This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you suffer a life or limb threatening injury while at work (life or limb threatening injury is defined as an injury that you believe threatens a portion of your body or your life in such a way that immediate medical care is needed to prevent death or serious damage.), first seek the appropriate medical attention, if necessary, and then notify your supervisor. You must notify your supervisor in writing.
You must notify your supervisor in writing of your injury, regardless of how severe your injury, within four (4) working days. You may still file a claim for benefits if you are late, however failing to report your injury may subject you to lost wages for each day you are late.
If your employer has chosen a medical provider for work-related injuries before or at the time of your injury, you are required to use that medical care provider. If you ignore the choice of your employer, you may lose benefits coverage. However, if your employer has not specified a medical provider for you to receive care, you may seek your own medical care provider.
An insurance provider may choose to accept or to deny your claim. If your claim is accepted, the insurance company will begin to pay for your authorized medical expenses and/or compensation benefits. If your claim is denied, however, you may contact your insurance provider to learn more about how the decision was reached.
After you notify your employer, your employer should file a report of the injury with the insurance provider within ten days of your injury.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
In Colorado, the workers' compensation system is structured around employers providing their employees with insurance coverage should an employee get injured while on the job or develop occupational diseases. Employers with one or more full or part time employees are required to provide workers' compensation insurance coverage to their employees. Those employers who do not provide insurance coverage may be subject to certain liabilities enforced by the Division of Workers' Compensation.
Most employees, both full and part-time, are covered under workers' compensation insurance programs. However, certain occupations and/or individuals are not awarded mandatory coverage under the Colorado Workers' Compensation Act. This list includes, but is not limited to, the following:
- Casual maintenance or repair work performed for a business for under $2,000/calendar year.
- Domestic work, maintenance or repaid work for private homeowners that is not done full time.
- Licensed real estate agents and brokers working on commission-based pay.
- Independent contractors working for-hire transportation jobs.
- Drivers under lease agreements with common/contract carriers.
- Volunteer ski-operators.
- Persons who provide home services as a part of residential supports and services.
- Federal employees.
- Railroad employees.
- Independent contractors.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
An insurance provider may choose to deny your claim for a host of reasons; however, this usually results from the insurance provider's belief that your injury was not work-related or there is not enough information to make an informed determination that you are eligible for benefits.
4. What benefits might I be eligible to receive?
Depending on the nature of your injury and the determination of your employer's insurance provider, you may qualify for one of the following kinds of benefits: medical benefits, compensation benefits (temporary disability or permanent impairment), or fatality benefits.
Workers' compensation insurance pays for all reasonable and necessary medical expenses as authorized by the doctor designated to treat you for your injury. This should include the costs of all reasonable and necessary supplies, prescription, and any transportation expenses incurred to receive scheduled treatments.
Temporary disability benefits- If you miss more than three work days/shifts due to a work-related injury or illness, you will be eligible to receive compensation benefits for lost wages. Your lost wages are calculated on your fourth day absent from work. You will only recoup the first three days pay if you are subsequently absent from work for more than two weeks as a result of the injury or illness. The insurance provider will pay you temporary disability benefits once every two week throughout the time you are unable to work. The amount you should expect to receive will be two-thirds of your average weekly wage up to a maximum amount permitted by law on the date of your injury. This considers your gross wages or salary, commissions, overtime, tips, per diem, reasonable board, value of rent, housing, and lodging, and employee's costs of continuing the insurance plan.
Permanent impairment- A doctor must determine whether your injury is considered a permanent impairment. If the insurance company is in agreement with the doctor's determination, they will file a Final Admission of Liability and you will receive weekly benefits for a set period of time to compensate you for your disability. This amount will depend on the date of your injury and the length of time you are entitled to these benefits as mandated by law. Permanent impairment is categorized as one of the following:
- Scheduled impairment: Loss of function to toes, feet, legs, fingers, hands, arms, teeth, vision or hearing.
- Whole Person Impairment: Loss of function to body parts such as the spine, lungs, or the brain.
- Permanent Total Disability: Inability to earn any wages.
The Final Admission of Liability is the insurance company's statement that they owe you a certain amount of money and the plan they which to adhere to in paying you the money owed. The insurance will usually proceed with a Final Admission of Liability when the employee's doctor makes the determination that the employee will not fully recover from the injury. The doctor will also classify the degree of permanent impairment based on the level of function you are able to maintain post-injury.
The Colorado Division of Workers' Compensation also provides a benefits calculator to help give you an idea of the benefits you may be entitled to throughout the process. You can get an estimate of your benefits here.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
Once you have notified your employer of your injury in writing (within four (4) working days of your injury) and your employer has filed a report of your injury with the insurance provider (within ten (10) days of your injury), your workers' compensation claim has commenced.
If your injury results in your absence from work for more than three days/shifts or causes permanent impairment or death, the insurance carrier must review your injury report and notify you of their decision to pay you (or your dependents) benefits within twenty (20) days. If you have not missed more than three (3) days/shifts of work, your insurance carrier is not required to provide you with written notice. Instead, you may contact your employer's insurance provider to receive updates on the status of your claim.
6. If I am not happy with the determination, how do I appeal?
If the workers' compensation insurance provider chooses to deny your claim, you may contact the insurance provider to discuss how this decision was reached. If you remain unhappy with the determination, you may request a formal hearing to settle any disputed issues. You may also choose to engage in a pre-hearing conference, or settlement conference, to help you reach an agreement. These are informal hearings led by administrative law judges that can help the parties to discuss issues, concerns, or even possible resolutions.
A formal hearing involves an administrative judge making decisions on the benefits applicable and other relevant issues at hand. This is very similar to a trial, where parties may present a case including evidence and sworn testimony from witnesses.
To request a formal hearing, you must complete and file an Application for Hearing and send a copy to your employer's insurance company. Most hearing will be scheduled within 80-100 days of the filing. However, you may qualify for an expedited hearing, which will be scheduled within forty-five (45) days.
If you are not satisfied with the decision of the administrative judge at the formal hearing, you may file an appeal. In order to appeal, you must file a Petition to Review within twenty (20) days the judge's decision and order is mailed to you. The appeals process is handled by the Industrial Claims Panel; the panel reviews your case and the administrative law judge's order to help arrive at a decision. If this decision does not satisfy your dispute, you may appeal to the Colorado Court of Appeals within twenty (20) days of receiving the decision from the panel.
This process can become complicated. You are not required to hire an attorney, however it may be in your best interest to hire one or at least consult with one to determine the best course of action for your case.