Workers' Compensation is a type of insurance intended to provide wage replacement, medical bill coverage, and other benefits to employees due to occupational injuries and illnesses. It is a mandated program governed primarily by laws found in the Connecticut General Statutes. The Workers’ Compensation program for state employees is managed by the Department of Administrative Services.
- Department of Administrative Services Workers’ Compensation Website
- Workers' Compensation Notice to Employees
- Workers’ Compensation Physician Provider Directory
- Workers’ Compensation Pharmacy Locator
- Workers’ Compensation Resource Guide
The State of Connecticut Workers’ Compensation Program requires that an employee report a work-related injury or illness to his/her supervisor immediately. To officially report the claim, the employee and supervisor must contact Human Resources at 860-679-1483.
| Worker Status Report (DAS Form 208) | This form must be completed by the physician at every visit; the employee must immediately provide a copy to his/her direct supervisor and to Human Resources, fax 860-679-4660. |
| Filing Status and Exemption (WCC Form1A) | This Workers’ Compensation Commission form is used to record the injured worker's federal income tax filing status and number of exemptions for use in establishing the base Workers’ Compensation rate of pay. |
| Concurrent Employment and Third Party Liability (DAS Form PER-WC 211) | This form is completed to identify if the injured worker has any employment other than the State of Connecticut for potential concurrent employment benefits and to identify any third party negligence, giving rise to the injury. |
| Use of Accrued Leave (Comptroller Form DAS-WC-715) | This form is used to designate the use of accrued leave to supplement lost wage workers’ compensation benefits for the injured worker. NOTE: Refer to General Letter 78 on administration of this form. |
Workers’ compensation also provides payment and mileage reimbursement for some medical appointments and workers' compensation hearings.
- Mileage Worksheet for Medical Treatment
- Workers’ Compensation Hearings Form 226
- Workers’ Compensation for Medical Appointments Form 226
Workers’ Compensation Health and Safety Committee
The Workers’ Compensation Health and Safety Committee is comprised of equally represented staff and management members whose charge is to promote safety and health at UConn Health. Members are as follows:
Lorri Adgers
Patient Accounts
adgers@uchc.edu
Cliff Ashton
Facilities Management
cashton@uchc.edu
Vani Cashman
University Medical Group
cashman@uchc.edu
Martin Cherniack
Occupational and Environmental Medicine
cherniack@uchc.edu
Dhruv Dave
Radiology
ddave@uchc.edu
Chris DeFrancesco
Communications
cdefrancesco@uchc.edu
Nancy Dupont
Epidemiology/Infection Control
dupont@uchc.edu
Christopher Emerton
Sodexo
cemerton@uchc.edu
Suzanne Ferreira
Emergency Department
ferreira@uchc.edu
Lauren Gangaram
Psychiatry
gangaram@uchc.edu
Jennifer Garza
Occupational and Environmental Medicine
garza@uchc.edu
Ann Marie Grella
Lab
angrella@uchc.edu
Anna Humennyj
Float Pool
humennyj@uchc.edu
Steve Jacobs
Environmental Health and Safety
jacobs@uchc.edu
Sue Kassey
Police Department
kassey@uchc.edu
Stephanie Makar
JDH Safety
smakar@uchc.edu
Cynthia Mitchell
Surgery Center
cynmitchell@uchc.edu
Necole Morrisey
Cancer Center
nmorrissey@uchc.edu
Kim Silverman
Rehabilitation Services
ksilverman@uchc.edu
Cathy Spisak
Operating Room
spisak@uchc.edu
Jessica Van Alstyne
Human Resources
jvanalstyne@uchc.edu
Giancarlo Vento
Facilities
gvento@uchc.edu
Guy Womack
Voice, Network and Mobile Device Services
womack@uchc.edu