It is important that you immediately report ALL work-related injuries to your employer. Although the law requires you to report injuries to your employer in writing within four days from the occurrence of the injury, you should report injuries no matter when they occur. However, the sooner you report your injury, the sooner you will receive the medical management and benefits you are entitled to by law.

In some cases, injuries do not appear immediately. You should file a claim as soon as you know you are injured. If you are still employed by the company where the incident occurred, ask your employer to file a first report of injury. If not, file your claim by contacting the Division of Workers' Compensation at 303-318-8700.

Click on the following links for more information on work-related injuries. If you need further assistance, please contact your Pinnacol Assurance claims representative.

Designated Medical Provider
Defining "Injuries"
Non-Lost Time vs. Lost Time
Claims Process: Non-Lost Time
Claims Process: Lost Time
Medical Expenses and Bills
Lost Wage Benefits
Returning to Work

Designated Medical Provider

Colorado law allows your employer to choose, or designate, the medical provider who will provide your care. Ask your supervisor or human resources office for the name and location of your company's designated medical provider. When you are injured at work and it is an emergency, go to the nearest hospital emergency room and then contact your employer and your company's designated medical provider, who will provide follow-up care. If your injury is not an emergency, see your employer's designated medical provider for treatment.

Pinnacol Assurance, like all Colorado workers' compensation insurance providers, provides benefits to workers with a work-related injury or illness in accordance with the Workers' Compensation Act. The Act defines occupational injuries and illnesses, which insurance companies follow to determine coverage. A work-related injury must have occurred within the course and scope of employment. Occupational diseases result directly from exposures during employment and can be linked to the employment being the reasonable cause; they do not result from hazards the worker would have been equally exposed to outside employment.

Claims resulting from a work-related injury fall into two groups: non-lost time claims and lost time claims. A lost time claim occurs when a worker misses more than three scheduled work shifts due to the injury. Although most work-related injuries are not serious enough for a worker to lose more than three workdays, it is still important that workers report the injury to their employer immediately.

As soon as your employer notifies Pinnacol Assurance of your claim, our claims management team is immediately notified. If you will not miss more than three scheduled work shifts, a medical claims associate (MCA) receives your claim information. We mail your claim number to you the same day, along with information on your benefits and the MCA's direct telephone number. As long as you see your employer's designated medical provider, he or she will automatically send the medical bills and appropriate information to Pinnacol Assurance. If you have any questions or concerns, please contact your MCA immediately.

Here is what happens when your employer notifies Pinnacol Assurance of a lost-time claim (more than three scheduled work shifts missed):
 

• A claims representative/nurse case manager team immediately receives your claim.
• Team members call you, your physician, and your employer to ensure appropriate medical care is underway.
• Pinnacol Assurance has 20 days to accept or deny your claim in writing.

When Pinnacol Assurance has accepted your claim, we pay necessary, related, and reasonable medical expenses prescribed by your employer's designated medical provider. These include surgery, dental, nursing, hospital, home health care, physical therapy, chiropractic care, prescriptions, medical supplies, and travel within certain limitations.

Once we have accepted your claim, please forward any bills related to your claim to your claims representative for review. Be sure your claim number is on all bills. If you are asked to pay for any medical expenses related to your claim, contact your claims representative. Hospitalization and certain procedures or treatments require prior authorization by Pinnacol Assurance's claims representative/nurse case manager team.

After you miss three scheduled work shifts, you may be entitled to compensation for lost wages. If you are still unable to work after 14 days, you may be paid for the first three workdays missed. Pinnacol Assurance will pay you two-thirds of your lost wages. Your lost wage benefits can be reduced by as much as 50 percent under the following conditions:
 

• The injury is caused by the willful failure of the employee to use employer provided safety devices.
• The injury results from the employee's willful failure to obey a safety rule adopted and enforced by the employer.
• The injury results from employee intoxication or use of illicit drugs.

Medical benefits are not reduced due to safety violations.

The goal of a return-to-work program is to get you back to work, either at your regular position or at a modified duty position, while you are recovering from a work-related injury. Modified duty can be full or part-time, but it must meet the physical restrictions set by your doctor and is not intended to be a permanent position. You will receive wages that are appropriate for the tasks performed while on modified duty. The goal is to eventually return you to your regular position.

If a modified duty position approved by your doctor is offered to you, you must accept the job or face losing wage benefits. If the modified duty position pays less than your regular pay, two-thirds of the difference will be paid to you by Pinnacol Assurance.

A Pinnacol Assurance return-to-work specialist can help your employer determine appropriate modified duty for your position. Please contact your employer directly with questions related to returning to work.

Click here to read the Return-to-Work brochure.