Colorado Workers’ Compensation Department – Burg Simpson

Workers Comp Frequently Asked Questions

If you’ve been injured on the job, you probably have a lot of questions. Take a look below for some quick answers but please don’t rely solely on this FAQ to determine if you have a case. Fill out a Free Case Evaluation form to speak with us or call directly at 303-792-5595. Our Colorado workers’ comp lawyers are here to help you right now.

1. Not reporting an on-the-job injury (such as a slip-and-fall, or injuries caused by repetitive work) in writing at the time it occurs.

2. Not reporting to the doctor or employer all parts of the body injured, or injuries and symptoms sustained at the time of the accident.

3. Not going to a doctor or physician designated by the employer.

4. Consenting to surgery or treatment without knowledge of the pertinent questions that should be addressed.

5. Not obtaining a second opinion to address the extent of the injuries.

6. Not understanding that it’s improper for an authorized health care provider to charge the employee for medical treatment.

7. Not understanding the different types of workers’ compensation benefits to which they’re entitled.

8. Not fully understanding the workers’ compensation settlement process.

9. Not fully understanding their legal rights and the possibility of filing a personal injury lawsuit against a negligent third-party.

It’s almost impossible for a layperson to ascertain what steps to take in the wake of an injury, or what mistakes to avoid. Our Colorado workmans comp lawyers are here to guide clients through the entire process.

1. Your employer’s insurance company is responsible for paying all authorized, reasonable, necessary, and related medical expenses that result from your injury. These can include, but are not limited to, medical examinations, surgeries, assisted transportation, therapy, nursing care, hospitalization, rehabilitation services, prescriptions, home care, pain clinic care, mileage to and from medical appointments and pharmacies, psychological counseling, MRI and CT scans, X-rays, medical supplies, and medical appliances.

2. If you’re injured at work and you need immediate medical attention, the law allows you to travel to the nearest hospital or emergency facility, regardless of whether the facility is your standard, authorized workers’ compensation provider.

3. Except for cases of true emergency, if you seek treatment from a medical facility or provider who’s not an authorized workers’ compensation provider, you’ll be responsible for the bill.

4. Disputes often occur between you and your employer’s insurance carrier about what’s reasonable, necessary, and related medical care. These disputes can be resolved between the insurance adjuster and your Denver workers compensation attorney. If there’s no resolution, the conflict can be litigated before a judge.

5. If you’re not satisfied with your initial health care provider, it’s possible to negotiate for a different provider, as well as for a second opinion from a doctor or surgeon. It’s very important to discuss this with an attorney within the first 90 days after the date of the injury, if possible.

6. Your authorized primary health care provider has the right to refer you to other authorized medical specialists.

7. Patients have the right to choose whether or not to have surgery. Electing not to have surgery won’t affect your rights to workers’ compensation benefits, and/or a settlement.

8. There are limits regarding how long your medical care can last. In certain circumstances, your right to ongoing medical care can continue after you’ve reached Maximum Medical Improvement and your permanent medical impairment has been determined. Although the insurance carrier has no obligation to pay for medical expenses with the authorized, treating physician before they admit liability, they frequently will.

Witnesses might disagree regarding the circumstances of your injury. Injuries might not be apparent and witness accounts can vary. For these reasons, it’s important to fill out all necessary paperwork, and to include details about all your injuries and symptoms.

Make sure you fully inform your physician and your employer about the extent of your injuries.
For example, a witness might claim that they didn’t see you picking up heavy boxes as you claim, or that you already had a bad back, or that you never complained to anyone of an on-the-job injury. A denial of your claim can be the result of inaccurate or incomplete information, or a lack of understanding of the law by the insurance adjuster. On-the-job injuries also can occur outside the presence of a witness.

Non-witnessed injuries can occur:
1. In an employee-designated parking lot before your shift.
2. In an employee-designated parking lot after your shift.
3. In an employee-designated locker room.
4. In an employee-designated lunch area.
5. While being assaulted by a fellow employee.
6. While running an errand for your employer.
7. In any situation where the employee is working alone or away from other employees.

Therefore, regardless of whether anyone witnessed your accident or injuries, you’re still entitled to workers’ compensation benefits. Unfortunately, many of these unwitnessed accidents are denied initially by the insurance company, so it’s very important to report it as soon as possible, and to give as many details as possible at the time it is reported.

