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Workers' Compensation
The Office of Workers' Compensation receives documentation of all Yale University at-work injuries/illnesses by way of a Department Report of Injury. Upon receipt, attention is given to ensure each employee receives all Workers' Compensation benefits applicable.
Yale University has a Workers' Compensation Medical Care Plan approved by the Chairman of the Workers' Compensation Commission of the State of Connecticut. This Plan covers employees who sustain work-related injuries or illnesses while employed by Yale University, and provides for medical treatment for those injuries. Any employee who is injured at work must see a physician on this Medical Care Plan. Failure to do so may affect the employee’s eligibility for benefits. It is Yale University's goal to provide all injured employees with prompt and effective medical care through the Plan's network of physicians, treatment centers and hospitals.
If a work-related accident occurs, it should be reported to the supervisor immediately. In the case of an emergency, the employee is directed to the Urgent Visit Department at University Health Services or to the nearest hospital emergency room.
For non-emergency services the employee must choose a physician from the Medical Care Plan. The supervisor will complete a Department Report of Injury Form which is to be faxed to the Office of Workers' Compensation at (203) 432-5432.
If the employee wishes to seek treatment at University Health Services, he or she should contact the Employee Health Department at (203) 432-7879 to schedule an appointment. The supervisor must supply the employee with a University Health Services Appointment Form for the initial evaluation at University Health Services.
If the employee wishes to seek treatment at St. Raphael’s Occupational Health Plus, no appointment is necessary, but it is helpful for the employee to call (203) 789-3721 and advise St. Raphael’s Occupational Health Plus that he or she is on the way there for treatment.
The supervisor must supply the employee with a
St. Raphael's Occupational Health Plan Authorization for Injury Care form for initial evaluations.
The employee may alternatively choose to select a physician in the appropriate specialty from the Yale University Workers' Compensation Medical Care Plan. If an employee chooses to treat with a specialist from the Plan, the Workers' Compensation Office must be notified to authorize coordination of information and benefits.
To assist the employee in choosing an approved provider, The Yale University Workers' Compensation Medical Care Plan is available at the Office of Workers’ Compensation, 55 Whitney Ave., Suite 470, (203) 432-
9830 or click here for the Provider Directory. Copies of the Directory are available at University Health Services (Urgent Visit and Employee Health reception areas), some Business Offices and at the Office of Human Resources.
Department's Report of Injury
 Reporting a Work-Related Illness/Injury
In the event of a work-related illness or injury, both the employee and the supervisor have a responsibility to assure that complete and accurate information is conveyed to the University's Office of Workers' Compensation as soon as possible.
If this information is not received, the Office of Workers' Compensation will be unable to process any claim or provide any benefits.
The Department Report of Injury Form is the standard method for reporting an on-the-job-injury.
Copies of the Department Report of Injury Form should be sent to:
1. Office of Workers' Compensation at 432-5432 (fax)
2. Employee's Department Head
3. Office of Environmental Health & Safety, 135 College Street,
Attn: Safety Engineer
4. University Health Services, 55 Whitney Ave.
Download the form here.
The supervisor must complete a Department Report of Injury whenever an employee has or reports a work-related injury, accident or illness. This form must be completed within 24 hours of being notified of an injury.
Supervisors should not make any decision as to the veracity of the claimed injury, or whether medical treatment should be obtained. In accordance with the State of Connecticut Workers’ Compensation law, if an employee reports an injury, the Department Report of Injury must be completed, and the employee must be allowed to seek authorized medical treatment if he or she wishes to do so.
In the event of a non-witnessed accident, the supervisor should question the employee in person (or via telephone if this is not possible) to get the specific facts of the accident and injury needed to complete the Department Report of Injury.
The form must be completed in its entirety. All requested information is necessary to ensure the personal information in Yale's online system is accurate and the Office of Workers' Compensation Office is able to contact the employee and meet OSHA requirements. Care must be taken in reporting accidents to ensure the employee’s exact words and description of the accident are captured.
If the supervisor has further information that he/she thinks is pertinent, he/she should add that information in the remarks section, or contact the Office of Workers’ Compensation.
On completion of the Department Report of Injury the supervisor should immediately fax a copy of the report to the Office of Workers' Compensation at (203) 432-5432. Early notification assures prompt and effective treatment and case management. The Department Head signature is not necessary before notifying the Office of Workers’ Compensation, and the notification should not be delayed while waiting for such signature.
The information contained in the Department Report of Injury is used to complete the mandated Workers' Compensation Commission of Connecticut Employer's First Report of Occupational Injury or Disease.
All employees are required to report work-related injuries, accidents or illnesses to their supervisor. It is mandatory that this be done at the time of injury or, if an illness, immediately when that illness is identified as being work-related.
The employee should assure that the Department Report of Injury form is completed by reporting the accident/illness to his/her supervisor and participating in the completion of a Department's Report of Injury. This form is to be faxed by the supervisor to the Workers' Compensation office at (203) 432-5432.
If medical treatment is needed after an injury, an employee must choose a physician on the Yale University Workers' Compensation Medical Care Plan.
For treatment at Yale University Health Services for a work-related injury, a Yale University Workers' Compensation Health Services Appointment form must be presented. This form is obtained from the supervisor or here and is used at the first appointment.
For treatment at St. Raphael’s Occupational Health Plus, a St. Raphael’s Occupational Health Plus Authorization for Injury Care form must be presented. This form is obtained from the supervisor or here and is used at the first appointment.
