Admission of Liability: There Are No Do-Overs in Workers’ Comp
Once you file a workers’ compensation claim in Colorado, you might assume that no further action is required on your part. Unfortunately, filing the claim is just the start of the process.
Workers’ compensation claims have been a classic case of “good news, bad news” for several years now. The U.S. Bureau of Labor Statistics reports that the number of nonfatal workplace injuries and illnesses recorded by private employers has been falling, which in turn results in fewer workers’ comp claims. However, the medical costs per claim continues to rise.
In short, although workers are not getting hurt on the job as much, it is more expensive than ever for employers when they do. Given the cost, it should come as no surprise that employers and their insurers will closely scrutinize claims for workers’ comp benefits. They may be less likely to pay the full value of the employee’s claim.
Like most states, Colorado has implemented a no-fault workers’ compensation system. When an employee gets hurt, benefits are paid regardless of who or what may have caused the accident. Even in a no-fault system, though, the question of liability is still crucial. If a workers’ comp insurer rejects liability, the worker would be forced to pay medical expenses out of their own pocket.
It is crucial to understand what an admission of liability is and what it means for your situation. Burg Simpson can help you file a workers’ compensation claim in Colorado and ensure you get the benefits you deserve. Call 303-792-5595 today for a FREE and confidential case evaluation.
Filing a Workers’ Compensation Claim in Colorado
Workers need to notify their employer of a work-related injury within 10 days. Once the injury is reported to the employer, the following should take place:
- The employer reports the injury to its workers’ comp insurance carrier within 10 days of the injury being reported.
- If the worker’s injury “results in more than three days/shifts of lost time, permanent impairment, or death,” the carrier has 10 days to file a First Report of Injury with the Colorado Division of Workers’ Compensation (DOWC).
- The carrier then has up to 20 days to accept or reject liability.
Injured workers also have the option to submit a Worker’s Claim for Compensation to the DOWC on their own. Your employer’s insurance company will be notified of the claim and have up to 20 days to admit or deny liability.
What Is Liability in a Workers’ Compensation Claim?
Liability is a legal obligation of responsibility. In workers’ comp claims, liability refers to a party’s obligation to cover the expenses of an employee who has been injured on the job.
Accepting liability is not the same as admitting fault for the worker’s injury. Because workers’ compensation in Colorado operates on a no-fault basis, questions of fault do not generally apply. Instead, an admission is simply a formal acceptance that an injury is work-related and therefore compensable (i.e., the worker is entitled to benefits).
What Is a General Admission of Liability?
The General Admission of Liability is a formal legal document. Completed by the workers’ compensation insurer, it states that the carrier “admits that the injury or occupational disease reported herein is compensable” (see WC2 General Admission of Liability). In other words, the General Admission of Liability serves as notice that you are entitled to workers’ compensation benefits.
For injured workers, one of the most important sections of the General Admission of Liability is the benefits for which the insurer is accepting liability. The form will specify what benefits will be paid, the weekly rate, and the time period for the following:
- Medical benefits
- Temporary partial disability benefits
- Temporary total disability benefits
- Rehabilitation maintenance benefits
- Disfigurement benefits
- Permanent partial disability benefits
The General Admission of Liability also includes a section where your average weekly wage is calculated. It is important to review this section carefully to make sure that your income prior to the work injury is calculated accurately.
What Is the Final Admission of Liability?
Insurers send the Final Admission of Liability when they are ready to close a workers’ compensation claim. It includes a summary of benefits, including the amount admitted for permanent total disability (if applicable).
Should you decide to accept the carrier’s Final Admission of Liability, you will not have the option to seek additional benefits at a later date. It is crucial to review the Final Admission of Liability carefully before determining whether your file should be closed.
Workers’ Comp Medical Payments Are Not Admissions
In the 20 days the insurance carrier has to accept liability, the carrier might cover all or some of an employee’s medical bills. This act of perceived generosity, or even responsibility, leads a lot of injured workers to believe their claim is progressing through the system because it looks like the carrier has admitted liability. If the employee has not missed that much work, it makes that misguided assumption that much more reasonable. But nothing could be further from the truth.
Unfortunately, that apparent act of kindness does not mean a thing to the Colorado legal system. In fact, there is an ulterior motive behind this responsiveness. Insurance companies would much rather dictate your choice of medical professionals. Obviously, they want to work alongside physicians or medical groups they have established relationships with and who are as familiar with the system as they are. These relationships, while perfectly legal and acceptable, only serve to put an uninformed employee further behind in the process.
It is also critical to keep in mind that once an employee returns to work, the carrier can deflect blame from any future absences from the original injury in a bid to absolve themselves from further liability. Employees need to look past their pride if they think they need more time to recover. Injured workers need to speak openly with their primary care provider and heed any professional medical advice.
Admissions Are Not Settlements
When an employee does receive a Final Admission of Liability form, they often mistake it for a case settlement. That is wrong. It is an acknowledgment of responsibility, but it often includes a lower than possible financial offer in the interest of settling the claim quickly.
Not only is it critical that injured employees retain legal counsel to help object to this initial offer, but it is also vital that it is done in a timely manner. Employees with work comp claims have a 30-day window to push back on this admission of liability before the case closes. Once that door is shut, it is incredibly difficult to reopen. Remember, there are rarely do-overs in workers’ compensation cases.
Get the Help You Need to File a Workers’ Compensation Claim in Colorado
The Colorado workers’ compensation system is governed by complex rules and strict deadlines. Every workers’ compensation claim is different, but every one of them is a race against time.
You will not get a do-over if you make a mistake. A workers’ compensation lawyer at Burg Simpson can help you protect your rights and maximize your benefits.
Our attorneys have substantial experience with the workers’ comp system. We know the tricks insurance carriers use to try to influence your medical care and get you back to work sooner—sometimes against your interest. Furthermore, we carefully review admissions of liability to ensure that you are being fairly compensated for all of your losses from a workplace injury.
For a FREE and confidential case evaluation, contact Burg Simpson today. In addition to helping injured employees file a workers’ compensation claim in Colorado, we advocate for claimants every step of the way and provide assistance with disputes.