Reminder: There Must Be a Timely Response to Workers’ Compensation Claims

The workers’ compensation process is usually routine. An employee injured at the workplace receives treatment, which could range from first aid to transport to an emergency room, the employer completes a first report of injury and informs its workers’ compensation insurance carrier, and the insurance company deals with any claim filed by the employee.  But in fact the Workers’ Compensation Act imposes strict requirements for the initial response to a claim, and lapses in the response can result in serious liability for the employer.

A workers’ compensation claim is formally initiated by an employee filing a form known as Form 30C with the Workers’ Compensation Commission.  That filing starts a 28-day period in which an employer (or its insurance carrier) that wishes to challenge whether the injury arose out of and in the course of employment must file a response, known as Form 43, giving notice of an intent to contest liability.  If the Form 43 is not timely filed, the claim is deemed compensable, and any defense to liability will be precluded.

A recent decision by the Connecticut Appellate Court provides examples of the consequences of failing to file a timely Form 43.  The decision involved an employee who filed her Form 30C claiming repetitive trauma injuries, but did not lose any time from work and did not seek medical treatment.  In an earlier case cited by the court, the employee fell and injured his knee following a business call away from his workplace, but similarly did not seek immediate medical attention or miss time from work.

In both cases the employers received the Form 30C’s, but did not file timely Form 43 responses, perhaps because the claims fell outside their normal routine. Consequently, the employers were not able to later contest their liability to provide workers’ compensation benefits.

These two examples provide a further lesson. One of the employers did eventually file a Form 43 using a proper filing method.  Although filed outside the 28-day period for contesting liability, the late filing was within a one-year period which allowed the employer to contest the extent of the employee’s disability; in other words, although the employer (in reality its insurance company) could not dispute whether it had to pay a claim, it could dispute how much it had to pay.

The other employer eventually sent a Form 43 to the Workers’ Compensation Commission, but sent it by fax, rather than using one of the three proper filing methods of personal delivery, registered mail, or certified mail. The Appellate Court ruled that this mistake precluded the employer from contesting either liability or the extent of disability.

The takeaway is that the Workers’ Compensation Act imposes strict compliance requirements on employers, so employers must strictly comply with their own reporting policies to ensure that no deadlines are missed.