July 29, 2024 | CSD Team

Navigate the claims and benefits process with information from DOWC’s Employer Guide.

Workers’ compensation insurance pays for all medical expenses that are reasonable, necessary, and related to the workplace injury if the care is received from an authorized treating physician (ATP). Other expenses like reasonable and necessary supplies, prescriptions, and mileage for medical appointments are also covered. If an injured worker gives you a medical bill or statement, contact your claims adjuster.

Compensation Benefits

Lost wage benefits are not due until the injured worker has missed three shifts from work. This “waiting period” will be compensated if the injured worker misses more than 14 calendar days from the date they left work as a result of their injury.

Temporary Total Disability (TTD)

TTD is due if the injured worker is taken completely off of work or if you cannot accommodate assigned restrictions. If the injured worker is having difficulty performing their duties, they should contact their ATP immediately. The worker cannot take themselves off of work. If they stop working without their ATP’s approval, the injured worker may not be entitled to lost wage benefits until they are evaluated by the ATP again.

Temporary Partial Disability (TPD)

TPD is paid when the injured worker returns to work but is earning less than their pre-injury wages due to reduced hours and/or wages. The injured worker may also be entitled to intermittent TPD in order to attend medical appointments.

Permanent Disability Benefits

Permanent Partial Disability (PPD)

Once an injured worker reaches Maximum Medical Improvement, the point at which reasonable and necessary medical treatment will no longer improve the injured worker’s condition, the ATP will determine if they sustained any permanent physical impairment due to their injury. This is known as the impairment rating. If the injured worker sustained a permanent physical impairment due to their injury, they would receive PPD benefits.

Permanent Total Disability (PTD)

If the injured worker is unable to earn wages for the rest of their life following the injury, they are entitled to lifetime payment of benefits.

Disfigurement

The injured worker may be entitled to a disfigurement award if their injury results in permanent disfigurement, such as scarring on any part of their body or face that is visible to the public.

A permanent limp as a result of an injury could also be considered disfigurement.

Fatality

If someone dies because of an injury that occurred on the job and the claim is found compensable, workers’ compensation provides benefits to their spouse, minor children, and other known dependents and reimbursement for at least some funeral costs, up to a maximum adjusted annually by the Director of the DOWC.

When a fatality occurs, you must report the fatality within 24 hours to your insurance carrier and the Division of Workers’ Compensation’s Customer Service Unit at 303-318-8700. If it is unclear what caused the employee’s injury or death, report it to your carrier and allow them to investigate. By not reporting the claim because you think the cause is not work-related, it could result in delaying the investigation and any benefits that may be due to the dependents of the deceased.

You are also encouraged to do the following when a fatality occurs:

Reach out to the deceased employee’s family and provide them with carrier information, the Division’s phone number, and the claim number if available.

Instruct the family of the deceased to reach out to the carrier to discuss any benefits they may be entitled to.

Inform the family that they will receive paperwork from the carrier as well as the Division and that it is important to return any requests for information as soon as possible to expedite the process.

To alleviate unnecessary additional stress, inform the family that the carrier’s investigation process is standard procedure.

Reduction or Termination of Benefits

In Colorado, workers’ compensation is a “no-fault” system. This means that regardless of who is at fault for the injury, an employer has to pay benefits. However, an injured worker’s benefits may be reduced or terminated based on the reasons listed below.

Communications With the Injured Worker

Injuries at the workplace are difficult and stressful. When workers suffer an injury, they are concerned about their future and their ability to return to work. Uncertainty can hinder their recovery. The longer an injured worker is out of work, the more difficult it is to return to work, both physically and psychologically. You are encouraged to maintain communication with the injured worker throughout their recovery.

For more information about the CSD Pool’s Workers’ Compensation program, visit our website csdpool.org/wc or check out our other Workers’ Compensation articles.