|Report Injuries Immediately|
|In Person||Pinnacol Assurance
8 a.m. to 5 p.m., Monday through Friday
|Online||Report an Injury Online|
|By Phone||Customer Service: 303.361.4000
Toll Free: 800.873.7242
|By Fax||First Report of Injury Fax: 303.361.5000
Toll Free: 888.329.2251
In almost all cases, reporting an injury immediately, and actively managing the claim, saves your business money. It also helps injured employees recover and return to work faster.
- If your employee's injury is life- or limb-threatening, go to the nearest hospital emergency room. Get him or her stabilized — that’s top priority.
- In all other cases, give the employee your list of designated medical providers before he or she seeks medical attention. This “Letter to Injured Worker” should list your two designated medical providers (four designated medical provider after 4/1/2015) so he or she can select a treating provider from your list. It is best to document that you have /provided the injured worker with this information. (Whenever possible, we recommend having your employee sign and date the letter. Give the employee one signed copy and keep one signed copy for your records.) If the employee is initially taken to an emergency room, the designated provider will step in afterward to manage all related follow-up care. Note: As of April 1, 2015, employers must designate four medical providers, based on legislation passed in Colorado in 2014.
- After the employee has received treatment, report the claim to Pinnacol immediately. Prompt reporting has been proven to reduce claims costs substantially and facilitate the entire claims process.
You can report the claim to us online, by phone (303.361.4000 or 800.873.7242); or by fax (303.361.5000 or 888.329.2251). We will need your policy number as well as some basic information regarding the injury, including the injured worker’s name, Social Security number, home address, occupation, and date of injury. If you report the injury online, you will be able to flag the claim if you believe a third party is at fault for the accident.
After we receive a first report of injury, we will send you, the injured worker, and the physician a claim number, as well as the name and telephone number of the claims representative handling your case.
- Document the injury for your records (no matter how small) and try to determine the cause.
- Maintain contact with all parties involved in the claim:
- Injured employee — Call to say hello and send a card. Talk regularly about his or her medical treatments, progress, and benefit questions.
- Treating physician — Let the doctor know what your employee’s regular job entails and the modified-duty tasks you have available. Make sure the doctor’s office sends you a work status report after each appointment.
- Pinnacol claims representative — Let your claims representative know immediately if:
- Your employee requests a change of medical provider, has any change in work status, or has questions that you can’t answer.
- You receive new information about your employee’s injury, or have questions about the employee’s medical treatment or work restrictions.
- Pinnacol nurse case manager — If a nurse case manager is assigned to your claim, he or she will coordinate your injured worker’s medical treatments. Call him or her anytime to better understand your employee’s care and progress.
Getting Employees Back to Work
Studies show that the longer an employee is off work, the lower his or her chances of returning. We can help you put a program in place to get your employees back to work quickly and safely.
Our free resources include:
Knowledgeable Experts: Call our return-to-work specialists at 303.361.4000 or 800.873.7242. They can provide you with free advice, including:
- Guidelines for writing a step-by-step return-to-work policy
- Lists of modified duty tasks for 43 industries in Colorado (For other industries, our return-to-work specialists can visit your workplace to help identify appropriate tasks.)
- Assistance in formally offering modified duty to injured employees
- Injured on the Job: Critical information for employees.
- Getting Back to Work: How employees can regain financial security during recovery.
- Online Return-to-Work Resources— This easy-to-navigate site is packed with clear, step-by-step instructions for creating a return-to-work policy for your company. If you're a policyholder, you can access the site now.
To protect our policyholders, Pinnacol will take an aggressive approach, when necessary, to resolve claims through legal means. Our legal team — working closely with our claims representatives — assesses when litigation may be necessary. These may include situations where:
- The claim is questionable — Facts of the claim are in dispute, regarding whether the worker was truly injured or if the accident occurred on the job.
- The claim falls into a gray area legally or medically —The law may not be clear regarding wage loss, the worker’s physical impairment, or medical benefits.
We also recognize that litigation can drive up claims costs, not only in legal fees but in increased medical expenses. When a successful legal outcome is uncertain — and could cause unnecessary expense — Pinnacol will actively negotiate resolutions outside of court.
On your behalf, Pinnacol works hard to combat workers' compensation fraud.
Subrogation means "to substitute." In workers' compensation, subrogation occurs when a third party — someone other than the injured worker or employer — is responsible for the injury. In these cases, Pinnacol can legally substitute itself for the injured worker to recover claims costs from the third party.
Some common examples of subrogation include:
- On-the-job automobile accidents — If a third party (the other driver) causes the accident, we can use subrogation to attempt to recover benefits costs from that driver and/or the driver’s insurance company.
- Equipment malfunction — Subrogation can be used to recover claims costs from an equipment manufacturer if a faulty piece of equipment causes an injury.
If one of your employees is injured and a third party may be responsible, document everything you can. Take pictures of the accident scene as soon as possible. Also, preserve any evidence, such as a broken piece of equipment. And as with any injury, contact Pinnacol immediately.
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