All employees are advised that if these instructions are not followed, Workers' Compensation claims cannot be reviewed. Employees will not be entitled to Workers' Compensation benefits and can be held responsible for any expenses incurred.
Medical Treatment Following a Work-Related Injury or Illness
Yale University has a Workers' Compensation Medical Care Plan accepted by the State of Connecticut Chairman of the Workers' Compensation Commission. This Plan covers employees who sustain work-related injuries or illnesses while employed by Yale University and provides for medical treatment for those injuries. Any employee who is injured at work must see a physician on this Medical Care Plan. Failure to do so may affect the employee’s eligibility for benefits. It is Yale University's goal to provide all injured employees with prompt and effective medical care through the Plan's network of physicians, treatment centers and hospitals.
If a work-related accident occurs, it should be reported to the supervisor immediately. In the case of an emergency the employee is directed to the Urgent Visit Department at University Health Services or to the nearest hospital emergency room.
For non-emergency services the employee must choose a physician from the Medical Care Plan. The supervisor will complete a Department Report of Injury Form which is to be faxed to the Workers' Compensation Office at (203) 432-5432.
If the employee wishes to seek treatment at University Health Services, he or she should contact the Employee Health Department at (203) 432-7879 to schedule an appointment. The supervisor must supply the employee with a University Health Services Appointment Form for all evaluations at University Health Services.
If the employee wishes to seek treatment at St. Raphael’s Occupational Health Plus, no appointment is necessary, but it is helpful for the employee to call (203) 789-3721 and advise St. Raphael’s Occupational Health Plus know that he or she is on the way there for treatment. The supervisor must supply the employee with a St. Raphael’s Occupational Health Plus Authorization for Injury Care Form for all evaluations at St. Raphael’s Occupational Health Plus.
The employee may alternatively choose to select a physician in the appropriate specialty from the Yale University Workers' Compensation Medical Care Plan. If an employee chooses to treat with a specialist from the Plan, the Workers' Compensation Office must be notified to authorize coordination of information and benefits.
Yale University Workers' Compensation Health Service
Appointment Form
This form is used the initial time an employee has treatment at the Employee Health Services Department at Yale University Health Services for a work-related injury or illness.
The top section Request to Employee Health Services is filled out, in its entirety, by the employee's supervisor. The remainder of this form is completed by personnel at University Health Services.
At the conclusion of the appointment the employee is given a copy to return to his/her supervisor.
The supervisor's copy allows him/her to ascertain the employee's work status (out of work, restricted duty or return to work). A definition of the work restriction levels can be found here.
If the supervisor is unable to provide work under these restrictions the supervisor must notify the Workers' Compensation Office.
In the event the employee is taken out of work by the Employee Health Services Department or the supervisor is unable to supply modified work, the employee must personally contact the Workers' Compensation Office to assure benefits.
The Workers' Compensation Office reviews its copy of this report to assure that this is an accepted Workers' Compensation claim, to follow up on work availability in the event work restrictions have been provided or changed, for notification of return to work and to assess comprehensiveness and appropriateness of care plan, diagnosis and length of disability.
Download Appointment Form here.
St. Raphael’s Occupational Health Plus Authorization for Injury Care Form
This form is used for the the initial visit to St. Raphael’s Occupational Health Plus for each work-related injury or illness.
The form is to be filled out, in its entirety, by the employee's supervisor and brought to the clinic by the employee. This allows St. Raphael’s Occupational Health Plus to confirm that the employee is there to treat for a Yale University work related injury.
At the conclusion of the appointment, the employee is given a work status note to return to his/her supervisor. This note will allow the supervisor to ascertain the employee's work status (out of work, restricted duty or return to work). If the employee is given a work status note with restrictions and the supervisor is unable to provide work under these restrictions, the supervisor must notify the Office of Workers' Compensation.
In the event the employee is taken out of work, or the supervisor is unable to supply modified work, the employee must personally contact the Office of Workers' Compensation Office to assure benefits.
The Office of Workers' Compensation will also receive a work status note from St. Raphael’s Occupational Health Plus, and will review its copy to assure that this is an accepted Workers' Compensation claim, to follow up on work availability in the event work restrictions have been provided or changed, for return to work, and to assess comprehensiveness and appropriateness of care plan, diagnosis and length of disability.
Download Authorization for Injury Care Form here .
Treatment Outside Yale University Health Services
If an employee chooses to see a physician or other provider listed in the Yale University Workers' Compensation Medical Care Plan the Workers' Compensation Office must be notified to authorize coordination of information and benefits.
If, at the time of initial medical evaluation (or any subsequent evaluation), an employee is given work restrictions or taken out of work, the employee must provide written documentation to the Office of Workers' Compensation. In the case of work restrictions, communication will take place with the employees' department to determine if work is available under those assigned restrictions.
It remains the employee's responsibility to obtain a note from the medical provider after each visit documenting the current work status. This note must be presented to the Workers' Compensation Office for appropriate follow up. A note from the medical provider must also be presented to the Workers' Compensation Office before an employee returns to work or to a full duty assignment.
The University Health Services Appointment Form is not used when treating with physicians chosen from the Directory.
If an employee is receiving medical treatment at Yale University Health Services or St. Raphael's Occupational Health Plus, he/she is allowed to change providers and pick a specialist from the Directory. When treatment begins with the specialist, the employee does not return to Yale University Health Services or St. Raphael's Occupational Health Plus for concurrent care.
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