, and the driver who may have caused the car accident. However, third party liability claims can be complex and a claimant must be vigilant of lien rights and the legal obligations imposed by the Act. If you have been injured while working then you should contact our office to make an appointment for a no-fee consultation.