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What To Do If You Receive A Form 43 Denial In Connecticut

The United States Bureau of Labor Statistics reports that approximately 2.8 million workplace injuries occurred throughout the country in 2019 alone. This research also reports that Connecticut’s incidence rate of total recordable workers’ compensation cases is much higher than the national average. Workplace injuries can lead to life-altering consequences including permanent disabilities and sometimes, even death.

Often, employers or insurers will use manipulative tactics to attempt to deny the payment of compensation by disputing the claim through a Form 43 Denial. If you believe your workers’ compensation claim was wrongly denied through Form 43, learn how a Connecticut Workers' Compensation Attorney at the Law Offices of Robert Sciglimpaglia at (203) 663-2803 can help you ensure your legal rights are protected.

Understanding the Connecticut Workers’ Compensation System

If you’ve received a Form 43 Denial, it might be helpful to know some of the important aspects related to Connecticut’s Workers’ Compensation Commission.

Scope

The benefits afforded under workers’ compensation laws in the state of Connecticut cover almost all types of employees except those working at a household for less than 26 hours per week. It is important to note that part-time employees are also covered under Connecticut’s workers’ compensation laws. Additionally, the protections provided by the law cannot be signed away except through a settlement approved by a Commissioner.

No-Fault System

Connecticut follows a no-fault insurance system for workers’ compensation claims. This means that the employee’s liability for an accident in the workplace or a pre-existing medical condition will not automatically lead to denial of their claim. Even when a pre-existing medical condition is aggravated by a workplace injury, the law provides the right to claim compensation through the workers’ compensation laws.

Compensation

Connecticut’s workers’ compensation laws provide two kinds of compensation for workplace injuries:

  1. Compensation for medical costs and treatment expenses

  2. Compensation for current and future lost wages and disability

Every workers’ compensation case will have a different set of facts and circumstances, which will ultimately determine the total amount of compensation that an injured worker receives. Visiting with Robert Sciglimpaglia, an experienced workers’ compensation attorney can help you better understand all of your legal rights and options if you suffer an injury or illness in the workplace.

What Is a Form 43 Denial in Connecticut?

In Connecticut, when an employer or insurer believes that the employee’s claim for compensation is partially or completely invalid, a Form 43 Denial is sent to that employee. Through this form, they dispute the employee’s claim to compensation under Connecticut’s workers’ compensation laws. Officially, this form is known as “Notice to Compensation Commissioner and Employee of Intention to Contest Employee's Right to Compensation Benefits.”

Generally, the employer or insurer has a time period of 28 days from the date of receiving the employee’s written claim for compensation to send a Form 43 Denial. The form must also be filed with the Connecticut Workers’ Compensation Commission (WCC) by the employer. When the employer disputes the medical care received by an employee, a copy of the form is also sent to the medical provider.

In most cases, the decision regarding an injured worker’s right to obtain workers’ compensation after receiving Form 43 is handled by the WCC. Additionally, an appeal against the decision of the WCC can be made to state appellate courts.

If an employer or insurer does not dispute the claim within the time set by law, they may later be precluded from contesting the claim or disputing the extent of the disability. When a preclusion is granted by the WCC, then the claim must be accepted by the employer and the compensation must be paid. The process of filing an appeal can be legally challenging and complex. Unfortunately, many workers are unaware of the steps to take to ensure that their appeal is approved and they receive the compensation they deserve under the law.

Reasons for Form 43 Denial

Some of the common reasons behind a worker receiving a Form 43 Denial in the state of Connecticut often include:

  • The injury was not reported on time to the employer.

  • There was no employer-employee relationship.

  • The claim for compensation was not filed within time.

  • The employer asserts that the injury did not happen at work.

  • The employer requires more time to assess the compensation claim.

  • The injured worker did not undertake medical treatment.

  • Alcohol consumption or substance abuse by the employee at the time of injury.

  • Administrative or clerical errors.

It is extremely important to note that simply because an injured worker receives a Form 43 Denial, they may still have the right to receive workers’ compensation under the law. Often, insurance companies dispute the claim simply to gain more time to investigate the claim, or to discourage a worker from pursuing their right to compensation. If you received a Form 43 Denial, contact our legal team today to learn how a Connecticut workers' compensation attorney at the Law Offices of Robert Sciglimpaglia can help you with your case, and ensure your legal rights remain protected.

Steps To Take After a Workplace Injury or Illness

If you suffered a job-related injury or illness, consider following these steps to potentially reduce the chances of receiving a Form 43 Denial:

Report The Injury

Any worker that suffers an injury or illness in the workplace should immediately report the injury to the employer in writing. Every company will have a different procedure for this, and it is important to check your employee handbook to make sure that you provide the proper documentation to the proper person within your company regarding your workplace injury or illness. After you properly provide documentation of your injury to your employer, a First Report of Injury Form should then be filed with the Workers’ Compensation Commission and the insurance carrier by the employer. Delay in reporting a workplace injury increases the chances of the claim being disputed later.

Seek Immediate Medical Attention

An injured worker should immediately seek medical care and a full medical evaluation. Generally, the employer is required to send the worker to a suitable medical facility as soon as possible after the injury.

File A Formal Claim

The injured worker is usually required to file a “Written Notice of Claim” in Form 30C. Filing this form officially puts the claim on record. Failure to file this paperwork can result in the inability of an injured worker to receive compensation under the law.

Employer’s Response

The employer should take action within 28 days of receiving written notice of the workers’ compensation claim. If an employer disputes the employee’s claim for compensation, then an official written notice that includes the specific reasons for the denial should be given within 28 days.

Statute of Limitations

In Connecticut, there is a time limit of one year for filing a workers’ compensation claim for injury in the workplace. A claim for an occupational disease or illness must be filed within three years from the time the symptoms were first discovered. Failure to file a claim within these time periods will result in an injured worker losing their legal right to pursue workers’ compensation benefits.

Learn How A Connecticut Workers’ Compensation Attorney Can Help You Understand Your Legal Rights

Workers’ compensation is there to help injured workers and ensure that they have the financial ability to provide for themselves and their families after a workplace injury or illness. Often, an injured worker files the claim for compensation without legal counsel. In many cases, this results in a Form 43 Denial, which can complicate the process even further.

Employees may not have a full understanding of all of their legal rights and options under Connecticut law to receive compensation. If you received a Form 43 Denial after submitting your workers’ compensation claim, learn how a Connecticut workers' compensation attorney at the Law Offices of Robert Sciglimpaglia at (203) 663-2803 can help you with your case.