This section of our Web site contains answers to employers' frequently asked questions about Pinnacol Assurance and workers' compensation. If you would like to add a question, please click here.

Auditing
Certificates of Insurance
Discounts
First Reports of Injury
Fraud
Group Short Term Disability Insurance
Independent Contractors
Loss Prevention
Other States Coverage
Policy Information
Premiums
Return-to-Work
SelectNet Medical Providers
Workers' Compensation

Auditing
What is a premium audit?
Premium audits are completed at the end of each policy period to determine actual payroll for that period. If your actual payroll differs from your billed estimated payroll, Pinnacol Assurance will credit or debit your policy accordingly. Because all policies are audited, it is essential that policyholders report any change in payroll to us immediately.

What is a FEIN and does my business need one?
All workers' compensation insurance companies are required to report the Federal Employee Identification Number (FEIN) for each of their policyholders to the Division of Workers' Compensation (DOWC). A Social Security number may be substituted for the FEIN. For more information on FEINs, go to the IRS Web site.  

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Certificates of Insurance
Do I get a general certificate of insurance to furnish my clients?
No. Pinnacol Assurance does not issue blank certificates; we can send a certificate to each of your clients. Please call 1-800-873-7242 or 303-361-4000 to request certificates, or you may fax requests to 303-361-5000. If premium payment is overdue, certificates will not be issued. If you work with a Pinnacol Assurance contracted agent, you can contact that agent for certificates.

How do I obtain a certificate of insurance?
If you have Internet access, you can order certificates of insurance through Pinnacol Assurance's online system, Pinnacol Online. You can also call our customer service team (1-800-873-7242 or 303-361-4000) or your agent. Certificates are issued for a one-year policy period. Your premium payment record must be current to receive certificates.

Do I need certificates of workers' compensation insurance from all subcontractors?
Yes. Pinnacol Assurance auditors use these certificates to determine if you have liability for a subcontractor. If you do not have these certificates, Pinnacol Assurance may charge you premium for any payments made to the subcontractor. Subcontractors with no employees may elect not to carry workers' compensation. These subcontractors should complete an independent contractor form, which can be obtained from Pinnacol Assurance's customer service team at 1-800-873-7242 or 303-361-4000.

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Discounts
What discounts do I qualify for?
Pinnacol Assurance offers a variety of discount options that may help you lower your premium costs. Most discounts rely on safety and claims management. To find out which options may work for you, review the Discounts That Work For You brochure or contact your agent or your Pinnacol Assurance underwriter.

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First Reports of Injury
How do I file a first report of injury?
In the event of an injury, contact Pinnacol Assurance immediately via phone, fax, or online. We will need to know some basic information regarding the injury, including:

To complete the filing process, we will need all details of the accident. To report an injury by phone, call 1-800-873-7242 or 303-361-4000. If you file your report by phone, you can expect the call to last seven to 10 minutes.

To file a report of an injury using the Internet, simply go to www.pinnacol.com, click on "Employers," then click on Pinnacol ServiceLink.

After we have a completed a First Report of Injury form, we will send you, the injured worker, and the physician a letter providing the claim number and the name and telephone number of the claims representative handling the case.

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Fraud
What if I suspect an employee of fraud?
Red flags do not mean fraud has occurred, but they may require a closer review of the claim. Immediately report all suspected cases of fraud through Pinnacol Assurance's Fraud Hotline at 1-800-873-1888 or 303-361-4053.

What can I do to reduce the likelihood of fraud at my workplace?
If you suspect fraud, report your suspicions immediately. The sooner Pinnacol Assurance knows of possible fraud, the sooner we can act on it. Keep all suspicions confidential and try to get a written statement from any witnesses. To help prevent the likelihood of fraud, implement these measures:

What if I suspect another business or a medical provider of fraud?
Pinnacol Assurance is committed to eliminating any workers' compensation fraud that may affect our policyholders' premium costs. If you suspect fraud, you can call Pinnacol Assurance's Fraud Hotline at 1-800-873-1888 or 303-361-4053.

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Group Short Term Disability Insurance
Do you offer short term disability coverage?
Pinnacol Assurance's short term disability plan, underwritten by Standard Insurance Company, offers wage replacement benefits for covered non-occupational physical disease, injury, pregnancy, and mental disorder. Contact Cindy Velasquez for more information, or click here to review our informational piece on group short term disability insurance.

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Independent Contractors
Why is my workers' compensation insurance carrier concerned if my business uses independent contractors?
Workers' compensation insurance carriers must determine whether an individual is a true independent contractor or an employee, per the Colorado Workers' Compensation Act (the Act). A business cannot avoid liability merely by referring to its subcontractors or, in some instances, its employees, as independent contractors. The employer has the responsibility to prove that the employment relationship meets the requirements of a true independent contractor, according to the Act. For more details, click here.

How do I determine independent contractor status?
The employer or policyholder has the responsibility to show that the individual performing the work is an independent contractor. Independent contractor status should be determined before the start of the contract or prior to the independent contractor beginning work for the employer or policyholder.

Pinnacol Assurance provides its policyholders with forms to use as written documentation to ensure statutory requirements have been met. To download the Independent Contractor Form, click here.

