Workers’ Compensation

Man looking out into the horizon

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.

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.

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

Cliff Ashton
Facilities Management

Vani Cashman
UConn Medical Group

Martin Cherniack
Occupational and Environmental Medicine

Dhruv Dave

Chris DeFrancesco

Nancy Dupont
Epidemiology/Infection Control

Christopher Emerton

Suzanne Ferreira
Emergency Department

Lauren Gangaram

Jennifer Garza
Occupational and Environmental Medicine

Ann Marie Grella

Anna Humennyj
Float Pool

Steve Jacobs
Environmental Health and Safety

Sue Kassey
Police Department

Stephanie Makar
John Dempsey Hospital Safety

Cynthia Mitchell
Surgery Center

Necole Morrisey
Cancer Center

Kim Silverman
Rehabilitation Services

Cathy Spisak
Operating Room

Jessica Van Alstyne
Human Resources

Giancarlo Vento

Guy Womack
Voice, Network and Mobile Device Services