Connecticut state employees who are awarded disability retirement receive a yearly form from the Retirement Services Division. Until recently, it was a one-page form. The form asked about paid employment, volunteer work, job training and income from worker’s comp or Social Security. This form has been revised into a two -page questionnaire. In addition to questions about employment, job training and other income, it also asks about income under Conn. Gen. Stat. 5-142, and medical treatment for disability.

Conn. Gen. Stat. 5-142 has several provisions.  In general, it provides special disability compensation benefits for certain state employees who are injured while in the performance of their duties that is a direct result of the special hazards inherent in their job. Those employees can receive full salary for five years.

The new form also asks about “Treatment for your disability.”  It asks for names of medical providers, nature of treatment, dates of treatment, and results of treatment. It asks about medications, including the amount taken. This part can be misleading, as it is not clear which disability it refers to.

Both the new and the old forms ask the employee to sign the statement under the penalty of perjury. The old form asks the employee to notify the Retirement Services Division in the event of the commencement of any employment, social security or worker’s comp benefits or the “commencement of any activities that would demonstrate an improvement in my medical condition.” The new form adds a statement asking the employee to also notify the Retirement Services Division if any payments were received under Conn. Gen. Stat. 5-142, or if there was a change to the amount of any benefits paid to the employee or to a family member, or if the employee engages in any activity that demonstrates an improvement in the employee’s medical or psychological condition. “Psychological condition”  was added to the new form.

The new form is confusing and burdensome. We have concerns about this form. If you have questions about it, call us at Zimberlin Law LLC.

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