When should I submit the independent contractor waiver forms to Pinnacol Assurance?
The waiver forms should be completed and submitted to Pinnacol Assurance for each independent contractor once for the lifetime of your workers' compensation insurance policy. Additionally, you should contact Pinnacol Assurance if the relationship changes.

Do I need independent contractor forms from all of my independent contractors?
Subcontractors with no employees may elect not to carry workers' compensation. These subcontractors should complete an independent contractor form, or you may be required to include them in your policy premium as an employee. Independent contractor forms should be completed once for each contractor for the lifetime of the policy, unless a change occurs.

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Loss Prevention
Do I have access to the Loss Prevention CD-ROM online?
Yes, but only through Pinnacol Online. Access to Pinnacol Online requires registration and then the use of your policy number and password. If you don't have a password, click here to download the "Pinnacol Online Registration Form."

How do I find out who my safety consultant is?
Call customer service at 1-800-873-7242 or 303-361-4000 with your policy number to be connected. Or, if you are registered for Pinnacol Online, click on “Loss Prevention Services” in the upper right-hand corner. The name of your safety consultant will be listed, along with a link to his/her phone number and e-mail address.

How do I request loss prevention services?
Ask your agent, contact your underwriter, or contact your safety consultant directly. Call customer service at 1-800-873-7242 or 303-361-4000 if you need any of this contact information.

Is there an additional cost for loss prevention services or materials?
Nearly all of Pinnacol's loss prevention services and materials are free. Contact your safety consultant if you have questions.

How do I sign up for a safety seminar?
Click here to register online or call Rachel Morley at 303- 361-4776.

How do I register for Pinnacol Online?
You must fill out a registration form and fax or send it to Pinnacol Assurance. Click here for the registration form. You'll receive your user ID and password in the mail, along with an information package that includes information about what's available on Pinnacol Online.

Do I have access to claims information in Pinnacol Online?
Yes. Go to the claims tab, click on “Find Claim, ” and enter the claim number. On the next screen, click on the claim number again, then look for the “View Claims Notes” option in the upper left-hand corner of the page. Click on this and you will see the complete chronological history of the activity for this claim.

How do I calculate my OSHA “Injury and Illness Incidence Rate”?
The OSHA Recordkeeping 300 Log brochure includes the formula for calculating your Injury and Illness Incident Rates. You need to have your 300 log completed for the year for which you are calculating your incident rates. Click here for the OSHA form and worksheet.

How can I obtain safety materials?
Pinnacol policyholders have access to free safety resources including training booklets, videos, and posters. You can find all of these resources on our Safety Materials Order Form, which you can complete and submit. You can also contact your safety consultant to obtain safety materials at 1-800-873-7242 or 303-361-4000.

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Other States Coverage
Do you provide workers’ compensation coverage to Colorado policyholders with operations outside of the state?
Pinnacol Assurance partners with Argonaut Insurance Company to offer workers’ compensation coverage to Colorado policyholders with operations outside of the state. This partnership allows you to obtain other states coverage in 45 states while you receive the same superior claims management and customer service you have come to expect. Please contact your agent or your Pinnacol Assurance underwriter if you have questions or would like more information. Click here to review our informational piece on other states coverage.

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Policy Information
How do I make a payment on my premium?
Several payment plan options are available for Pinnacol Assurance's policyholders.
Annual premium is premium based on your organization's estimated payroll for the upcoming policy year. For eligible policyholders, installment plans are available for a $5 per installment fee after the initial billing. You may qualify for monthly and quarterly payroll reports, especially if your business experiences large, seasonal changes in payroll. The payroll reporting option allows you to pay premiums based on your actual payroll for the previous month or quarter. For more information, contact your agent or your Pinnacol Assurance underwriter.

What happens if I make a late payment on my premium?
You are billed for the total estimated annual premium 35 days in advance of your policy renewal date, unless you made prior arrangements for a payment plan. Payment must be received 15 days prior to your current policy's expiration date or your coverage will not be renewed.

How do I make adjustments to my policy? Do I have to contact my underwriter or claims representative each time I need general information?
If you have Internet access, Pinnacol Assurance's online system - Pinnacol Online - allows you to order certificates of insurance, file a first report of injury, monitor the progress of a claim, run claims summary reports, and view billing and policy information 24 hours a day, seven days a week. You can call our customer service team (1-800-873-7242 or 303-361-4000) for these services and for many policy adjustments. You may also call your agent or your Pinnacol Assurance underwriter to report policy adjustments. Please have your policy number ready to expedite the process.

Can I change the billing cycle date for my policy?
Pinnacol Assurance automatically assigns policyholders a billing cycle date, which is the day of the month the policy is scheduled for billing. If this date is not convenient, please contact your underwriter to see if it can be changed to fit your needs.

What if one of my employees is injured outside of the state of Colorado?
If an employee hired for regular employment in Colorado suffers a work-related injury outside the state, he or she is entitled to coverage under the Colorado Workers' Compensation statutes and fee schedules. This coverage applies for up to six months of out-of-state work, unless the employer files advance notice with the Division of Workers' Compensation to extend coverage. Pinnacol Assurance also requires an independent contractor form be completed when appropriate.

