The State of Connecticut has an approved Managed Care Plan filed with the Connecticut Workers’ Compensation Commission. Under this plan, we are required to pay for reasonable and necessary medical costs of a workplace injury or illness where services are rendered by an approved provider, with no charge to the employee.

Pursuant to Sec. 31-294d [Medical and surgical aid, Hospital, ambulatory surgical center and nursing service] of the Workers’ Compensation Act (Chapter 568):

• The employer is responsible for initial medical treatment at designated office or facility. If the injured employee chooses not to visit the designated initial treatment provider or treats outside the Workers’ Compensation provider network, they may risk suspension of their benefits per order of the Workers’ Compensation Commission.
• The injured employee may choose an attending physician AFTER the initial visit from the State of CT Workers’ Compensation provider network. An injured employee whose employer does participate in an approved medical care plan must choose a physician from the list of doctors included in that plan.

If you have any questions, please contact The State’s Workers’ Compensation Third Party Administrator Gallagher Bassett at 1-866-422-7622.

By checking this box I understand that in accordance with the above that I am required to initially treat at an employer designated Occupational Clinic. I also understand that it is within my rights to choose an attending physician after the initial visit from the approved provider listing.