Claims Kit

Posting Requirements 3-5

Employers must continuously post a notice to employees in one or more conspicuous places on the employer's work site advising employees that the employer is insured for workers' compensation as required by law, identifying the name of the employer's insurance carrier or stating that the employer is self-insured, and containing information about the Colorado workers' compensation system on a form prescribed or approved by the Division and furnished by the carrier or self-insured.

WC49 - Notice to Employees This poster should be displayed on the workplace premises and provides information, in English and Spanish, on possible workers' compensation entitlements.

Employers also must continuously post a notice to employees in one or more conspicuous places on the employer's work site advising employees that written notice must be given to an employer within 4 working days after an injury as set forth in 8-43-102

WC50 - Notice to Employer of Injury This poster must be displayed on the workplace premises and provides notice to the employee of the requirement to report all work-related injuries to the employer. In addition, notice is provided that benefits may be reduced if the injury results from use of a controlled substance. The poster must be at least 11x14. It may be printed on (2) 8 1/2 x 11 pages and taped together.

Failure to Comply 8-43-304 C.R.S provides that any person who violates any provision of articles 40 to 47 shall be fined not more than $500 dollars per day for each such offense. The fine is determined by the director. Fines imposed are transmitted to the state treasurer, who shall credit 75% to the general fund and 25% to the workers' compensation cash fun

Physician Selection 8-43-404(5)(a)(1)(A)

In Colorado, the employer or insurance company has the right in the first instance to select the physician who attends an injured employee. This becomes the designated medical provider.

When selecting the designated physician it is extremely important to assure that you are furnishing the best medical care possible. Quality and appropriate medical care is important in cost containment and minimizing the effects of an injury to an employee. Be sure to check with your insurance company. They may have established preferred provider networks that can save additional medical expense.

The statute requires with some exceptions, that a list of at least four physicians, corporate medical providers, or a combination of both, where available, be provided by the employer so as to afford the injured employee the opportunity to select a treating physician. At least one of the designated providers must be at a distinct location from the other three and have distinct ownership. (Prior to 4/1/2015 only 2 physicians were required to be on the list)

If no physician is properly designated, the employee may attend the health care provider of his or her choice.

Initial Referral

When an employer has notice of an on the job injury, the employer or insurer must provide the injured worker with a written designated provider list, from which the injured worker may select a physician or corporate medical provider.

1) The designated provider list can initially be provided to the injured worker verbally or through an effective pre-injury designation. If provided verbally or through a pre-injury designation, a written designated provider list must be mailed, hand-delivered or furnished to the injured worker within seven (7) business days following the date the employer has notice of the injury.

2) The designated provider list must state the insurer responsible for the claim, or that the employer is self-insured. In addition, the designated provider list must include the name and contact information of the person, or a maximum of two people, that the employer and/or insurer designate as their representative(s).

If the employer fails to comply, the injured worker may select an authorized treating physician of the worker's choosing.

If an employer has a qualified on-site health care facility, the employer may designate that facility as the authorized treating physician.

One Time Change of Physician

Within 90 days following the date of injury, but before reaching maximum medical improvement, an injured worker may request a one-time change of authorized treating physician. The new physician must be a physician on the designated provider list or provide medical services for a designated corporate medical provider on the list. The medical provider(s) to whom the injured worker may change is determined by the designated provider list given to the injured worker

The injured worker must complete and sign the form established by the division for this purpose, form WC03 - Notice of One-Time Change of Physician.

The insurer must file any objection to the request in writing on a form prescribed by the director within 20 days of the certificate of service of the request form.

If permission is neither granted or refused within 20 days, the insurer is deemed to have waived any objection to the request.

Reporting of Claim by Employer C.R.S. 8-43-103 Rule 5-2 (A)

The law requires an employer to notify the insurance company of an injury within 10 days, no matter how minor the injury. This is done by filing an Employer's First Report of Injury form (WC1). If the employer questions whether an injury is work related, this should be documented and filed with the first report form. Timely filing is critical because the carrier cannot pay compensation benefits or medical bills until it has knowledge of the injury and has the opportunity to evaluate liability.

Failure of the employer to file this report in a timely manner may result in penalties against the employer.

Notice of a fatality or an accident in which three or more employees are injured should be given immediately.

Filing the Employer's First Report of Injury is not necessarily an admission that the employer agrees with the facts of the incident. It is a statement that the employee is making a claim.