Workers' compensation law has been developed by the legislatures of the various states to create benefits for injured workers without question as to whether the accident was caused by the fault or negligence of anyone. As a general proposition, an individual who is injured, or suffers an occupational disease in the course and scope of his or her employment, is probably entitled to receive workers' compensation benefits.

There are several different workers' compensation laws, depending upon the date of the injury. Therefore, the amount of benefits available and certain procedural rules depend upon the date of injury. The information listed below will indicate the relevant injury dates when appropriate; however, due to the complexity of the various Workers' Compensation Acts, as well as medical science's evolving understanding of the hazards that may exist in today's work place, consultation with a qualified workers' compensation attorney is recommended. When disputes arise, it is important to note that workers' compensation cases are administrative cases heard by Colorado Administrative Law Judges. Jury trials are not permitted.

Workers' Compensation Insurance is Required

The law requires employers to have workers' compensation insurance coverage or to qualify as a self-insurer. There are substantial penalties payable to the injured worker by the employer if there is an injury, and the employer does not have complying workers' compensation insurance.

Third Party Claims

The injured employee may bring a claim against a third party at fault in the accident if that third party is not employed by, or a part of, the employer's business. This happens most frequently in cases of on-the-job automobile accidents and injuries from faulty equipment. If a claim against a third party is pursued, however, the injured worker is required to give notice of the claim to the workers' compensation insurance carrier or self-insured employer. If an injured worker receives workers' compensation benefits, and also chooses to pursue a lawsuit against a third party that caused his injury, he or she may be required to reimburse the workers' compensation insurance carrier some or all of the workers' compensation benefits that are paid. The injured employee cannot bring an action against either his employer or his fellow employees, even if there is fault on their part. His or her only remedy will probably be a workers' compensation claim.

Requirement of Good Faith

The Colorado Workers' Compensation Act provides that the compensation insurance company has a direct obligation to pay workers' compensation benefits to the injured employee. The insurance company can be liable to the employee for a failure to process the claim in good faith. This is a developing area of compensation law and the issue of what is or is not "good faith" is continuing to be defined; therefore, consultation with a qualified and experienced workers' compensation attorney is recommended.

Reporting and Notice Requirements

The injured employee, or someone in his or her behalf, is required to report a job-related accident to an employer in writing within 4 days of injury (for injuries which occur on or after July 1, 1991), and failure to do so could result in the loss of one day's compensation for each day the report is late. Late reporting will not bar a claim, but certain penalties can be assessed against the injured worker.

Written notice of an occupational disease is required within 30 days after the first distinct manifestation of the disease. Failure to give this notice may also result in a reduced award to the injured worker.

The employer is required to file a notice of injury, within 10 days with the Division of Workers' Compensation for any accident resulting in a loss of more than three days employment, or in cases of occupational diseases, or in cases involving permanently physically impairing injuries. In the case of fatal injuries immediate notice must be provided by the employer.

If an employer/insurer has not filed a "General Admission of Liability" admitting for temporary or permanent disability benefits, the injured worker is required to file a claim for compensation within 2 years of the date of the accident. Failure to file a Workers' Claim for Compensation form within 2 years may preclude the worker from obtaining benefits. In some circumstances, such as in cases of certain occupational diseases, or when an employer has failed to file a required report or injury with the Division of Workers' Compensation, the statute of limitation on claims will be "tolled" or extended. Please consult a qualified attorney for specific details.

A Colorado Worker Injured Outside the State of Colorado

A worker injured outside the state of Colorado may still be covered for workers' compensation benefits if he or she was regularly employed in this state, and has not been out of state for more than 6 months. There are other circumstances where a worker may have a choice of several states in which to file a claim.

Who is an Employee

The issue of whether a person is an "employee" for purposes of the Workers' Compensation Act is not always clear. Although there are certain workers not covered for benefits under the Compensation Act, there are instances in which workers may be covered in what would not be considered an "employment" situation. For example, "independent contractors" are often considered employees under the workers' compensation system.

Cases of Reinjury

An injured worker who was already disabled at the time of the injury can still receive benefits, but may have his or her compensation reduced to the extent of the previous disability.

Medical Benefits

The employer has an obligation to provide medical care to a worker injured on the job. The amount charged for the medical care is subject to a fee schedule. Furthermore, the employer has the right "in the first instance" to choose the medical provider who will be authorized to treat the injured worker. Only that medical provider, or referrals from that medical provider, will be paid by the employer or insurance company for treating the injured worker.

If the employer or the insurance company does not provide medical care at the time of the accident, then the injured worker may choose a physician for himself or herself. For injuries occurring after July 1, 1991, medical bills must be paid within 30 days, or penalties can be assessed.

A worker can request an administrative law judge to change his authorized medical provider. The worker can also send a letter to the insurance company requesting that a certain medical provider be authorized to provide treatment, and if there is no objection within 20 days, the requested medical provider will become authorized. The injured employee is required to submit to medical examinations upon the written request of the employer or its insurance company. Refusal to do so may result in the termination of benefits.

