Colorado Workers Compensation Claims: Eligibility, Filing and Appeals
Employers with one or more employees must purchase worker’s compensation coverage for all non-exempt employees. Exempt employees include those employed by passenger trams, real estate agents or brokers who are paid only on commission or who act as independent contractors, people in jail, volunteers at ski resorts, drivers with common carriers, and domestic workers.
Covered Work Related Injuries in Colorado
Employers are liable for accidents and personal injury sustained by employees “while engaged in the line of duty” or for “death resulting from personal injuries so sustained.” Employers are liable even if the employee was negligent or if a 3rd party caused the harm. Disability or death that begins five years or more after employment ends is presumed not to be covered unless it is an injury caused by exposure to chemicals including uranium or asbestos.
In order to be covered, an employee must be providing service arising out of or in the course of their employment and the injury or death must be proximately caused by an injury or occupational disease arising out of and in the course of employment. The injury may not be intentionally self-inflicted.
Filing a Colorado Workers Compensation Claim
If you are injured, you should notify your supervisor in writing as soon as possible, preferably prior to obtaining medical care. Your employer may have a designated medical provider that you are required to get treatment from, in order for you to receive full payment of medical costs. You must notify your employer in writing of your injury within four days in order to ensure that you receive your full workers compensation benefits.
To file a formal claim, you should fill out Workers Compensation Claim for Compensation, or form WC15. This form is available from your employer or from the Colorado Division of Workers Compensation. This form constitutes sufficient notice of injury and begins the claim review process.
You are required to submit medical records from an approved provider when filing a claim. In some cases, you may be asked to get an independent medical exam, in which an independent doctor selected by the employer or insurance company verifies your injury and impairment rating.
Denial of Colorado Workers Compensation
Claims may be denied for a number of reasons. Common reasons for denial include failure to file the appropriate forms, insufficient evidence presented at a hearing, or failure to comply with requests for independent medical exams.
Appealing a Colorado Workers Compensation Denial
Denials of benefits are appealed to the Worker’s Compensation appeals board. When a claim is denied, a petition to review must be filed. After the petition is filed, the employee appealing the worker’s compensation denial has 20 days to submit a brief in support of their appeal. When the 20 days has passed, the Administrative Law Judge has 30 days to make a ruling, called a supplemental order. A hearing can be held, which may be preceded by a prehearing conference to facilitate settlement.
If the Administrative Law Jude does not issue a supplemental order, or if you are dissatisfied with the order and want to appeal further, the case is transferred to the Industrial Claim Appeals Office. A panel of two administrative judges who work for the Industrial Claims Appeals Office will then review the case and the evidence presented to make a final decision. If you are still dissatisfied with this decision, you can file an appeal to the Colorado Court of Appeals.
Collecting Compensation Benefits
Medical and death benefits are provided to workers injured or killed in Colorado. Temporary and permanent disability benefits are provided as well. If you are permanently disabled, your benefits are calculated by considering your impairment rating (the level of permanent injury you suffered) as well as your average wages. Permanent disability benefits are paid bi-weekly until the entire amount due is paid.
Hiring a Colorado Workers Compensation Lawyer
Hiring a worker’s compensation lawyer is advisable, especially in the case of a benefits dispute. Colorado workers compensation laws have a number of deadlines in order to recover full benefits and a workers compensation attorney can help ensure you comply with all deadlines and complete all paperwork properly.
Colorado Workers Compensation Office Locations
Division of Workers' Compensation
633 17th Street, Suite 400
Denver, CO 80202
(303) 318-8710 (Fax)