Colorado Workers' Compensation Benefits: Eligibility, Filing, and Appeals

What you need to know about qualifying for workers' comp in Colorado, how to file a claim, how to appeal, and how much you might receive.

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 its website.

Colorado Employees Not Covered by Workers' Comp

Certain classes of employees are not eligible for workers compensation benefits in Colorado. 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.

Steps to Take If You're Injured on the Job in Colorado

In most cases, your first step after becoming ill or injured at work is to notify your employer right away. If your injury or illness requires immediate medical attention, seek medical care before provide notification. When you do notify your employer do so orally 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.

Your Choice of Doctor and Workers' Comp

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.

Filing a Workers' Comp Claim in Colorado

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).

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 (that is, an approval of your claim) 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 [email protected]. Mail the completed form to:

Workers' Compensation
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 don't file within this timeframe.

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.

Appealing a Denied Workers' Comp Claim in Colorado

If you disagree with any decisions made by the insurance company on your workers' comp claim, you have the right to appeal those decisions. It is a good idea to have an attorney help you navigate this complex procedural process in order to ensure all of your rights are protected.

First, if you are unhappy with the final decision of the insurance company and want to take it to a workers' comp judge, you can ask for a hearing. Before requesting a hearing, you can first try to talk with your employer or their insurance company to work out your differences, but if this doesn't work, you can request a hearing or prehearing. Next, if you are unhappy with the hearing decision, you can appeal to a higher court.

Requesting a Prehearing Conference

If you are unable to resolve any problem by informally discussing your concerns with the adjuster or your employer, you have the right to request a formal hearing on any disputed issue. But before you do that, or while you are waiting for the formal hearing, you can request a prehearing conference, or a settlement conference, through the Division of Workers' Compensation.

The Worker's Comp Division offers staff persons who will informally meet with you and your employer and/or the insurance company to help settle your differences. But be forewarned: this staff person is not your advocate and cannot give you legal advice. If the informal process doesn't work to your satisfaction, you will still have the right to go to a formal hearing.

What Happens at a Prehearing?

A prehearing is an informal meeting presided at by an administrative law judge. This judge has the right to order both parties to attend. The meeting is a chance to talk about the disagreements in the case before the judge to try and reach a resolution. The judge has the right to order certain documents to be provided to help decide the case.

You can also ask the judge to preside over a settlement conference, but in that case, both parties must voluntarily agree to attend. You may be able to resolve some or all differences. If you are not successful you can go on to the formal hearing.

Requesting a Full Hearing

To ask for a hearing, you will need to file an Application for Hearing. If you want to request an expedited hearing, you must file an Application for Hearing within 45 days of the date the Notice of Contest was mailed to you. (The Notice of Contest is the form you will receive in the mail telling you your claim has been denied.)

You must submit the Application for Hearing online or mail or fax it to the Colorado Office of Administrative Courts that is closest to you. You also must mail a copy to the insurance company.

Expedited hearings are scheduled within 45 days of the date you submit the Application for Hearing. Other hearings will be scheduled within 80 to 100 days.

You can ask for a hearing in one of the following cities: Denver, Boulder, Colorado Springs, Durango, Fort Collins, Glenwood Springs, Grand Junction, Greeley, or Pueblo.

While you are waiting for your hearing date, you can try to reach an agreement with your employer through a prehearing, mediation of a settlement agreement, or arbitration.

What Will the Formal Hearing be Like?

The hearing will be a formal proceeding before an administrative law judge. Both you and your employer or the insurance company can present evidence, and a court reporter will make a record of the hearing. There will not be a jury, and you will not be charged a fee for having the hearing.

A decision may be issued against you if you do not appear for the scheduled hearing.

Should I Use Arbitration?

Another informal process for resolving disputes is arbitration. Administrative law judges are available in various cities to conduct arbitrations. These judges are available in Colorado Springs, Boulder, Fort Collins, Durango, Denver, Pueblo, Greeley, Grand Junction, or Glenwood Springs. It is best to hire an attorney to help with arbitration as arbitration, unlike a hearing, may be binding (permanent).

The Division of Workers' Compensation is also a resource for information regarding options for arbitration before an administrative law judge.

What If I Disagree With the Judge's Decision?

The judge's decision is called an order, and you will receive a copy of this decision in the mail.

If you disagree with the judge's decision you have the right to file an appeal. It is very important to get an attorney to assist you if you want to appeal a hearing decision as there are strict procedural rules that must be followed or you might lose your right to appeal. For example, you must file a Petition to Review within 20 days from the date the judge's order was mailed to you.

You will also need to order a transcript of your hearing. You'll need to write to the court reporter who presided at your hearing to request this transcript. There will be a cost for ordering the transcript. If you cannot afford it, file an Application for Indigent Determination (Hearing Transcript). This application must be submitted either online or by mail to:

Division of Workers' Compensation
633 17th ST., Suite 400
Denver, CO 80202-3626

Appeals Process

The next step to appealing a hearing decision is to submit a brief, which will contain detailed legal arguments in support of your appeal. The administrative law judge will read the arguments submitted by both sides and make a decision or may send the appeal to the Industrial Claim Appeals Panel.

