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Medical and Lost Wage Benefits

If you have been injured, here's what to expect:

If you miss three or fewer days (or shifts) at work:

• Pinnacol will mail your claim number to your home just a couple of days after your employer notifies us of your injury. We'll also include information about your benefits and a direct phone number for the Pinnacol claims representative who's been assigned to your case.
• You won't need to hassle with paperwork as long as you continue seeing one of your employer's designated medical providers for follow-up care related to your injury. He or she will automatically send bills and appropriate information to Pinnacol, and we'll take care of the rest. If you happen to receive bills directly from your provider, please let us know right away.

Fortunately, most employees who suffer workplace injuries are able to return to work within three days.

If you miss more than three days (or shifts) at work, in addition to the steps above:

• Pinnacol has 20 days to accept or deny your claim. Most claims are fairly straightforward and accepted promptly. Other claims may need further review or may not be covered under the Colorado Workers' Compensation Act. If your claim is denied, you or your health insurer would become responsible for your medical bills. If you feel a claim has been incorrectly denied, please call your Pinnacol claims representative.
• If accepted, Pinnacol will begin paying for all reasonable, necessary, and related medical expenses prescribed by your employer's designated medical provider. These expenses may include surgery, dental repair, nursing care, hospital charges, home health care, physical therapy, chiropractic care, prescriptions, medical supplies, and travel to and from medical appointments.
• Pinnacol may also begin paying two-thirds of your lost wages. Lost-wage benefits are non-taxable and paid every two weeks. You will continue to receive compensation until:
  • You're released by your doctor to go back to regular employment
  • Your doctor feels you’ve reached maximum medical improvement, the point at which no further treatment is expected to improve your condition
  • Your employer offers you a temporary job with modified duties that you're capable of performing
• A Pinnacol nurse case manager or claims representative will call you, your physician, and your employer to ensure you're receiving appropriate medical care. He or she will maintain contact with you throughout your recovery.
• We encourage you to call your employer, or your Pinnacol nurse case manager or claims representative, with questions or concerns at any time throughout your recovery.