Provided By Touchstone Consulting Group Workers Compensation Employee Benefits

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1 Prvided By Tuchstne Cnsulting Grup Wrkers Cmpensatin Emplyee Wrkers cmpensatin is a system f n-fault insurance that prvides mnetary cmpensatin and medical benefits t emplyees fr wrk-related injuries and diseases. Wrkers' cmpensatin is gverned by state law. The Cnnecticut Wrkers' Cmpensatin Act (WCA) sets frth the cmpensatin emplyers must prvide t eligible emplyees in the state. The Cnnecticut Wrkers' Cmpensatin Cmmissin (Cmmissin) administers the wrkers' cmpensatin system and calculates the specific benefits payable. ELIGIBILITY AND DATE OF INJURY T receive wrkers' cmpensatin benefits, a persn must be a cvered emplyee and sustain an injury r disease arising ut f and in the curse f his r her emplyment. The date f an injury is used t determine an emplyee s cmpensatin rates. Fr ccupatinal diseases, the date f injury is the date an emplyee becmes ttally r partially unable t wrk as a result f the disease. Unless therwise specified, this dcument uses injury t refer t any cmpensable cnditin. MEDICAL CARE BENEFITS Emplyees are entitled t full cverage f any and all medical expenses that a physician deems reasnable r necessary as a result f a wrk-related injury. If an injured emplyee needs medical treatment but is nt disabled frm wrk, he r she is entitled t full hurly wages fr any time spent receiving medical treatment. Cmpensatin fr individuals wh are disabled frm wrk is discussed in the sectin belw. Medical care benefits als include mileage reimbursement fr transprtatin t and frm medical appintments and payment fr ambulance r taxi rides if they are medically required. MONETARY BENEFITS If an emplyee is disabled frm wrk (in whle r in part) r sustains any permanent physical impairment due t a wrk-related injury, he r she may be entitled t receive mnetary cmpensatin. This cmpensatin is usually payable in weekly increments and the payments are ften referred t as disability benefits. Disability benefits are nt cnsidered incme fr tax purpses and the amunts paid are immune frm wage assignments and creditr claims. The types f benefits available are: This guide is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. It is prvided fr general infrmatinal purpses nly. It bradly summarizes state statutes and regulatins generally applicable t private emplyers, but des nt include references t ther legal resurces unless specifically nted. Readers shuld cntact legal cunsel fr legal advice. Temprary Ttal Disability (TTD) Temprary Partial Disability (TPD) Permanent Partial Disability (PPD) Permanent Ttal Disability (PTD) In additin, an emplyee s surviving spuse and dependent may be entitled t cmpensatin fr burial expenses and weekly benefits payments if a wrk-related injury r disease results in the emplyee s death Zywave, Inc. All rights reserved. CMP 11/15

2 Waiting Perid Injured emplyees are nt eligible t receive disability benefits fr the first three days f missed wrk after an injury. Hwever, if the injury results in seven r mre days f disability, benefits fr the first three days must be paid retractively. The date f injury des nt cunt as a day f disability fr this calculatin. Emplyers must pay an injured emplyee s full wages fr that entire day. Average Weekly Wage (AWW) An injured emplyee s benefit rates are calculated as percentages f his r her AWW. The AWW is determined by taking the emplyee s ttal earnings frm the emplyer, after deducting taxes and Scial Security cntributins, fr the 52 weeks prir t the date f injury, and dividing that number by 52. AWW = ( Emplyee s ttal earnings (after deductins) during the 52 weeks befre the date f injury 52 ) If an injured emplyee has wrked less than 52 weeks fr the emplyer, the ttal earnings (after deductins) are divided by the number f weeks the emplyee actually wrked. Other specific calculatins may apply in cases where an emplyee: Has wrked fr fewer than tw weeks fr the emplyer befre the injury; Is a minr; Is a trainee r apprentice; Had mre than ne jb n the date f injury; r Claims an ccupatinal disease and has nt wrked fr the emplyer fr at least 26 weeks. Weekly Rate Limits All wrkers' cmpensatin benefit rates are subject t limits based n the date f injury. The Cmmissins sets these limits annually using the previus year s average weekly earnings (AWE) f all wrkers in the state (fr ttal disability rates) and the AWE f prductin and related wrkers in manufacturing in the state (fr partial disability rates). New rates becme effective n Oct. 1 f each year. The fllwing table lists the current and mst recent applicable rate limits. Weekly Mnetary Benefit Limits Ttal Disability Partial Disability Maximum Minimum Maximum Minimum Date f injury TTD PTD Death TTD PTD Death TPD PPD TPD PPD Oct. 1, 2014, t Sept. 30, 2015 Oct. 1, 2013, t Sept. 30, 2014 Oct. 1, 2012, t Sept. 30, 2013 $1,175 $235 $20 $ nne $50 $1,184 $ $20 $ nne $50 $1,172 $ $20 $1, nne $50 TEMPORARY TOTAL DISABILITY (TTD) An emplyee is entitled t weekly TTD benefits while he r she is healing frm a wrk-related injury and unable t perfrm any wrk as a result. Weekly TTD benefits are 75 percent f the AWW, subject t the limits utlined in the Weekly Mnetary Benefit Limits table abve. TTD benefits are payable fr as lng as an emplyee remains cmpletely unable t wrk due t a wrk-related cnditin. 2

