When an employee is injured on, or becomes ill from, the job, he or she becomes eligible for a number of statutory benefits. First of these is necessary medical treatment.
The most immediate concern in cases of occupational injury or occupational disease is the health and physical well-being of the employee. (Information about monetary and other benefits provided by workers' compensation is presented on the following pages in this section.)
[NOTE: Numbers cited indicate the applicable section(s) of the Workers' Compensation Act, Connecticut General Statutes, or the state's Administrative Regulations.]
Initial Medical Treatment [31-279, 31-279-10, 31-294d]
An injured or ill employee is entitled to receive all necessary and appropriate medical treatment.
The employer is responsible for furnishing the initial medical treatment at an employer-designated office or facility. After this initial treatment, the employee may choose an attending physician.
Refusal to Accept Medical Treatment [31-279, 31-279-10, 31-294e]
An injured or ill employee has the option of refusing any initial employer-provided medical care and obtaining the required medical treatment on his or her own and at his or her own expense. However, if an employee refuses such initial employer-provided medical care and fails to obtain treatment, a Workers’ Compensation Commissioner may suspend all rights to workers’ compensation benefits during the period of refusal.
[NOTE: An employee’s option to refuse such medical care and seek medical care on his or her own is ONLY available if the employer has no medical care plan for treatment of work-related injuries/illnesses which is approved by the Workers’ Compensation Commission Chairman. When an employer has such an approved plan, a covered employee MUST seek medical care from a medical practitioner participating in the plan; if an employee covered by an employer’s approved plan chooses to seek “outside treatment, a Workers’ Compensation Commissioner may suspend all rights to workers’ compensation benefits.]
Choice of Physician [20-1, 31-275, 31-279, 31-279-10, 31-294d]
A claimant may choose an attending physician AFTER first receiving one initial visit with an employer-designated medical practitioner, if the employer offers one. An employee may choose any medical practitioner on the approved list of medical practitioners of the Workers’ Compensation Commission Chairman who is licensed to practice in Connecticut, including practitioners of chiropractic, medicine, natureopathy, optometry, osteopathy, and podiatry.
[NOTE: An employee covered by an approved employer medical care plan for injuries/illnesses MUST receive medical treatment from a medical practitioner participating in the employer’s plan. If the employee chooses a physician “outside the plan, all rights to workers’ compensation benefits may be suspended by a Workers’ Compensation Commissioner.]
Out-Of-State Physicians [31-294d]
A claimant MUST receive all necessary medical care for the injury or illness from medical practitioners licensed to practice in Connecticut. If an employee must reside in a different part of the country for medical reasons (i.e., the employee requires a hot, dry climate to reverse effects of asthma, etc.), a Workers’ Compensation Commissioner may authorize medical care by an out-of-state physician.
Healing by Prayer or Spiritual Means [31-275, 31-294d]
A claimant may request treatment by prayer or spiritual means from a bona fide member of a church and without the use of any drug or material remedy, provided sanitary and quarantine regulations are complied with and such treatment is approved by a Workers’ Compensation Commissioner.
Change of Physician [31-279, 31-279-10, 31-294d]
A claimant may change his or her attending physician, if he or she feels dissatisfied with the medical treatment being rendered. There is a three-step process which MUST be followed to change a physician:
obtain a referral from the present attending physician to be treated by another physician; or
obtain approval to change physicians from the workers’ compensation insurance carrier involved (or the employer, if it is self-insured); or
write to the Workers’ Compensation Commissioner in the District Office having jurisdiction, requesting a change of physician and indicating the name, address, and medical specialty of the present physician, the name, address, and medical specialty of a “new physician, and the reason(s) for requesting a change (in such event, a Commissioner will reply by mail, indicating his or her decision on the request).
[NOTE: If the employee is covered by an approved employer medical care plan, the “new physician MUST also be a participating practitioner in the plan. If the employee chooses a physician “outside the plan, all rights to workers’ compensation benefits may be suspended by a Workers’ Compensation Commissioner.]
If a claimant does not have an attending physician’s referral to another medical practitioner, or permission to change physicians from the insurer, self-insured employer, or Commissioner, he or she will probably be liable to pay for any “unauthorized medical bills which may arise.
