If It’s A Worker’s Compensation Case

This is the injured worker

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.

If It’s NOT A Worker’s Compensation Case

This is the person who has been hurt because of someone’s wrongdoing.  The plaintiff asks to be paid “damages” as compensation for these injuries.  The plaintiff is sometimes referred to as a “party.”

This is the person (or business) whose improper behavior caused the plaintiff’s injuries.  The defendant is asked to pay “damages,” even though the actual payment is almost always made by an insurance company.  Like the plaintiff, the defendant is sometimes referred to as a “party.”

This is the insurance company’s representative responsible for your claim or lawsuit.

After a motor vehicle collision, an appraiser is often sent by an insurance company to look at the property damage and calculate what it will probably cost to repair your vehicle, and tell the “adjuster” what your car is “worth” on the open market.

A “claim” is made when the plaintiff (or his or her lawyer) contacts the defendant (or the defendant’s insurance company) to report an injury.  Most claims are resolved, or “settled,” once the plaintiff and the defendant’s insurance company have a good idea of how badly the plaintiff has been injured and can agree on what “damages” should be paid for fair compensation.  If a claim cannot be settled, a law suit is usually filed.

“Damages” are described in Connecticut law as “economic” and “non-economic.”  Economic damages include all the bills for treatment of the plaintiff’s injuries-including ambulance, hospital, doctor, x-ray, therapy and prescription costs-and any lost wages and out-of-pocket costs that are caused by the defendant’s wrongdoing.  Non-economic damages include the physical injuries, pain, discomfort, emotional distress, aggravation, scarring and the inability to fully enjoy life’s pleasures.
Economic and non-economic damages are paid for what has happened and what is probably going to happen in the future, especially if the injuries or losses are permanent and likely to last a lifetime.
No matter what the “damages” that might be justified, Connecticut rules only allow a lawsuit to state they are “more than $15,000.”

In our society, we cannot just do as we please without paying any mind to those around us.  Instead, each of us is expected to act as a “reasonable person” in our dealings with others.  When someone does not act as a reasonable person and, without really meaning to, hurts another, the person who has acted improperly is said to have been “negligent.”
The behavior expected of a reasonable person can be set out in laws-like traffic laws about speed limits or stopping at a red light, for example.  But reasonable conduct can also be a matter of commonly accepted responsibilities-like keeping your property safe by fixing a broken step or railing.    Though wrongdoing can be intentional, most injuries are caused by those who have been negligent.  And injuries that result from the negligence of others result in “claims” and a request for fair, just and reasonable compensation for all “damages.”
People who have been hurt by the negligence of another can overlook their own need to act reasonably.  A reasonable person who is hurt is expected to try to get better as quickly and completely as possible.  This usually means going to a doctor and following the doctor’s advice and instructions.  If you’ve been hurt by someone else’s negligence, don’t think that the defendant’s insurance company will be pleased if you decide to “tough it out” and don’t see a doctor for weeks or months.  Unless there are very strong reasons for not going to a doctor, reasonable people who have been hurt get examined by a doctor and get treated.  Even the insurance companies want an injured person to act reasonably.

This is a formal “complaint” by a plaintiff against a defendant.  The complaint is in writing, and Connecticut law requires a marshal to “serve” (deliver) a copy to the defendant with a “summons”-a document that tells the defendant when an “answer” (response) must be made.  A complaint will describe the defendant’s negligence and the plaintiff’s injuries, and it will ask that damages be paid by the defendant to compensate the plaintiff for those injuries.  Connecticut court rules only allow a lawsuit to claim that the damages to be paid are “more than $15,000.”

These are laws from the legislature that are set out in writing.  Most of the “statutes” we deal with have been passed by Connecticut’s state representatives and senators and signed by the governor.  Because most of these laws come from our state government, they are different from the laws of other states.  Some of the “statutes,” however, are passed by Congress and signed by the President.

Statute of Limitations
You can hold a grudge forever, but you only have a certain amount of time to try to settle your claim or else file a lawsuit.  In other words, there are Connecticut statutes (laws) that “limit” the time for the lawsuit to be started.
Though there are some exceptions, in most negligence cases that do not involve medical negligence (malpractice) or death, the deadline for starting a lawsuit is two years from the date of injury.  Some states extend this time-if a child has been hurt, for example.  Connecticut does not allow this.
You should not wait until the deadline is about to go by before contacting a lawyer, or you may find it’s too late to be compensated for your injuries.

