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. Call us at 303-792-5595. Our professionals are here to help.
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 his/her 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 his or her injuries.
6. Not understanding that it is improper for an authorized health care provider to charge the worker for medical treatment.
7. Not understanding the different types of workers’ compensation benefits to which they are entitled.
8. Not fully understanding the workers’ compensation settlement process.
9. Not fully understanding his or her legal rights and the possibility of filing a personal injury lawsuit against a negligent third-party.
It is almost impossible for a layperson to ascertain what steps to take in the wake of an injury, or what mistakes to avoid. The attorneys at Burg Simpson guide clients through the whole process.
1. Your employer’s insurance company is responsible to pay all authorized, reasonable, necessary, and related medical expenses that result from your injury. These may include, but are not limited to, medical examinations, surgery, 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 are 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 is not an authorized workers’ compensation provider, you will be responsible for the bill.
4. Disputes often occur between you and your employer’s insurance carrier about what is reasonable, necessary, and related medical care. These disputes may be resolved between the insurance adjuster and your attorney. If there is no resolution, the conflict can be litigated before a judge.
5. If you are not satisfied with your initial health care provider, it is possible to negotiate for a different provider, as well as for a second opinion from a doctor or surgeon. It is 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 will not affect your rights to workers’ compensation benefits, and/or a settlement.
8. There are limits regarding how long your medical care can continue. In certain circumstances, your right to ongoing medical care can continue after you have 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 may disagree regarding the circumstances of your injury. Injuries may not be apparent and witness accounts may vary. For these reasons, it is important to fill out all necessary paperwork, and to include all 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 may claim you were not seen 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 a result of inaccurate or incomplete information, or a lack of understanding of the law by the insurance adjuster. On-the-job injuries may also occur outside the presence of a witness.
Non-witnessed injuries can occur:
1. In an employee-designated parking lot prior to the beginning of your shift;
2. In an employee-designated parking lot after your work shift has ended;
3. In an employee-designated locker room;
4. In an employee-designated lunch area;
5. By being assaulted by a fellow employee;
6. While running an errand for the benefit of your employer; or
7. In any situation where the employee is working alone or out-of-sight of other employees.
Therefore, regardless of whether your accident or injuries were witnessed by others or not, you are still entitled to workers’ compensation benefits. Unfortunately many of these unwitnessed accidents are denied initially by the insurance company, so it is 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 are denied or believe that FPPA has made an incorrect decision on your claim, you have the right to request a hearing and an attorney will ensure that the regulations are correctly applied 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 also covered.
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 (like Social Security Disability or The Colorado Public Employees Retirement Association).
1. 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 fire fighter 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% reduction in benefits, but this violation must be proven at a hearing.
Temporary Disability includes both Temporary Total Disability (TTD) and Temporary Partial Disability (TPD) payments. Temporary Disability benefits are lost wages that are paid until you have reached Maximum Medical Improvement (MMI) from all of your injuries or illnesses sustained through your work related accident or work environment. Temporary Total Disability (TTD) payments commence after you are off work
for three calendar days or three shifts. You will receive Temporary Total Disability (TTD) payments if your primary care physician states, in writing, that you are unable to work, or imposes work restriction with which your employer cannot comply, such as light duty or modified work within those restrictions.
You receive Temporary Partial Disability (TPD) payments when you are released to light duty by your primary health care provider, and your employer provides work that is available within your restrictions, but you are still earning less than your gross wages at the time of your injury. If light duty work is not available, you continue to receive TTD. Temporary Disability payments end (including both TTD and TPD) when you reach MMI or you return to work full time, even when your permanent restrictions preclude you from performing your job.
Maximum Medical Improvement (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.
Temporary Total Disability 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 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 to you by your employer while you are 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 Temporary Partial
Disability (TPD) benefits, which is two-thirds of the difference between your regular gross wages and your modified duty gross wages. If you are working two jobs (concurrent employment) and you are injured and
cannot work either job, you will receive Temporary Disability based on the gross wages of both jobs.
