State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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What is the "typical" flow of a workers' compensation case?


This page presents a simplified chart representing the basic steps through a “typical” undisputed workers’ compensation case. These steps include the main events in the life of the claim and the corresponding actions taken by the injured/ill employee, the employer/insurer, and the employee’s attending physician.

[NOTE: Any given workers’ compensation case may or may not include any or all of the following steps (e.g., an employee may completely bypass Temporary Total Disability benefits and begin receiving Temporary Partial Disability benefits, if his or her injury only partially incapacitates him or her from work). Also, if an employee’s employer operates an approved Preferred Provider Organization, or PPO, then the appropriate statutes and regulations are in effect.]

1 - Employee Has Work-Related Injury or Illness


Employee

Immediately reports injury/illness to employer

Accepts initial medical treatment from employer-designated physician

Files 30C Claim Form (Notice of Claim for Compensation)


Employer/Insurer

Provides employee with initial medical treatment

Files “First Report of Injury” Form
(Accident Report)


Attending Physician

Renders initial medical treatment

Submits initial medical report to employer/insurer and to injured/ill employee at same time

2 - Continued Medical Treatment and Total Incapacity from Work


Employee

Chooses attending physician, after initial medical treatment

Accepts appropriate medical treatment from attending physician

Furnishes employer/insurer with record of physician/treatment visits for mileage reimbursement


Employer/Insurer

Provides wage statement to insurer, who initiates payment of Temporary Total Disability (TT) benefits upon confirmation of total incapacity from work

Insurer provides Cost-of-Living Adjustment(s) and/or Dependency Allowance(s), if applicable

Pays medical bills


Attending Physician

Renders appropriate medical treatment

Confirms Temporary Total Disability

Provides medical reports as needed to employer/insurer and to injured/ill employee at same time

Sends medical bills to employer/insurer

3 - Continuing Period of Total Incapacity while under Treatment
by Attending Physician


Employee

Continues to accept medical treatment from attending physician

Signs Voluntary Agreement for TT benefits

Calls employer/insurer and/or Workers' Compensation Commission with any questions

Submits receipts for prescriptions to insurer for reimbursement


Employer/Insurer

Continues paying weekly TT benefits

Issues Voluntary Agreement for TT benefits

Continues paying medical bills


Attending Physician

Renders appropriate medical treatment

Provides periodic medical reports on injured/ill employee's medical status to employer/insurer and to injured/ill employee at same time

Sends medical bills to employer/insurer

4 - Medical Status Improves & Employee Becomes Capable of
“Light Duty” or “Restricted” Work


Employee

Requests light duty/restricted work from employer

If unavailable from employer, performs a job search and contacts insurer to request Temporary Partial Disability (TP) benefits

If attending physician indicates that restrictions are permanent, may apply to WCC's Rehabilitation Services for help with job retraining and/or placement


Employer/Insurer

Sends a Form 36 (Discontinuation Notice) to Workers' Compensation Commission and to injured/ill employee for discontinuation of TT benefits

Begins payment of TP benefits

Continues paying medical bills


Attending Physician

Reports injured/ill employee's medical status and work restrictions to employer/insurer and to employee at same time

Renders appropriate medical treatment

Provides periodic medical reports, as earlier

Sends medical bills to employer/insurer

5 - Injured/Ill Employee Reaches Maximum Medical Improvement
(MMI)


Employee

Contacts insurer to reach agreement on Permanent Partial Disability (PPD) benefits for any permanent physical impairment

Signs Voluntary Agreement for PPD benefits


Employer/Insurer

Begins payment of PPD benefits

May request an Independent Medical Examination (IME)

Issues Voluntary Agreement for PPD benefits for any permanent physical impairment


Attending Physician

Issues disability evaluation for any permanent physical impairment on Form 42 or in the form of a medical report to the Workers' Compensation Commission, the injured/ill employee, and the employer/insurer, at the same time

6 - Employee Exhausts Period in which PPD Benefits are Paid
(Specific Award)


Employee

May request an Informal Hearing with a Workers' Compensation Commissioner in a District Office to apply for additional discretionary wage differential "308a" benefits, just prior to the end of the period for which PPD benefits are paid


Employer/Insurer

Pays additional wage differential "308a" benefits, if directed by a Workers' Compensation Commissioner at an Informal Hearing

Continues paying medical bills


Attending Physician

Renders further medical treatment, if necessary

Sends medical bills to employer/insurer

7 - Injury or Surgery Causes Disfigurement and/or Scarring
(except for inguinal hernia or spinal surgery)


Employee

Just prior to a year after the date of the injury or surgery which caused the disfigurement or scar, contacts Workers' Compensation Commission District Office to request scar/disfigurement evaluation by a Workers' Compensation Commissioner


Employer/Insurer

Makes payment for scar or disfigurement award, if directed by a Workers' Compensation Commissioner


Attending Physician

NONE


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State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
Home News RSS News QUICK Find Index Search E-Mail
General Information Glossary Law CRB Opinions Workers' Compensation Commission Downloadable Forms and Publications Links

State of Connecticut
Workers' Compensation Commission
Page last revised: May 21, 2001
Page URL: http://wcc.state.ct.us/gen-info/if-injured/flow.htm

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