Unlike so many of the legal terms lawyers use, this one actually describes exactly what it is:  after a lawsuit is filed, each side gets to “discover” useful information about the other.  For example, the defendant’s lawyer will want a lot of details about the plaintiff’s injuries.  And the plaintiff’s attorney will want details about insurance coverage.  Discovery is usually done with three tools:
a.  Interrogatories.  These are written questions (that sometimes seem like you’re being interrogated).  Answers are prepared by the attorney with your help, and are based on all the information that has been gathered.  You must swear that the answers are true to the best of your knowledge and belief.  Answers must be supplemented as new information comes in.
b.  Production Requests:  These are usually requests that relevant documents be produced for inspection and copying-documents like medical records and bills, photographs and insurance policies.  When swearing that the answers to Interrogatories are true, you are also swearing that you are producing all of the proper documents.  And new documents, such as records and bills of additional medical care, must be provided, too.
c.  Depositions:  A “deposition” is a face-to-face, question-and-answer meeting with the other attorney.  The person being questioned (“deposed”) is under oath, sworn to “tell the truth, the whole truth and nothing but the truth.”  A licensed court stenographer takes down everything that is said and then prints it out in a script (it reads like a play).
Though the process can seem informal, and at its best is like a good conversation, everything said counts as if it were being said in court.  For this reason, your attorney sits next to you at the deposition and, most important, your attorney will meet with you to prepare well in advance.  In addition to the plaintiff and defendant, witnesses and doctors are also commonly deposed.

Medical Malpractice
Medical malpractice is “negligence” by a hospital, clinic, doctor, nurse, chiropractor, etc.-just about any health professional.  Just like any negligence case, medical malpractice requires proof that someone did something that should not have been done (or proof that someone didn’t do something that should have been done) and that the wrongdoing caused harm.  But malpractice claims and lawsuits are different in some important ways:
First, there are usually no laws that tell a doctor how to care for a patient “reasonably.”  And though people can usually agree on how a “reasonable person” should behave, most of us don’t know enough about medicine to know what treatment a “reasonable doctor” (or any health professional) should give a patient.  This means that we have to depend on other doctors to tell us what should be expected of a “reasonable doctor.”  Having to depend on doctors as witnesses means paying doctors for time spent studying medical records, meeting with attorneys, and testifying.  This is a very expensive undertaking.
Second, to protect the doctors in our state from “frivolous” claims of negligence, Connecticut law does not even allow a lawsuit to be filed against a health professional unless the plaintiff’s attorney gets-in advance-a written opinion from a highly qualified health professional stating it is likely there was malpractice.  This is not a bad requirement:  it would be foolish to file a lawsuit, especially one that is bound to be hard-fought and costly, without having firm support from medical witnesses in advance.  But it does mean that investigating and pursuing a malpractice claim is expensive from the start.
The expense that comes with any medical malpractice lawsuit means that the harm caused by the health professional’s wrongdoing must be substantial-the damages must significantly outweigh the expense of pursuing the lawsuit.

Pre-trial Conference
After a lawsuit is underway and well before trial, there is always at least one meeting-a “pre-trial conference”-between the attorneys and a judge.  Courts in some parts of the state may set a pre-trial conference early-on to set a schedule for “discovery.”  Other courts find that attorneys can usually set their own discovery schedules without an early meeting.  But every court will set a pre-trial conference as the time to start the trial grows closer.
The pre-trial conference gives a judge a chance to press both sides to settle their differences and avoid the time and expense it always takes to go through trial.  Some courts want the plaintiff and defendant to be at the pre-trial conference, some judges even meet with the parties to get a better understanding of what help is needed to arrange a settlement.  Your lawyer will be able to tell you how the pre-trial conference will be conducted in your case.

Trial is time-consuming and can be expensive.  Arbitration is a way people can resolve a dispute by a process that is similar to, but more streamlined than a trial.
Typically, arbitration involves a hearing in front of an “arbitrator,” or decider, who will learn about the lawsuit in depth and make a decision in place of a jury.  The arbitrator is always someone with legal experience who is impartial and respected by the attorneys.  By reading statements from each attorney, reviewing documents and deposition transcripts in advance, and then hearing some live testimony, an experienced arbitrator can avoid many of the formalities of trial and save everyone a lot of time and expense.
There are many variations on how arbitrations are done.  If your attorney thinks that arbitration can be helpful in your case, you will learn about how your arbitration will be run.

Trial is time-consuming and can be expensive.  Like arbitration, mediation is a way people can resolve a dispute without a trial.  But in mediation, a lawsuit can only be resolved when the plaintiff and defendant agree-there is no outside decider.
With mediation, the attorneys choose a “mediator”:  someone who has both legal experience and exceptional skill in getting people to come to an agreement.  The mediator is often a judge, or a retired judge or attorney, who knows how to listen carefully and help each side better understand the strengths and the weaknesses of its case.
Mediators read statements from each attorney, review documents, and often spend time talking with the plaintiff and defendant.  And because mediation is usually used to resolve more difficult, complicated lawsuits, the attorneys and the mediator must be thoroughly prepared in advance to maximize the chance of success.

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