The Industrial Claim Appeals Panel will review the judge's decision and both sides' arguments and issue a decision within 60 days. The decision will be mailed to you.

If you are still unhappy with the decision, you can appeal to the Colorado Court of Appeals, but you must do so within 20 days. If you are still dissatisfied, you can then appeal to the Colorado Supreme Court, but the court is not able to hear all cases submitted to it.

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.

Types of Workers' Comp Benefits Available in Colorado

If you are injured or become ill at work in Colorado, in addition to having your medical care paid for by workers' comp, you have the right to be compensated for part of the wages you are losing due to your inability to work.

Temporary Disability Benefits

You are eligible to begin receiving temporary compensation benefits after you have missed more than three shifts or more than three days of work as a result of your work-related injury. You will be paid for the first three days of missed work only if you are out of work for at least two weeks.

If you are completely unable to work, you will be paid temporary total disability benefits. These benefits are two-thirds of your average weekly wage, up to a maximum amount set by law each year. As of July 1, 2021, the maximum benefit is $1,158.92 per week. If you are able to work, but you're earning less due to your injuries, you can receive temporary partial disability benefits. These benefits are two-thirds of the difference in your earnings, up to the same weekly maximum.

Temporary benefits continue until one of the following happens:

  • You're able to work full-time at your regular job again.
  • Your treating doctor says you are able to work at a "modified" job and your employer offers you a suitable job.
  • Your doctor finds that you have stabilized and further medical treatment will not improve your condition (this is called "maximum medical improvement").

Permanent Total Disability Benefits

If your doctor finds that you will be unable to work in any capacity due to a permanent and total disability, you will receive benefits at your temporary total disability rate for life. You should be aware, however, that any Social Security or other disability pension you receive may reduce the amount you will receive in workers' compensation benefits. (See our article on the workers' comp offset for more information.)

Permanent Partial Disability Benefits

Colorado workers' compensation also pays for permanent partial disabilities, including scheduled impairments, whole body impairments, and disfigurement.

Scheduled Impairment

A "scheduled impairment" is a loss of function to certain body parts listed in a state schedule, including feet, toes, hands, fingers, arms, eyes, ears or teeth. The doctor will give you a disability rating, in the form of a percentage, which will determine the amount of your benefits.

Scheduled impairments are paid for a number of weeks determined by the state schedule. For example, a total loss of use of an arm at the shoulder is worth 208 weeks of compensation. The loss of a hand below the wrist will get you 104 weeks of compensation, and complete deafness in both ears 139 weeks. The maximum weekly benefit for a scheduled impairment is $337.11 (as of July 1, 2020).

Whole Person Impairment

A "whole person impairment" is any permanent loss of function that is not listed on the state schedule. For example, this includes mental impairments, impairment of the spine, or impairment of the organs, such as the lungs. Unlike scheduled impairments, discussed above, whole person impairments do not have a set number of weeks for which payment will be made. Instead, your doctor will evaluate the severity of the loss of function and rate your disability on that basis. The maximum weekly benefit for whole person impairments is $590.24 (as of July 1, 2020).

Payment for Disfigurement

Scars on a part of the body that are visible, such as on the face or arms, are eligible for additional compensation up to approximately $5,686.96. For certain severe disfigurements, such as burn scars on the face or other severe facial scars, or complete or partial loss of a limb, a maximum payment of up to $11,371.92 is available (in 2020).

Cap on Combined Benefits

Colorado also places caps on how much a worker can receive in temporary total disability benefits and permanent partial disability benefits. For impairments of 25% or less, the maximum is $99,094.93; for impairments of more than 25%, the maximum is $198,187.35.

Getting Permanent Disability Benefits in a Lump Sum

If you are awarded permanent disability benefits on the basis of a partial disability, such as for a scheduled impairment, disfigurement, or whole person impairment, you have the right to receive the benefits as a lump-sum payment of up to $10,000. You can also request multiple lump-sum payments of $10,000 up to a total of $60,000.

If you take lump-sum payments, your award will get reduced by 4% a year. The Claims Management Unit will run calculations for you to see whether a lump sum payment makes sense. Call the Customer Service Unit for assistance. This may be something worthwhile to discuss with an attorney.

Caution: If you request to receive lump sums for more than $10,000, you will be waiving the right to appeal your impairment rating. It is inadvisable to do this without first consulting with a workers' comp attorney.

Contact a Colorado Workers' Comp Attorney

Consider contacting a workers' compensation attorney for help with your claim. The attorney will not charge you an initial consultation fee and will be paid only if the attorney is successful on the claim. If the attorney wins your case, their fee will be a percentage of the amount of money awarded by the insurance company. Read more in our article on how to find a qualified workers' compensation attorney.

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