When would I need to cancel my policy and how do I do it?
If you sell your business or have a majority change in ownership (50.1 percent or greater), you may need to cancel your policy and have the new owners obtain their own policy. You should also cancel if you do not have any employees and are not going to hire any employees. Pinnacol Assurance requests 30 days written notice to cancel a policy. Cancellation can be effective the day after notification is received in our office. When you cancel your policy you must complete a final audit to determine the final balance on your account.

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Premiums
How is my workers' compensation premium determined?
Premium is the amount you pay to Pinnacol Assurance after all discounts and experience modification factors have been applied to your policy. Rates are the amount assessed to the business classification code that best describes your business. There are approximately 600 industrial classifications and each is assigned a rate, per $100 in payroll, which corresponds to its potential for loss. The combination of the rates for your classification of business and any potential discounts on workers' compensation coverage determines the basic cost of your premium/policy.

Several organizations are involved in setting rates. The National Council on Compensation Insurance (NCCI) receives loss and payroll reports from all Colorado workers' compensation insurance carriers. Since loss reports are a factor in determining rates, the safer a business is, the lower its rates. NCCI then sets rates without profit margin or business expense included. These rates are passed to the Insurance Commissioner for approval. Once approved, Pinnacol Assurance adds the cost of doing business to rates (covering administrative costs such as issuing, recording, and auditing) and then applies the rates to policies.

Rates are based on $100 units of payroll. For example: If you have an $80,000 payroll in the "printing" class code, the manual premium would be calculated as follows:

$80,000 = 800 units of payroll

800 x 2.60 (NCCI's rate)

= $2,080 (manual premium)

Manual premium is premium before any adjustments, such as discounts, experience modification credits or debits, and annual policy fees, are applied.

Can I dispute my class code?
If you have any questions about the class code assigned to your policy, please contact your Pinnacol Assurance underwriter or your agent. Pinnacol Assurance or our representatives must explain why a particular classification code was used for your business. If you disagree with this decision, you can appeal to have your classification code reviewed by Pinnacol Assurance's Classification and Rating Committee. The committee will review your file and will issue a final decision. If you disagree with the committee's review, you can file a written appeal with the Workers' Compensation Industrial Claim Appeals Office within 30 days of the final decision. The address is: Workers' Compensation Industrial Claim Appeals Office, 633 17th St., Suite 600, Denver, CO 80202-3660 (phone 303-318-8131). Please send Pinnacol Assurance a copy of your appeal.

What is minimum premium?
It is the minimum amount of premium necessary to issue coverage based upon the highest rated classification on a policy.

How can I reduce my premium? If I don't have any accidents, will my premium go down?
Claims history impacts discounts that may be applied to your policy. Several discounts are available to Pinnacol Assurance policyholders, depending on premium size, including:

Most of these discounts rely on a company's claims history and dedication to safety. To learn more about discounts, please contact your agent or your Pinnacol Assurance underwriter. Pinnacol Assurance also participates in NCCI's Experience Rating Plan, which rewards businesses with good claims loss histories and penalizes businesses with poor loss histories. To qualify, businesses must have three consecutive full years with a premium of $4,000 or more.

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Return-to-Work
What is modified duty and how does it work?
Modified duty positions are transitional jobs workers perform while they are recovering from a work-related injury. If a modified duty position approved by the treating physician is offered to an injured worker, the worker must accept the job or face losing compensation benefits. If the modified duty position pays less than the worker's regular pay, the difference will be covered by compensation benefits.

Contact a Pinnacol Assurance return-to-work specialist at 1-800-873-7242 or 303-361-4000 to help you develop a plan of action for employees who are faced with workplace injuries.

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SelectNet Medical Providers
What is a designated medical provider and how do I choose one?
You have the right to designate the medical provider your employees will see when injured on the job. Employers who designate a medical provider from Pinnacol Assurance's SelectNet provider network are given a 2.5 percent discount. You may designate a non-SelectNet provider, which may also entitle you to the 2.5 percent discount.

For a complete list of SelectNet providers, access our online SelectNet Directory Search. To designate a SelectNet medical provider, complete a SelectNet Medical Provider Designation Form and mail or fax it to Pinnacol Assurance at 303-361-5945.

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Workers' Compensation
Does my business need a workers' compensation policy?
Colorado law requires any business with one or more employees to carry workers' compensation insurance. Sole proprietors and partners in a business are not considered employees and are not required to be covered on a policy. Corporate officers and members of limited liability companies who are active in the company are considered employees, but they may be eligible to exempt themselves from coverage. They must meet certain statutory conditions to reject coverage. For information on other exemptions, please refer to Pinnacol Assurance's Employer's Guide to Workers' Compensation or contact the Division of Workers' Compensation.

What happens if my business doesn't have a workers' compensation policy?
Employers have sole responsibility to provide insurance for their employees. If unlawfully uninsured at the time of an injury, the employer must pay all statutory medical and disability benefits for the injured employee and an additional 50 percent of all temporary, permanent, and disfigurement benefits for having been uninsured.

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