Worker's Compensation (CIRMA)

Workers Compensation

Please note that incidents should be reported no more than 24-48 hours after an occurrence.

The  Employee Accident/Injury Report  form Download form, fill in, save/print, also known as the First Report of Injury, is the document that initiates workers’ compensation benefits to the injured employee.  Any delay involving the submission of this form is delaying an injured employee’s receipt of benefits to which he or she may be entitled.  The  Employee Accident/Injury Report must be completed in its entirety, in detail, and signed by a supervisor. Once completed, it should be faxed to the attention of  Lucy Gennuso, Insurance & Benefits Coordinator, Board of Education  (Fax # 860 638-1457).  Please keep a copy for your records.

The  Witness Statement   Download form, fill in, save/print  should be filled out only if there are any witnesses to the incident.

The   Supervisor’s Accident Investigative Report   Download form, fill in, save/print should be filled out by the employee’s immediate supervisor.  The purpose is to find out how a similar incident can be prevented in the future.

(It is important that this office receives the accident/injury form a.s.a.p. even without the other two forms initially, if there is delay in completion.)

If further medical attention is needed after seeing the school nurse, the employee should be immediately referred to Middlesex Occupational Medicine (Outpatient Center - 2nd floor), 534 Saybrook Road, Middletown, CT for care. 
Middlesex Occupational Medicine’s telephone number is (860) 358-2750, option 6.  Should an employee need emergency care, please proceed to the nearest Hospital Emergency Room.

If the employee is put out of work by the doctor, he/she must use sick time until CIRMA (workers' compensation insurance), reviews and authorized the claim. They will notify this office once approved, which will prompt the Payroll Department to reimburse your sick time back to you. Please note that payment will be reimbursed after three lost days of work (per State of Connecticut Workers' Compensation Commission) Day of Injury Covered [31-295]-You should receive your full pay for the day of occurrence of your injury. Temporary Total Disability [31-307]- Temporary Total (TT) Disability benefits are essentially "wage replacement" benefits which are paid by your employer's workers' compensation insurance carrier while you are unable to perform any type of work due to your work-related injury or illness. TT benefits begin on the fourth calendar day of disability from work. If the disability lasts for seven or more calendar days, payment will be made retroactively to cover all the days of disability from work. (The day of injury is not counted as a "day of disability" from work).

*Please note:  If a contracted worker or any person who is not an employee, is injured on Middletown Board of Education property, he/she would not be covered under CIRMA Workers' Compensation insurance, but rather, should submit a letter to the Town Clerk’s Office (245 deKoven Drive) at City Hall advising the City of the incident along with any supportive documentation Please notify this office of any injury that occurs.

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