Independent Medical Examination (IME) [31-294f]
At any time while claiming or receiving workers’ compensation benefits, an employee may be directed by a Workers’ Compensation Commissioner, or requested by the employer or its workers’ compensation insurance carrier, to submit to an independent medical examination (IME), paid for by the employer. The purpose of the IME is to determine the nature and extent of the injury. At an IME the employee may have his or her own attending physician in attendance (at his or her own expense), but this is not a common practice.
The employee must submit to examination upon reasonable request, and refusal to do so suspends any right to receive compensation (a request may be considered unreasonable if it involves lengthy or difficult travel, and it is a Commissioner that makes such a determination). The examining physician must furnish the IME medical report within 30 days of its completion, at the same time and in the same manner, to both the employer (or its insurer) and to the employee (or his or her attorney, if represented).
Medical Bills [31-279-9(e)]
All medical bills for a work-related injury or illness should be paid by the workers’ compensation provider (workers’ compensation insurance carrier or self-insured employer); it is the responsibility of the workers’ compensation provider to pay all authorized medical bills. However, medical care provided by a medical practitioner other than the attending physician (or the attending physician’s referrals) is the employee’s responsibility, as these treatments and their charges are considered unauthorized.
All medical bills must be sent directly to the workers’ compensation provider, NEVER to the claimant. It is also against Connecticut Regulations for any medical practitioner to ask a claimant for payment for medical treatment, or to refuse a claimant necessary medical care because the practitioner has not yet been paid by the workers’ compensation provider for previously rendered services.
Travel Expenses for Medical Services [31-312]
The employer must furnish, or pay for, transportation for an injured employee to go to and from medical examination, treatment, or testing. If medically necessary, this includes transportation by ambulance or taxi.
If the claimant uses a private vehicle to travel to and from medical services, he or she must be reimbursed for travel at the federal mileage reimbursement rate of 40.5 cents per mile (effective February 4, 2005). If the employee uses public transportation, the employer must pay for the cost, when the employee is required to travel beyond a one-fare limit.
In practice, most employees keep a record of their travel with each visit’s date, location, and mileage, and send a copy of this record to the workers’ compensation insurer or self-insured employer periodically or at the end of treatment; the insurer or employer should send the employee a check for the expenses.
Lost Time Reimbursement for Medical Treatment [31-312]
An injured or ill employee who returns to work, but who still needs medical attention, should obtain such medical care during normal work hours, if this is possible, and should be paid by the employer at his or her normal rate of earnings (if the employee is not receiving or eligible to receive workers’ compensation benefits). An employer CANNOT require an injured or ill employee to receive medical treatment outside of his or her regular work hours, if such treatment is available during regular work hours.
If it is not possible to receive necessary care during normal work hours, the employee should receive care when it is available and should be reimbursed (at his or her average hourly earnings) by the employer for his or her personal time, as if it were time lost from work.
Prescription Reimbursement [31-279-9(e)]
Prescriptions given by an attending physician (or by his or her referral) as part of medical treatment for a work-related injury or illness are fully covered.
In some cases, the workers’ compensation insurance carrier or self-insured employer will direct the employee to a specific pharmacy that bills the insurer or employer directly. In most cases, however, the employee pays prescription costs as out-of-pocket expenses and should forward copies of any pharmacy receipts to the insurer or employer for full reimbursement.
Effective January 1, 2002, all expenses for prescriptions should be paid directly by the carrier or self-insured employer, and claimants should not have to pay for them or seek reimbursement.
Right to Medical Reports [31-279-9(f), 31-294f]
An injured or ill employee is entitled, at no additional charge, to a copy of every medical report by any medical practitioner providing care for the injury or illness, in the same manner as and at the same time as reports provided to the employer or its workers’ compensation insurance carrier. If the employee retains legal counsel, the reports must be furnished to the attorney.
For More Information . . .
. . . please call your local Workers' Compensation Commission District Office or Education Services at 1-800-223-WORK (toll-free in Connecticut).
State of Connecticut
Workers' Compensation Commission
Page last revised: February 17, 2005
Page URL: http://wcc.state.ct.us/gen-info/if-injured/medcare.htm