Workers’ Compensation

Employee injuries can and do happen in the workplace. When they do, the State of Connecticut Workers’ Compensation Program requires that an employee report a work-related injury or illness to his/her employer immediately. Such reporting facilitates employee benefits and payments under the program and makes for a safer work environment. For injuries prohibiting the employee from immediately notifying his/her supervisor, the supervisor, on behalf of the injured employee, can work with Human Resources to directly report the claim.

QVCC accepts all reports of injury from an employee and cannot deny the employee from filing a claim. The Third Party Administrator (TPA) determines issues of compensability and causation, based in part on the information facilitated through the claim reporting process.

The most fundamental piece of claim reporting is communicating the occurrence information to QVCC’s Human Resources office and the TPA. In most cases, the injured worker and supervisor work together with Human Resources to complete the WC claim packet and reporting process.

Provided below are links to brochures for both the supervisor and employee communication brochures on WC claim reporting.  Click on each underlined title to link to the actual brochure. In addition, important forms are linked for you to review and use when necessary.

Supervisors’ Guide to Workers’ Compensation Claim Reporting
Outlines the supervisor’s responsibilities for recording and facilitating an employee’s claim for workers’ compensation benefits. Prompt and accurate completion of the WC Claim Packet enables (a) the injured employee to pursue his/her claim and (b) the agency and TPA to obtain critical information associated with the reported claim and to commence benefits under the claim.

Employee Guide to Workers’ Compensation Claim Reporting
Outlines general information regarding workers’ compensation, managed care and employee responsibilities associated with their claim.

Workers’ Compensation Brochure

Worker’s Compensation Posting

First Report of Injury WC 207

Supervisor’s Accident Investigation Report

Initial Care Provider Network

Physician’s Worker Status Report

Notice of Claim for Compensation

Concurrent Employment Third Party Liability Form

Request for Use of Accrued Leave with Worker’s Compensation