The FPPA disability process can be long and confusing. It helps to have an experienced attorney guiding you through the process.

• If you’re denied or believe that FPPA has made an incorrect decision on your claim, you have the right to request a hearing and a Colorado workers comp attorney will ensure the regulations are applied correctly to your case, and all the evidence is contained in your file.
• In many cases, your employer will pay for the attorney’s fees, so there may be no cost to you.

How do I know if I am eligible under the program?

You must be unable to work for at least a year. Temporary and short-term impairments lasting less than one year are not sufficient.

There are several different types of plans. Look at your plan to see what it requires. Most plans require that you are a full-time employee at the time you became unable to work. In some cases part-time employees are covered, as well.

Most plans don’t require the impairment to have happened while at work. It will still be covered if it happened while off-duty or on an authorized leave of absence. You must have paid into the FPPA Disability program or the FPPA supplemental program rather than only paying into an alternative disability program (such as Social Security Disability or The Colorado Public Employees Retirement Association).

A heart attack due to overexertion, even if the heart attack occurs outside of working hours, can be compensable as a workers’ compensation claim. For example: A firefighter who, during a fire, is pulling water hoses, climbing ladders, running up and down stairs, or performing other such duties that result in overexertion, who then goes home and suffers a heart attack, is covered under workers’ compensation.

While there are others, these are a few examples of events that can be compensable under the Colorado workers’ compensation laws. The employer’s workers’ compensation insurance covers injured employees even if they are at fault for the injury. If a known safety rule has been willfully violated there can be a 50 percent reduction in benefits, but this violation must be proven at a hearing.

Temporary Disability includes both Temporary Total Disability and Temporary Partial Disability payments. Temporary Disability benefits are lost wages paid until you have reached Maximum Medical Improvement from your injuries or illnesses. TTD payments commence after you’re away from work for three calendar days or three shifts. You’ll receive TTD payments if your primary care physician states, in writing, that you’re unable to work, or imposes work restrictions with which your employer cannot comply, such as light duty or modified work within those restrictions.

You receive TPD payments when you’re released to light duty by your primary health care provider, and your employer provides work that’s available within your restrictions, but you’re still earning less than your gross wages at the time of your injury. If light duty work isn’t available, you continue to receive TTD. Any and all temporary disability payments end when you reach MMI or you return to work full time, even when your permanent restrictions preclude you from performing your job.

MMI is determined when your primary health care provider finds that the medical condition caused by your injury is stable and further medical care is not necessary.

In Colorado, TTD is two-thirds of your gross average weekly wage. A fair gross wage can be averaged by including past wages over a reasonable period of time. A pay raise, which was anticipated to occur just before your accident, can be considered as a component in raising your average weekly wage. Your average weekly wage can include overtime and bonuses. Your average weekly wage can also include the value of employer paid health insurance benefits. The Colorado Supreme Court recently ruled that workers who lose their employer paid health insurance benefits are entitled to claim the cost of continuing health insurance when computing their average weekly calculation. This is true even if the worker does not actually purchase the insurance after his or her health insurance is terminated.

Sick and vacation benefits paid by your employer while you’re receiving temporary benefits can be added to your Temporary Disability payments but cannot be used to substitute for your Temporary Disability benefits. Your gross average weekly wage is very important in determining the value of your temporary and permanent disability payments. In addition to your modified duty pay, you also receive TPD benefits, which is two-thirds of the difference between your regular gross wages and your modified duty gross wages. If you’re working two jobs (concurrent employment) and you’re injured and cannot work either job, you will receive Temporary Disability based on the gross wages of both jobs.

Example for TTD Per Week
Gross average weekly wage: $600
Employers Portion of Health insurance: $100
Overtime: $100
Concurrent employment: $100
Total gross average weekly wage: $900
TTD ($900 x 2/3): $600
Payable every two weeks: $1,200
Add accrued sick leave payable every two weeks: $100
Add accrued Vacation pay payable every two weeks: $100
TOTAL paid every two weeks: $1,400

You’re paid every two weeks for the days your health care provider states you cannot work.