Example for Total Temporary Disability (TTD) Per Week
Gross average weekly wage $600.00
Employers Portion of Health insurance $100.00
Concurrent employment $100.00
Total gross average weekly wage $900.00
TTD ($900 x 2/3) $600.00
Payable every two weeks $1,200.00
Add accrued sick leave payable every two weeks $100.00
Add accrued Vacation pay payable every two weeks $100.00
TOTAL paid every two weeks $1,400.00
You are paid every two weeks for the days your health care provider states that you cannot work.
Example for Total Partial Disability (TPD) Per Week
Gross average weekly wage $600.00
Light duty job wages $300.00
Less light duty wages ($600-$300) $300.00
TPD ($300 x 2/3) $200.00
Total TPD ($200.00 + $300.00) $500.00
TOTAL paid every two weeks $1,000.00
TTD and TPD payments are limited by law at a fixed maximum amount that changes yearly on July 1. TTD and TPD benefits are not 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 are given a written release to return to regular work by your
authorized treating health care provider;
3. You begin modified work;
4. Your authorized treating health care provider releases you to work with
restrictions, and you elect not to report to work;
5. You resign or are terminated; or
6. Your authorized treating health care provider determines that you have
reached Maximum Medical Improvement (MMI).
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
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;
1. You and/or your dependents receive social security disability benefits;
2. 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;
3. You receive workers’ compensation benefits for the same injury from
another state; or
4. You receive Unemployment Insurance benefits.
1. When you reach a point where additional medical care is not necessary to improve your condition, your health care provider will place you at Maximum Medical Improvement (MMI). 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 utilize these guidelines to determine the rating of your medical impairment. The percentage of impairment
has monetary value.
2. When you reach MMI and are provided with a Permanent Disability Rating, your temporary benefits will end.
3. If the injured person disagrees with the health care provider’s impairment rating on the date of Maximum Medical Improvement, the claim can be contested through a Division Independent Medical Examination (DIME). 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.
Workers’ Compensation Injury:
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 is advisable to consult with an attorney before a health care provider schedules you for an evaluation. It is important to note that the results of an FCE could adversely affect your chances of future employment.
1. A Functional Capacity Evaluation (FCE) consists of a series of physical tests and activities used to determine your permanent physical restrictions.
2. The FCE can last from one to six hours.
3. Workers’ compensation laws do not require that you submit to an FCE; however, the employer may require the evaluation as a condition of your continuing employment at the time you are 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.
1. A General Admission allows you to receive all workers’ compensation benefits, including authorized medical benefits and temporary disability payments.
2. A General Admission does not automatically mean you will receive the correct temporary disability payments or the appropriate medical care. Your attorney should review the General Admission of Liability to
ascertain whether all your entitled benefits are included and have been calculated correctly.
3. 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 after they have been notified of the injury. Sometimes insurance companies will still cover medical expenses so that they will be able to choose the health care provider who will treat you. You can request a hearing to dispute a Notice of Contest, but the hearing may not be scheduled for up to 100 days after the injury. At this point it is advantageous to utilize an attorney, as the hearing process can be difficult and complicated, and may incorporate medical and wage investigations from the insurance company.
A hearing will be presided over by a judge from the Office of Administrative Courts. You will 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 during the period when you are temporarily disabled. You must accept this arrangement in order to receive benefits. If you are terminated for something unrelated to the injury, you will lose benefits. It is 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 may also have a personal injury claim against the at-fault non-employee.
Example: A secretary whose wrists are injured by typing all day.
Example: If a shop floor worker is injured by industrial machinery, it may be possible to prove that the machine was defective and possible 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 may 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 fire fighter 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 attorneys who specialize in workers’ compensation in Colorado and have 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 that’s 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 workers’ compensation 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 that the law and your situation allow.
If you are too injured to come to the office, our 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 may be found in photos, status updates, or other material posted on these sites.
Even benign posts can be taken out of context and utilized 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 that you write or post on the Internet to be permanent and discoverable information.