If It’s A Worker’s Compensation Case

Claimant
This is the injured worker

Respondent
In practical terms, the Respondent is the insurance company (“carrier”) that handles and pays workers’ compensation claims for the injured worker’s employer.  In formal papers, the Respondent is described as either the Respondent-Employer, or the Respondent-Carrier.

Claim Representative or Adjuster
This is the person who represents the employer or the employer’s workers’ compensation insurance company.

Workers’ Compensation Commissioner
The Commissioners in the workers’ compensation system are like Judges in the courts.  They may hold more “informal” conferences to help the parties resolve disputes quickly.  But in the end a commissioner may hold a “formal conferences,” or trial, to decide facts and make decisions.  The formal conference includes both witness testimony and written documents for the commissioner to consider.  As in the court system, decisions by workers’ compensation commissioners can be appealed.

Informal Conference (of Informal Hearing)

When disputes arise that the parties cannot resolve on their own, either side can request an Informal Conference.  This is a chance for the parties to meet with a Commissioner and get his or her help and advice about how the dispute can be resolved.  Many of the Commissioners are good at either helping the parties find an acceptable solution or strongly suggesting a solution.

Temporary Total (TT) Disability
This is the period of time during which a worker’s injury and its treatment (in combination with any pre-existing condition) keeps an injured worker from doing any work.

Temporary Partial (TP) Disability
This has two meanings.  Many times, while healing from an injury, a worker heals enough to be able to do some work, even though he still cannot perform the full duties of his regular job.  When this happens, the worker is said to be on “light duty,” and is encouraged to do work that meets the restrictions outlined by the doctor.
This may also refer to a time after permanent impairment benefits have been paid but the worker, though able to do some work, is still not able to perform the duties of the job being done at the time of injury, or is not capable of earning as much.

Maximum Medical Improvement (MMI)
This is the time when a doctor-usually the treating doctor-says that the worker has healed as much as he or she is probably ever going to heal.  The date of maximum improvement is usually when the doctor is able to decide on the extent of the workers’ permanent injury.  This date marks the start of any payments for “permanent partial disability.”

Permanent Partial Disability (PPD)
These benefits must be paid as of the time of Maximum Medical Improvement (MMI) if the worker has a lasting disability from the injury and is able to do some work (he or she is not still totally disabled).  PPD benefits are paid whether or not the worker is employed, and whether or not he can do his old job.
PPD payments are sometimes called “specific” benefits because much of the information used to calculate what will be paid to the worker is “specifically” set out in the law.  In our Workers’ Compensation Act, almost all body parts are assigned a value of a fixed number of weeks of compensation benefits.  Often referring to the American Medical Association’s Guides to the Evaluation of Permanent Impairment, a doctor will offer an opinion about the “percentage” of permanent impairment (or disability).
For example, Connecticut’s law says that the low back is valued at 374 weeks of compensation benefits.  A 10% disability rating of the low back means that the worker will be paid 37.4 weeks (10% of 374) of his weekly benefits as of the time MMI is reached.  This may not sound so bad.  But a knee is only “valued” at 155 weeks.  So a 5% disability of the knee-enough to end many careers in construction-results in only 7.75 weeks of compensation benefits.

“308a” or Discretionary Benefits

What happens to the worker who heals as much as he can, receives his PPD benefits, but is still not capable of earning what he could be earning back at his old job?  The Workers’ Compensation Act gives the worker some help in this case-but the help is limited.
Section 31-308a of the Compensation Act gives discretion to (allows) a Workers’ Compensation Commissioner to award additional benefits to the injured worker.  The Commissioner does his best to estimate what the worker would be earning in his old job and compares this to what the worker is capable of earning after his injury.  He may then order the employer’s insurance company to pay extra compensation benefits to try to make up much of the difference (up to the full compensation total disability rate).
Years ago, this law was often used to save injured workers from financial ruin-especially higher income earners whose injuries forced them into low wage jobs-since the Commissioner’s discretion was unlimited.  Unfortunately, the Commissioner’s discretion is not what it used to be:  he can only award these extra “discretionary” benefits for the same number of weeks that permanent injury benefits (PPD) were paid.

Voluntary Agreement

The Workers’ Compensation Commissioners try to get the injured worker and the employer (its insurance company) to agree about some of the most important issues and facts.
For example:  Do both sides agree that the worker was hurt on the job?  Do they agree about what the injuries were?  Do they agree on the worker’s weekly compensation benefit if time is lost from work?  When Maximum Medical Improvement is reached, do they agree on the extent of permanent disability?
Agreements about these issues are supposed to be put down in writing, usually on a special form provided by the Commission.  Getting an Agreement may involve a compromise between you and your employer, but a Voluntary Agreement is not a settlement of your workers’ compensation claim.

Form 30C
This is a form the Workers’ Compensation Commission makes available to an injured worker so that the injury can be officially reported to the Commission and the employer.
Completing the form is really easy and one should be filed with the Commission and your employer in every injury case.  For a typical injury-a sudden event on the job-you have one year to file, but don’t wait.  You can get a copy of a Form 30C-and all of the Commission’s forms-at the Commission’s website, http://wcc.state.ct.us/index.html.  You can also call any of the Commission offices to have the form and an information packet mailed to you, or stop by an office and pick up the package.

Form 1A
In order to calculate your weekly compensation benefit, the Workers’ Compensation Commission and your employer’s compensation insurance company must know how may exemptions you are officially entitled to take on your tax return.  The Form 1A is where this information is written down.
We know that some people take “zero” deductions and get a larger refund.  Others, like those who have a large mortgage debt, may sometimes take more deductions than they have family members.  No matter how many deductions you claim on your paycheck, the Form 1A requires every injured worker and every one of the worker’s dependants to be listed.

Form 43
This is the form your employer sends to the Commission to formally deny one or more of the following:
a.            that you were hurt on the job,
b.            that your injuries came from the work accident;
c.            that you need the medical care you are trying to get.
Because your employer has a limited time either to file a Form 43 or start paying benefits, a Form 43 is sometimes filed when an employer is still investigating your claim-it’s a lot easier for an employer to say no, and then yes, than to say yes and try to change its mind.  The best response to a Form 43 is almost always a request for a hearing with a Commissioner.

Form 36
Your employer (or its workers’ compensation insurance company) is not allowed to stop or change your benefits without giving you a fair opportunity to explain why your benefits should not be stopped, or not be changed.  The Form 36 is an official warning from your employer of what it intends to do if you don’t object.
A Form 36 should never be ignored-if you don’t object within the time required on the document, it will be granted automatically.  The objection should be in writing, and a Commissioner will quickly hold a hearing to resolve the dispute.

Full and Final Stipulation (Settlement)
By law, your employer is responsible for paying for injury-related medical bills and wage losses for your lifetime.  Sometimes, though, the injured worker wants to receive-and the compensation insurance company wants to pay-money now in place of the money that may have to be paid in the future.  This is a true “settlement,” and in workers’ compensation it is called a Full and Final Stipulation.
The most important thing to know about a Full and Final Stipulation is that in exchange for money, you are giving up your right to future compensation coverage for the particular work injury.
Because we should never give up a legal protection without fully understanding what is involved, every Full and Final Stipulation must be approved by a Workers’ Compensation Commissioner.  The Commissioner usually approves a settlement that the workers and employer want-but there is no guarantee.  The Commissioner will hold a hearing, review the terms of the settlement, and question the worker.  The Full and Final Stipulation is only approved when the Commissioner is convinced the terms are fair and the worker really understands the future protection he is giving up.

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