Example for TPD Per Week
Gross average weekly wage: $600
Light duty job wages: $300
Less light duty wages: ($600-$300) $300
TPD ($300 x 2/3): $200
Total TPD ($200 + $300): $500
TOTAL paid every two weeks: $1,000

TTD and TPD payments are limited by law at a fixed maximum amount that changes yearly on July 1. TTD and TPD benefits aren’t typically taxable, but you should check with your accountant. Employers are allowed to pay your full salary instead of Temporary Disability payments.

There are two types of disability benefits: Temporary Total Disability (TTD) and Temporary Partial Disability (TPD). Payment of both categories of disabilities cease when:

1. You return to full time regular or modified work.
2. You’re given a written release to return to regular work by your authorized treating health care provider.
3. You begin modified work.
4. Your authorized health care provider releases you to work with restrictions, and you elect not to report to work.
5. You resign or are terminated.
6. Your authorized treating health care provider determines that you have reached Maximum Medical Improvement.

If your employer’s workers’ compensation insurance company discontinues the payment of TTD, you may be without any source of income unless it is determined that you are entitled to compensation for your permanent impairment or disability. It is important to make sure you accept light duty assignments because failure to do so can result in a loss of Temporary Disability benefits.

Can my workers’ compensation benefits be reduced?

Yes. Your benefits can be reduced if any of the following occur:

1. You willfully fail to use a safety device.
2. You willfully fail to obey a reasonable safety rule.
3. At the time of your employment, you willfully mislead your employer about your physical ability to do the job.
4. Your injury resulted from the use of drugs or alcohol.
5. You owe unpaid or delinquent child support.
6. You return to full or part-time work, and you are eligible to receive TPD.
7. You and/or your dependents receive social security disability benefits.
8. You receive a pension or other disability benefit that is funded by your employer, in which case the reduction is only the percentage of your employer’s contribution to your pension.
9. You receive workers’ compensation benefits for the same injury from another state.
10. You receive unemployment insurance benefits.

When you reach a point where additional medical care isn’t necessary to improve your condition, your health care provider will place you at Maximum Medical Improvement. At that time, your health care provider will determine the percentage, if any, of compensable medical impairment caused by your injury. This rating is based on guidelines issued from the American Medical Association. Health care providers use these guidelines to determine the rating of your medical impairment. The percentage of impairment has monetary value.

When you reach MMI and are provided with a Permanent Disability Rating, your temporary benefits will end. If the injured person disagrees with the health care provider’s impairment rating on the date of MMI, the claim can be contested through a Division Independent Medical Examination. This is another opportunity for a health care provider to re-evaluate your medical condition.

While there are others, here are a few examples of events that can be compensable under the Colorado workers’ compensation laws:

1. An injury, condition, or death that occurs at work and that is caused by the work environment.
2. A mental and/or physical injury or death caused by the intentional or unintentional conduct of a co-employee.
3. Injury caused by a person who is not a co-employee and whose conduct is negligent, reckless or intentional.
4. Negligence is not a necessary component to obtaining worker’s compensation. If the accident or injury happened at work, workers’ compensation is available in most cases.
5. Repetitive motion injuries.
6. Injuries to the lungs or other organs of the body as a result of factors in the work environment are compensable as a workers’ compensation claim.
7. An aggravation of a pre-existing medical condition due to the work environment can be found to be compensable as a workers’ compensation claim.
8. A heart attack due to overexertion, even if the heart attack occurs outside of working hours, can be compensable as a workers’ compensation claim.

It’s advisable to consult with our Colorado workers comp lawyers before a health care provider schedules you for an evaluation. It’s also important to note that the results of a Functional Capacity Evaluation could adversely affect your chances of future employment.

An FCE consists of a series of physical tests and activities used to determine your permanent physical restrictions. The FCE can last from one to six hours. Workers’ compensation laws don’t require that you submit to an FCE; however, the employer might require the evaluation as a condition of your continuing employment at the time you’re released from medical care or reach MMI.

You will receive a written notice entitled “General Admission of Liability” that provides written proof that you were injured on the job.