3 An emplyee s TTD rate is subject t annual cst-f-living increases if the perid f ttal disability: Lasts fr mre than five years; r Is due t a recurrence f ttal disability after a perid f recvery. TEMPORARY PARTIAL DISABILITY (TPD) An emplyee whse wrk-related injury results in nly a partial inability t earn his r her full wages may be entitled t TPD benefits during the recvery perid. TPD benefits are 75 percent f the difference between the injured emplyee s AWW and the amunt the injured emplyee earns (again, bth after taxes and Scial Security deductins) during each week f the partial disability. TPD weekly benefit rate* = 0.75 x ( AWW - Emplyee earnings (after deductins) frm any emplyment during the week fr which TPD benefits are payable ) *Up t a maximum f 100 percent f the AWE f prductin and related wrkers in manufacturing in the state fr the year f the date f injury, raised t the next even dllar. See Weekly Mnetary Benefit Limits table abve. An injured emplyee is entitled t receive the full 75 percent f his r her AWW if, during the healing perid, he r she is: Cmpletely unable t perfrm his r her pre-injury wrk; but Able and willing t perfrm ther wrk that the emplyer des nt have available. Hwever, it is imprtant t nte that the maximum limit fr TPD rates (utlined in the Weekly Mnetary Benefit Limits table abve) is lwer than the maximum limit fr TTD benefits. Mrever, an emplyee may nt receive TPD benefits fr mre than 520 weeks. PERMANENT PARTIAL DISABILITY (PPD) If an injured emplyee permanently lses a bdy part r the use f a bdy part as a result f a cmpensable injury, he r she may be entitled t PPD benefits fr the number f weeks listed in a PPD schedule in the WCA. The specific number f benefit weeks payable fr a PPD depends n the bdy part injured and the percentage f lss t (r lss f use f) the bdy part. This is determined by a treating physician after the emplyee has reached maximum medical imprvement (MMI) and is therefre n lnger in the healing perid fr the injury. As an illustratin, cnsider the example f an emplyee wh lses 50 percent use f his master hand. PPD Example Injury t master hand at wrist level 0.5 x 168 = 84 Impairment rating (Treating physician determines master hand is impaired by 50 percent) WCA PPD Schedule Maximum (WCA Schedule assigns value f 168 weeks fr cmplete lss f master hand) Number f PPD weeks payable (Emplyee is entitled t 84 weeks f PPD benefits) The weekly PPD rate is 75 percent f the AWW, subject t the limits utlined in the Weekly Mnetary Benefit Limits table abve. Disfigurement PPD In additin t PPD benefits based n the WCA schedule, the Cmmissin may award up t 208 weeks f PPD benefits fr a disfigurement that ccurs as a result f a wrk-related injury. These benefits are payable at (and subject t the same limits as) the PPD rate. 3

4 Disfigurement PPD benefits are available if an injured emplyee sustains a permanent, significant disfigurement r scar n his r her: Face; Head; Neck; r Discretinary Wage Differential PPD Any ther part f the bdy, if the disfigurement r scar disables the emplyee frm btaining r cntinuing wrk. In additin t bth f the PPD benefits described abve, an emplyee may receive up t 520 additinal weeks f PPD benefits if his r her cmpensable injury results in an nging inability t earn the same r higher wages as he r she had earned prir t the injury. The Cmmissin makes this determinatin after any ther PPD awards have been paid. The rate fr Discretinary Wage Differential PPD benefits is 75 percent f the difference between the emplyee s AWW and the amunt the emplyee will prbably be able t earn in any emplyment after the injury, as determined by the Cmmissin. This rate is als subject t the PPD maximum as utlined in the Weekly Mnetary Benefit Limits table abve. Discretinary Wage Differential PPD weekly benefit rate* = 0.75 x ( AWW - Estimated emplyee weekly earnings (after deductins) ) *Up t a maximum f 100 percent, raised t the next even dllar, f the AWE f prductin and related wrkers in manufacturing in the state. Als subject t a minimum f $50. PERMANENT TOTAL DISABILITY (PTD) PTD benefits are payable if the Cmmissin determines that an injured emplyee is permanently unable t earn any wages r if a wrk-related injury causes: Ttal and permanent lss f sight in bth eyes; Reductin t ne-tenth r less f nrmal visin; Lss f bth feet at r abve the ankle; Lss f bth hands at r abve the wrist; Lss f ne ft at r abve the ankle and ne hand at r abve the wrist; Incurable imbecility r mental illness; r Permanent and cmplete paralysis f: Bth legs; Bth arms; r One leg and ne arm. The weekly PTD benefit rate is 75 percent f the AWW, subject t the limits as utlined in the Weekly Mnetary Benefit Limits table abve. PTD benefits are adjusted fr cst-f-living increases each year. DEATH AND BURIAL BENEFITS If a wrk-related injury r illness results in an injured emplyee s death, the emplyer must pay burial expenses f $4,000 t the deceased emplyee s surviving dependents. If there are n dependents, this amunt is payable t whmever cvers the csts f funeral expenses. In additin, weekly death benefits are available t surviving dependents. Death benefit rates are 75 percent f the emplyee s AWW, subject t the maximum and minimum as utlined in the Weekly 4

5 Mnetary Benefit Limits table abve. Death benefits are als subject t cst-f-living adjustments each year. Death benefits are payable t a surviving spuse fr life r until remarriage. If there is n surviving spuse, death benefits are payable t dependent children until age 18, r, if a dependent child is a fulltime student and is nt married, until age 22. MORE INFORMATION Cntact Tuchstne Cnsulting Grup r visit the Cmmissin s website fr mre infrmatin n wrkers cmpensatin laws in Cnnecticut. 5