Wage Benefits

A worker temporarily disabled for more than three days is entitled to wage benefits of 2/3 of his or her weekly wage, not to exceed $659.12 per week (this figure is adjusted each year on July 1st). If the injured worker misses more than 14 days, he or she is then entitled to these wage benefits from the date of the accident. Temporary disability benefits usually continue until the worker returns to work or is found to be at "maximum medical improvement" (meaning that the injured worker's condition is "stable, and when no further treatment is reasonably expected to improve his or her condition").

Permanent Disability Benefits

Injuries to certain parts of the body have scheduled benefits under the Colorado Workers' Compensation Act. The schedule is fairly lengthy and should be consulted for loss of the use of a specific part of the body. Alternatively, the statute provides that a worker with permanent partial disability shall be paid a disability award determined by the percentage of general permanent disability, usually called the percentage of disability "as a working unit".

The maximum dollar amount that can be paid for permanent partial disability is $37,560.00 for accidents which occurred after July 2, 1987, but before July 1, 1991, and $26,290.00 for accidents which occurred before July 2, 1987. For most injuries occurring on or after July 1, 1991, the amount of temporary and permanent benefits combined cannot exceed $60,000.00; however, those who suffer an injuries not listed in the scheduled injury section of the Colorado Workers' Compensation act that result in greater than 26% impairment are entitled to temporary and permanent benefits not to exceed $120,000.

On July 1, 1991, a new Workers' Compensation Act took effect in the State of Colorado. This law drastically reduced permanent disability awards, and for all practical purposes, eliminated the concept of disability from the workers' compensation system. The prior law, in effect for accidents which occurred between July 2, 1987 through June 30, 1991, determined disability by focusing on whether an injured worker's earning capacity had been diminished; and considered such factors as the person's age, his or her educational background, vocational experience, language and abilities, and physical condition.

However, the new Workers' Compensation Act uses only a mathematical formula to determine permanency benefits. Under the new system, there is no consideration of whether a person's earning capacity has been diminished, since the award of permanency is tied to a medical impairment rating issued by a physician. If there is a dispute regarding the first doctor's determination of permanency, a second opinion may be requested at the expense of the requesting party (usually the Claimant).

Permanent Total Disability Benefits

If a worker has been determined to be permanently and totally disabled, the weekly wage benefits shall continue until the death of the injured worker.

This determination has been redefined under the new Workers' Compensation Act, however, often making it more difficult for a worker to be found permanently and totally disabled. Under the prior law, a person could be found to be permanently and totally disabled if the injured worker was unable to engage in "general employment to some substantial degree." Under the new law, however, if a worker is capable of earning "any wage", he or she cannot be deemed permanently and totally disabled. However, if the injured worker is "so handicapped that he or she is not regularly employable in any well known branch of the labor market", then it is still possible to win a permanent total disability case.

Disfigurement

In addition to the other benefits awarded, if the injured worker becomes disfigured on a part of the body normally exposed to public view, he or she is entitled to an award of disfigurement not to exceed $2,000.00.

Vocational Rehabilitation

For injuries prior to July 2, 1987, the injured worker is entitled to vocational rehabilitation, which is intended to assist the worker to locate suitable gainful employment. Rehabilitation is under the supervision of the Director of the Division of Workers' Compensation and subject to specific rules. During the period of rehabilitation, the worker is entitled to a weekly wage benefit.

For injuries which occurred after July 2, 1987, vocational rehabilitation is no longer a required benefit. The employer or insurance company can still offer it, and may seek to do so in cases of permanent total disability. In practice, however, vocational rehabilitation is rarely offered by an insurance carrier.

Lump Sum Awards

Permanent partial or permanent total disability awards may be paid in a "lump sum" rather than by weekly payments. Lump sum awards are subject to the approval of the Director of the Division of Workers' Compensation and are limited to $37,560.00. Lump sum awards are subject to reduction by a four percent discount to "present value".

Unemployment Insurance

An injured employee receiving temporary total disability benefits is not eligible for unemployment benefits concurrently.

Acts by the Employee which Reduce Compensation

Compensation is to be reduced by 50 percent if the worker:

(1) willfully failed to use a safety device provided by the employer, or (2) willfully failed to obey a reasonable safety rule; or (3) was intoxicated at the time of the accident.

Other than the reductions mentioned above, an injured employee's benefits are not affected by the employee being "at fault" for the injury.

Social Security Disability Benefits Offset

Colorado law requires that an award for permanent partial or permanent total disability be diminished but not below zero, by one-half of any Social Security disability benefits the claimant receives during the period of work-related disability. The combination of benefits will normally be higher than those from workers' compensation benefits alone.

Reopening a Claim for Compensation

At anytime within six years from the date of the injury, or at any time within two years after the date of the last compensation becomes due and payable, whichever is later, the Division of Workers' Compensation may, upon a showing of worsened condition, overpayment, fraud and mutual mistake of material fact, error or mistake, reopen a workers' compensation claim for additional compensation. A Petition to Reopen for a worsening condition requires a supporting medical report showing how the condition has worsened.

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