Connecticut Medical Direction of Care
Sec. 31-294d. Medical and surgical aid. Hospital, ambulatory surgical center and nursing service. (a)(1) The employer, as soon as the employer has knowledge of an injury, shall provide a competent physician or surgeon to attend the injured employee and, in addition, shall furnish any medical and surgical aid or hospital and nursing service, including medical rehabilitation services and prescription drugs, as the physician or surgeon deems reasonable or necessary. The employer, any insurer acting on behalf of the employer, or any other entity acting on behalf of the employer or insurer shall be responsible for paying the cost of such prescription drugs directly to the provider. If the employer utilizes an approved providers list, when an employee reports a work-related injury or condition to the employer the employer shall provide the employee with such approved providers list within two business days of such reporting.
(2) If the injured employee is a local or state police officer, state marshal, judicial marshal, correction officer, emergency medical technician, paramedic, ambulance driver, firefighter, or active member of a volunteer fire company or fire department engaged in volunteer duties, who has been exposed in the line of duty to blood or bodily fluids that may carry blood-borne disease, the medical and surgical aid or hospital and nursing service provided by the employer shall include any relevant diagnostic and prophylactic procedure for and treatment of any blood-borne disease.
(b) The employee shall select the physician or surgeon from an approved list of physicians and surgeons prepared by the chairman of the Workers’ Compensation Commission. If the employee is unable to make the selection, the employer shall do so, subject to ratification by the employee or his next of kin. If the employer has a full-time staff physician or if a physician is available on call, the initial treatment required immediately following the injury may be rendered by that physician, but the employee may thereafter select his own physician as provided by this chapter for any further treatment without prior approval of the commissioner.
(c) The commissioner may, without hearing, at the request of the employer or the injured employee, when good reason exists, or on his own motion, authorize or direct a change of physician or surgeon or hospital or nursing service provided pursuant to subsection (a) of this section.
Connecticut Managed Care Plan
Sec. 31-279-10. Medical care plans. (a) All medical care plans submitted pursuant to Section 31-279 of the Connecticut General Statutes by any employer or, on behalf of one or more employers, by any insurer, mutual employer association, self-insurance service organization or other sponsoring organization to arrange for the provision of medical and health care services, including medical and surgical aid or hospital and nursing service and medical rehabilitation services, shall include the following in addition to the information required by said section.
Managed Care Plan Benefits:
- Allows direction to the Network for all care; (access to non-emergency care is available within the MCP Network specialties must be within 25 miles of the employer’s location)
- Limits exceptions for accessing non-network services;
- Requires prior approval for seeking non-network care;
- Requires aggressive UR & CM focused on Return-To-Work (RTW) or alternative light-duty opportunities;
- Requires the dispute process to be exhausted before appealing to the Workers' Compensation Commission (WCC).
Per the An Employee’s Pocket Guide To Connecticut Workers’ Compensation, published by the State of Connecticut Workers’ Compensation Commission:
Effective March 25, 1993, an employer or an employer’s workers’ compensation insurance carrier may establish a medical care plan for treatment of employees who incur work-related injuries or illnesses. If your employer has such a medical care plan which is approved by the Chairman of the Workers’ Compensation Commission, you MUST seek appropriate care from a medical provider who is part of your employer’s managed care program. If you choose to seek treatment outside of the employer’s program, a Commissioner may suspend your rights to receive any workers’ compensation benefits [see Sec. 31-279(c)].
- Conducting Training & Education to Insureds and Employees
- Managing “Collective Bargaining”, if applicable
- Completing the Application for State certification
- Supporting a Safety Program if >25 employees
- Requires a labor-management safety committee for each employer
- Committee members must include equal representation from Labor and management
- Committee must comply with WCC regulations under §31-40v-1 through 31-40v-11, unless the representation is inconsistent with a collective bargaining agreement
- Supporting an Alternative Light Duty program if > 50 employees
To view the Medical Care Plan Regulation Sec. 31-279-10, please click on this text - http://wcc.state.ct.us/law/wc-regs/31-279-10.htm
For additional information regarding Gallagher Bassett's Connecticut Managed Care Plan offering, please contact your Gallagher Bassett Account Executive.
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