Connecticut General Statutes 31-279 – Notice of availability of compensation. Uniform system for determination of degree of physical impairment. Employer-sponsored plan for medical care and treatment. Indemnification of medical advisory panel members
(a) The chairperson of the Workers’ Compensation Commission shall adopt regulations, in accordance with the provisions of chapter 54, specifying the minimum information to be contained in a notice of the availability of compensation which shall be posted in the workplace by each employer subject to the provisions of this chapter pursuant to subsection (f) of § 31-284.
Terms Used In Connecticut General Statutes 31-279
- Administrative law judge: means the administrative law judge who has jurisdiction in the matter referred to in the context. See Connecticut General Statutes 31-275
- Commission: means the Workers' Compensation Commission. See Connecticut General Statutes 31-275
- Compensation: means benefits or payments mandated by the provisions of this chapter, including, but not limited to, indemnity, medical and surgical aid or hospital and nursing service required under §. See Connecticut General Statutes 31-275
- Employee: means any person who:
(i) Has entered into or works under any contract of service or apprenticeship with an employer, whether the contract contemplated the performance of duties within or without the state. See Connecticut General Statutes 31-275
- Employer: means any person, corporation, limited liability company, firm, partnership, voluntary association, joint stock association, the state and any public corporation within the state using the services of one or more employees for pay, or the legal representative of any such employer, but all contracts of employment between an employer employing persons excluded from the definition of employee and any such employee shall be conclusively presumed to include the following mutual agreements between employer and employee: (A) That the employer may accept and become bound by the provisions of this chapter by immediately complying with §. See Connecticut General Statutes 31-275
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. Source: FDIC
- injury: includes , in addition to accidental injury that may be definitely located as to the time when and the place where the accident occurred, an injury to an employee that is causally connected with the employee's employment and is the direct result of repetitive trauma or repetitive acts incident to such employment, and occupational disease. See Connecticut General Statutes 31-275
- Member: includes all parts of the human body referred to in subsection (b) of §. See Connecticut General Statutes 31-275
- Physician: includes any person licensed and authorized to practice a healing art, as defined in §. See Connecticut General Statutes 31-275
(b) The chairperson of the Workers’ Compensation Commission shall, not later than July 1, 1991, adopt regulations, in accordance with chapter 54, to create a uniform system to be used by medical professionals in determining the degree of physical impairment of persons receiving compensation under this chapter.
(c) (1) Any employer or any insurer acting on behalf of an employer, may establish a plan, subject to the approval of the chairperson of the Workers’ Compensation Commission under subsection (d) of this section, for the provision of medical care that the employer provides for treatment of any injury or illness under this chapter. Each plan shall contain such information as the chairperson shall require, including, but not limited to:
(A) A listing of all persons who will provide services under the plan, along with appropriate evidence that each person listed has met any licensing, certification or registration requirement necessary for the person to legally provide the service in this state;
(B) A listing of all pharmacies that will provide services under the plan, to which the employer, any insurer acting on behalf of the employer, or any other entity acting on behalf of the employer or insurer shall make direct payments for any prescription drug prescribed by a physician participating in the plan;
(C) A designation of the times, places and manners in which the services will be provided;
(D) A description of how the quality and quantity of medical care will be managed; and
(E) Such other provisions as the employer and the employees may agree to, subject to the approval of the chairperson.
(2) The election by an employee covered by a plan established under this subsection to obtain medical care and treatment from a provider of medical services who is not listed in the plan shall suspend the employee’s right to compensation, subject to the order of the administrative law judge.
(d) Each plan established under subsection (c) of this section shall be submitted to the chairperson for his approval at least one hundred twenty days before the proposed effective date of the plan and each approved plan, along with any proposed changes therein, shall be resubmitted to the chairperson every two years thereafter for reapproval. The chairperson shall approve or disapprove such plans on the basis of standards established by the chairperson in consultation with a medical advisory panel appointed by the chairperson. Such standards shall include, but not be limited to: (1) The ability of the plan to provide all medical and health care services that may be required under this chapter in a manner that is timely, effective and convenient for the employees; (2) the inclusion in the plan of all categories of medical service and of an adequate number of providers of each type of medical service in accessible locations to ensure that employees are given an adequate choice of providers; (3) the provision in the plan for appropriate financial incentives to reduce service costs and utilization without a reduction in the quality of service; (4) the inclusion in the plan of fee screening, peer review, service utilization review and dispute resolution procedures designed to prevent inappropriate or excessive treatment; and (5) the inclusion in the plan of a procedure by which information on medical and health care service costs and utilization will be reported to the chairperson in order for him to determine the effectiveness of the plan.
(e) Any person who serves as a member of the medical advisory panel, appointed by the chairperson of the Workers’ Compensation Commission pursuant to subsection (d) of this section, shall be deemed to be a state officer or employee for purposes of indemnification and defense under § 5-141d.