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Medical and lost wage benefits

If you have been injured, here's what to expect
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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 include information about your benefits, and a direct phone number for the Pinnacol claims representative who's been assigned to your case. You can also follow your claim anytime online.

You will be referred to a designated medical provider for medical treatment related to your work injury. They will automatically send bills and appropriate information to Pinnacol, and we'll take care of the rest.

Pinnacol will begin paying for all necessary, reasonable and related medical expenses prescribed by your medical provider. Hospitalizations and certain procedures may require prior authorization by your Pinnacol claims representative.

If you miss more than three work days (or shifts), notify your claims representative.

Restrictions

When you receive treatment for your injury, your doctor may provide light duty or modified duty work. These are both performance limitations aligned with your recovery to prevent further injury.These restrictions are for your safety. For example, someone with an arm injury may be restricted to lift no more than 20 pounds. Restrictions apply at work and at home, and they may be updated as you recover. Make sure your employer understands your restrictions.

When your recovery has plateaued and there is no significant change expected in your physical condition, your doctor will place you at Maximum Medical Improvement (MMI). Your doctor will also address any permanent physical impairment you may have incurred as a result of your work-related injury.

Compensation for lost wages

If your doctor takes you off of work and you miss over three scheduled work shifts, or if your employer doesn’t have work for you due to your restrictions, you may be eligible for wage replacement benefits. The amount of this benefit, set by the State of Colorado, is two-thirds of your normal average weekly wage for the time period that you’re not able to work. If you miss more than three scheduled shifts while on restrictions, you may receive wage replacement benefits.

Vehicle mileage reimbursement

Pinnacol will reimburse you for mileage to and from authorized medical appointments, the pharmacy and other trips related directly to your medical care. You can submit your mileage reimbursement request on Pinnacol’s Injured Worker Portal. We can also provide you a mileage form to fill out on your computer or by hand.

Medical expenses

You can submit your receipts to your claims representative for any related and authorized out-of-pocket medical expenses, such as medication, crutches and bandages.

What to do if you receive a bill

Please write your claim number on the bill and send a copy to your claim representative, and we’ll follow up with your provider. It may also be helpful to call your provider, give them your claim number and ask them to bill Pinnacol.

Transportation

In some cases, Pinnacol can arrange for transportation for travel to and from appointments for your treatment. Speak with a claims representative to see if you qualify.

Interpretation services

Please contact your claims representative if you need an interpreter at any time.

You may be eligible for additional compensation if you suffer serious injuries that result in disfigurement, permanent impairment or permanent total disability. The amount and duration of these payments are specified under the Colorado Workers' Compensation Act.

In the event of a job-related fatality, the workers' dependents and spouse are eligible for death benefits as specified in the Colorado Workers' Compensation Act.

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.

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