A general admission allows you to receive all workers’ compensation benefits, including authorized medical benefits and temporary disability payments. This general admission doesn’t automatically mean you’ll receive the correct temporary disability payments or the appropriate medical care. Denver work comp lawyers should review the General Admission of Liability to ascertain whether all your entitled benefits are included and have been calculated correctly. If your injury results from a safety violation, or your use of alcohol or a controlled substance, your workers’ compensation benefits may be reduced by up to one-half, but the insurance company can be forced to prove the violation in order to take the reduction.

If your employer’s insurance company denies your claim, they will issue a Notice of Contest within 20 days from the time they received notification of the injury. Sometimes insurance companies will still cover medical expenses so that they’ll be able to choose the health care provider who’ll treat you. You can request a hearing to dispute a Notice of Contest, but the hearing might not be scheduled for up to 100 days after the injury. At this point it is advantageous to utilize our Colorado work comp lawyers, as the hearing process can be difficult and complicated, and may incorporate medical and wage investigations from the insurance company.

A judge from the Office of Administrative Courts will preside over your hearing. You’ll need to provide specific information regarding your employment and medical history, since these are the focus of the insurance company’s investigation. Sometimes an employer will offer you a different work schedule and duties while you’re temporarily disabled. You must accept this arrangement to receive benefits. If you’re terminated for something unrelated to the injury, you’ll lose benefits. It’s important not to give your employer any reason to terminate you during this process.

Example: A truck driver, while working, is injured by a non-employee who drives through a red light and causes an accident that injures the truck driver. The truck driver can be entitled to workers’ compensation and could also have a personal injury claim against the at-fault non-employee.

Example: A secretary whose wrists are injured from typing all day.

Example: If a shop floor worker is injured by industrial machinery, it might be possible to prove the machine was defective, which would allow you to bring a claim against the supplier or contractor who supplied/installed/maintained the equipment.

Example: If an office worker is travelling to a client meeting and is involved in a car accident caused by a negligent driver, it could be possible to bring a claim against the insurance policy of that negligent driver.

Example: If a construction worker employed by company A is run over by a cement truck operated by a subcontractor employed by company B, it may be possible to bring a lawsuit against company B.

Example: A firefighter who, during a fire, is pulling water hoses, climbing ladders, running up and down stairs, or performing other such duties that result in overexertion, who then goes home and suffers a heart attack, is covered under workers’ compensation laws.

Under Colorado law, injured workers cannot sue their employers for injuries sustained at work. You would have to claim against a workers’ compensation insurance policy.

You should report your injury immediately, even if you aren’t sure about the seriousness of it. Also, be sure to keep a hard copy of your notification in case there are any problems during the claims process. For more on reporting workplace injuries read the post, “Should I Report My Work Related Injury?”

If you want to know about the first steps you should take after being injured, read “Decoding Work Comp: First Steps for a Work Injury”.

The most important thing to look for is a firm that has Colorado workers’ compensation attorneys with a track record of winning big cases in the courtroom. Not all cases go to court; however, if yours does, you want to make sure you have a top-notch trial team on your side.

Call us immediately at 303-792-5595. We have a full-time staff of workers’ compensation lawyers that are ready to answer your questions and get you the advice you need.

There are so many factors to consider when determining the worth of a case. The best way to get some answers about your specific case is to call us at 303-792-5595 and speak to an experienced Colorado work comp attorney.

If we think you have a strong case and we want to help you through it, you don’t pay us anything up front. We don’t take a dime of your money until we collect every cent the law and your situation allow.

If you’re too injured to come to the office, our workers’ compensation attorneys are still able to accommodate your legal needs by conducting phone conferences or meeting you at another location (for example a hospital where you are being treated).

Facebook, Twitter, LinkedIn and other social networks can be pertinent to workers’ compensation claims because they provide information that can be accessed by attorneys, investigators, and other parties to produce evidence that could potentially be used to weaken your case. For an injured person, information unfavorable to your case can be found in photos, status updates, or other material posted on these sites.

Even benign posts can be taken out of context and used to discredit you or your claims. If you cringe when you look at a photo or post, you can be sure the insurance adjuster and judge will, too. Consider everything you write or post on the Internet to be permanent and discoverable information.

If you’ve been hurt on the job, don’t make the mistake of trying to handle the claim yourself. Contact the Colorado workers’ compensation attorneys at Burg Simpson today by calling 303-792-5595 or fill out our FREE CASE EVALUATION FORM right now to find out how we can help.

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