Workers’ compensation insurance in Connecticut is a state mandated requirement of nearly every employer. Compensation covers all medical costs and a large percentage, but not all, of any lost earnings. If you are injured at work or suffer from a workplace-related illness you must let your employer know as soon as possible. Your employer will notify its insurer who is responsible for making a decision about compensation. Not every claim is allowed and it may take a concerted effort through the state’s workers’ compensation body to recover rightful compensation. An experienced workers’ comp. attorney can help you with any step in the compensation process. Workers' Compensation Law in Connecticut Workers’ compensation in Connecticut is overseen by a state body, the Connecticut Workers’ Compensation Commission. The Commission makes sure that employers are properly insured and adhere to the state laws on workers’ compensation. The Commission will adjudicate any problems in compensation and arrange for both informal and formal hearings in the event that a claim is denied. In Connecticut, the provision for workers’ compensation is relatively generous. All medical costs are covered and up to a maximum of 75% of average earnings if time at work is lost due to treatment or recovery. Unlike many other states, heart attacks are also covered as long as they are workplace related. Workers’ compensation in Connecticut as elsewhere in the U.S. is a no-fault type of insurance. Unlike personal injury claims, it is not necessary to prove that an injury or illness was the fault of the employer. However, there are still many reasons why an insurer may deny a claim or limit the compensation payment. Why Your Claim Might be Denied There are many reasons why your claim could be denied or a payment reduced below what you need. Insurance companies do not like paying out compensation even when the evidence that it is deserved is compelling. In some instances a denial is made because you were too late making a claim. This may be reversed if it can be proved that you were not physically able to do so on time. Some denials are a result of clerical mistakes made by an employee at the same workplace as you. The date given by your employer may not match the dates you were working. These sorts of mistakes are usually easy to correct. Other claims made by the insurer may include alleging that: your injury or illness was pre-existing and had nothing to do with your job; you deliberately caused the injury to obtain compensation; you were drunk or affected by drugs when you were injured; deliberately refused to obey safety rules; your medical treatment was unnecessary. The Appeals Process in Connecticut If your claim has been denied or insufficient compensation has been awarded, you have an opportunity to challenge the decision. If you do go ahead with an appeal, you are advised to use a workers’ comp. attorney to explain the procedure and help represent you, although this is not mandatory. You will at first need to file a petition with the Workers’ Compensation Commission. You will need to present a reason why you want to make an appeal. Most appeals are heard in informal hearings when you, your attorney (if you have one) and someone from the insurance company are present with a Commissioner. These hearings are meant to be impartial and in most cases they will lead to an agreement being struck between the employee and insurer. If the informal hearing does not result in a satisfactory result, then the next step is to request a Formal Hearing, which will also be heard by a Commissioner. If there is no satisfactory resolution and you are still convinced that a denial was the wrong decision there are further avenues that you can still pursue. This involves taking the case to the state’s Appellate Court or even the Supreme Court. The latter is very rare. Why a Workers' Compensation Attorney May be of Help Appeals against a workers’ compensation claim denial in Connecticut are not easy. The hearings, informal or formal, are designed for those who are well prepared, ready to commit their time and energy and who have accumulated sufficient evidence to support their claim. An experienced workers’ comp. attorney can make all the difference between frustration at the lack of progress and successful resolution of a compensation dispute between you and the employer’s insurer.
