Colorado Workers Comp Claims: Eligibility, Filing and Appeals
Answers to common questions on how Colorado workers' comp works.
Most employers in Colorado with at least one employee must provide workers' compensation coverage. Workers' compensation is an insurance benefit provided to employees who become injured at work or become ill due to working conditions. It pays for medical costs, temporary loss of wages, and in some cases, permanent loss of wages. The program is administered by the Colorado Division of Workers' Compensation (which publishes a helpful Employee’s Guide on the Colorado Workers’ Compensation website).
Are Some Employees Not Covered?
Certain classes of employees are not eligible for workers compensation benefits. These include:
- maintenance or repair workers earning less than $2,000 for services to a company
- domestic and repair work done part-time for a private homeowner
- real estate agents and brokers
- contractors who provide ad hoc transportation services, and
- federal and railroad employees who receive coverage under federal laws.
What Do I Need to Do After Being Injured?
If you become ill or injured at work, notify your employer right away. Only if you feel your life is at risk or you body is at risk of permanent damage (such as loss of a limb) should you first seek medical services and then later notify your employer. Provide this notification verbally and in writing.
You have four days from the date of injury to provide this written notice to your employer. You can still ask for benefits if your notification is late, but you might get docked some benefits based on the number of days late you were.
Which Doctor Can I See?
Your employer has the right to specify the doctor or other medical provider that you must see, but your employer might give you an approved list of doctors to choose from. If you go to a doctor who is not on the approved list, the workers' comp insurer might not pay your medical care. However, if your employer doesn't require you to see a certain provider, then you may choose the doctor of your choice and receive benefits coverage (have your medical bills paid) for the care you receive.
After your claim is filed (see below), the insurance company might ask you to see another doctor to be evaluated. It is important to comply with this request. The insurance company will pay for the medical evaluation, and if you don’t cooperate, you risk losing your benefits. It’s also very important to keep appointments with the primary doctor providing treatment for your work-related injury, in order to retain your benefits.
How Do I File a Worker's Comp Claim?
It is your employer’s responsibility to file the claim on your behalf. Within ten days of the time you notify your employer of your injury, your employer must file an Employer’s First Report of Injury form with its insurance company if:
- you've been out for more than three shifts or more than three days
- you have suffered a permanent injury, or
- you have an occupational disease (meaning, an illness that has arisen due to conditions on the job).
When Will a Decision Be Made on the Claim?
Within 20 days of receiving the first report of injury (or, the date it should have been received), the insurance company must issue a decision about whether or not to provide benefits coverage to you.
If the insurance company finds you eligible for benefits, it will begin paying for your medical expenses and payments for time lost from work. You will receive a letter from the insurance company titled “Admission of Liability.”
If the insurance company denies your claim, call to find out if you can provide some additional information to support your claim. If, despite your efforts, the insurance company continues to deny your claim, then you may need to appeal the denial. See our article on appealing a workers' comp denial in Colorado to learn more.
What if My Employer Doesn’t File the Claim?
If your employer doesn’t report your injury or if you don’t get an Admission of Liability in the mail from the insurance company, then you will need to report the injury yourself to the Division of Workers’ Compensation. You use the Worker’s Claim for Compensation form to file the claim (call the Customer Service Unit at (888) 390-7936 if you want a copy mailed to you). You can also email the division at firstname.lastname@example.org. Mail the completed form to:
633 17th Street, Suite 400
Denver, CO 80202
Do not delay filing your claim for compensation. You have two years from the date you were injured (or if there was a good reason you couldn't file, up to three years) to file your claim. You are likely to lose all benefits if you do not file within this timeframe.
What Medical Care Will I Receive?
Medical care that is considered “reasonable and necessary” is covered by workers’ compensation. Medical supplies, prescriptions, and mileage to and from the doctor, will also be covered. If the doctor approved by your employer sends you to another doctor for needed care, then those bills will also be covered.
You have the right to change doctors once as long as you do so within three months of your injury and before you are improved enough to return to work. Use the Notice of One-Time Change of Physician to change doctors, or write a letter to the insurance company to make your request. If you change doctors without permission, your bills may not be covered.
What Type of Temporary or Permanent Compensation Will I Get?
You are entitled to receive temporary compensation to make up for the wages you are losing due to being out of work with a work-related injury. Likewise, you can be compensated for permanent injuries you have sustained at work. See our article on Colorado workers' compensation benefits to learn more.