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Workers' comp law and the claims process

As your workers' compensation carrier, Pinnacol Assurance provides the benefits due to your injured
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As your workers' compensation carrier, Pinnacol Assurance provides the benefits due to your injured employees as required by the Colorado workers' comp laws. We also file the necessary paperwork for you. The Division of Workers' Compensation (DOWC) administers and enforces workers' comp laws and the Workers' Compensation Rules of Procedure in Colorado.

Claims can vary greatly in severity, complexity and duration. To better understand the basic benefits, forms and claims terms, follow the steps below for information about workers' compensation law and the typical claims process. For detailed information about a specific claim, please call your claims representative at 303.361.4000.

Injury occurs, but does not cause lost time from work in excess of three shifts or any permanent medical impairment

For this type of injury, medical benefits are the only benefits that an injured worker is entitled to.

  • Pinnacol may pay for reasonable, necessary and related medical treatment by the authorized treating physician, along with any referrals
  • The injured worker does not pay a copay or deductible

If you have any questions, please call Pinnacol at 303.361.4000.

Injury occurs, and there is lost time from work in excess of three work shifts, or permanent medical impairment is anticipated

Pinnacol is required to send the First Report of Injury form to the Division of Workers' Compensation (DOWC).

Pinnacol has 20 days from receipt of the First Report of Injury to admit or deny compensability.

If Pinnacol admits compensability, the following steps take place:

  • A General Admission (GA) is sent to the DOWC, the injured worker and the employer
  • If the injured worker is missing time from work, the GA states the admitted Average Weekly Wage (AWW) and the wage replacement benefits that are being applied for

Wage replacement benefits may be one of the following:

  • Temporary Total Disability (TTD) benefits — when an employee does not return work at all due to the injury
  • Temporary Partial Disability (TPD) benefits — when an employee returns to work on modified duty, either with reduced hours or reduced wages

Once wage replacement benefits start, they cannot be suspended, modified or terminated unless one of the circumstances listed in Rule 6 of the Workers' Compensation Rules of Procedure exists.

Typically, wage replacement benefits may be terminated when one of the following qualifying events occurs:

  • Your employee returns to work at pre-injury wages
  • Your employee is released for regular work by the treating physician
  • Your employee voluntarily returns to work on modified duty at regular wages
  • You make a formal modified duty job offer at pre-injury wage that complies with Rule 6-1 (A)(4)

A new GA is filed whenever there is a change in the employee's wage status. When we receive written documentation that one of the qualifying  events (listed above) has occurred, we file a new GA form.

If wage replacement benefits have not been terminated by one of the qualifying events, they may be terminated when the injured worker is determined to be at Maximum Medical Improvement (MMI) by the authorized treating physician.

If the authorized treating physician has determined that the injured worker has a Permanent Medical Impairment, the physician will provide a Permanent Impairment Rating and Pinnacol may pay the injured worker Permanent Partial Disability (PPD). PPD is based on the rating and amount required under the Workers' Compensation Act.

When the MMI report outlining PPD is received, we may file a Final Admission (FA) with the DOWC.

If the injured worker or Pinnacol does not agree with the treating physician's determination of MMI or PPD, either party may contest it by requesting a Division Independent Medical Exam (DIME).

If you have any questions, please call Pinnacol at 303.361.4000.

Related materials available for order:

If you are Injured On the Job poster
(English)

Notice to Employees poster (English)

If You are Injured On the Job poster
(Spanish)

Notice to Employees poster (Spanish)

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