Claims

The claims process

Let's make this simple and fast.

Report an injury

A list of designated providers or a Letter to Injured Worker should be provided, so the employee can seek medical attention. (If an employee's injury is life- or limb-threatening, they should go to the nearest hospital emergency room immediately. Later treatment can be done by a designated medical provider.)

After the employee has received treatment, report the claim to us immediately — either online, by phone or by fax. One of our claims specialists will be available to answer questions about the claim.

Phone: 303.361.4000 or 800.873.7242
Fax: 303.361.5000 or 888.329.2251​​

Workplace injuries are stressful enough, filing a first report of injury doesn’t have to be. Find out how with this short, informative video.

Initial treatment

We take injuries very seriously. And we know from experience that getting them treated quickly is an important part of the healing process. So, while each injury is different, we strive to make the entire process as smooth as possible.

For an injury that doesn't require missing more than three shifts, and where no permanent medical impairment occurs, we'll pay for reasonable and necessary medical treatment by the authorized treating physician as well as for any referrals. The injured worker does not pay a copay or deductible.

When an injured worker misses more than three shifts and medical impairment is anticipated, continued treatment may be required. When this happens, we work closely with the employer, medical providers and others to ensure an employee's treatment is in good hands and that wage replacement is calculated for covered injuries.

Medical case management

Pinnacol’s Medical Case Management (MCM) team ensures injured workers receive the right care at the right time to optimize health, well-being and functionality.

Return to Work™ consulting resources

Getting back to work is an important part of the healing process. Creating a plan of action for making this happen safely not only helps boost the employee's morale, it also saves employers on claims costs.

Let our Return to Work consulting specialists help you identify industry-specific modified duty tasks and a proactive policy you can share with your employee.

Offer your injured employee modified duty work shortly after their treatment begins, so they know what to expect along their journey to recovery.

Call our Return to Work consulting specialists at 303.361.4000 at any time for help.

Continued treatment

When a more severe injury occurs, we go through a comprehensive, personalized process that includes:

  • Sending you a First Report of Injury form
  • Letting you know within 20 days if the injury is covered under your workers' compensation policy
  • Filing an admission (injury is covered) or denial (injury is not covered) with the Division of Workers' Compensation (DOWC)
  • If the injury is covered, calculating lost time benefits and determining if lost wages are due

Through each step of the process, we strive to provide the most compassionate care possible — every injury, every time.

Claim closure

When an employee is back to work or a different resolution has been determined, we work with you and the employee's medical provider to close the workers' comp claim.

Once documentation indicating work can be resumed is provided or the treating physician indicates care is completed, a Final Admission is filed with the DOWC. In addition:

Wage replacement benefits are stopped

Additional compensation or benefits may be provided in the event of a permanent impairment or loss of life

Make your policy work for you

Together, we'll help you manage your claims and look for ways to lower your premium by pointing you to safety resources, alerting you to annual audits and doing regular claims reviews.
Questions?
Call 303.361.4000
to talk to a claims representative
COVID-19 Policy Update