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When an employee suffers an injury on the job in Colorado, there are procedures that he or she must follow to receive coverage by workers’ compensation insurance.
These procedures are designed to ensure that the employee receives proper medical treatment for that injury or wage coverage for missed time from work.
Emergency treatment and written notification to employer
The first thing the employee must do is get any necessary emergency care and then let the employer know what happened. The employer should receive notification from the employee or someone on the employee’s behalf, in writing, within four days. The written notice is mandatory even if the employee has already spoken to the employer. If the employee fails to give the notice by the fourth day, he or she may still file a claim. However, the employee may lose compensation for each day he or she failed to provide the notice after the fourth day.
The employer may have a list of medical providers that the employee must choose from for ongoing treatment for this particular work-related injury
Employer’s report of injury to insurance carrier
The employer then files a report with its workers’ compensation insurance carrier within 10 days of the injury. This is the start of the claim for coverage, and a claim number will issue. The employee provides the medical provider with the claim number, so the medical provider can then send the bill for visits to the carrier.
Once the employer’s workers’ compensation insurance company accepts the filed claim, the employee should not receive a bill for appropriate medical care for the injury. However, the carrier generally has 20 days from the date the employer filed the claim with the carrier, to notify the worker of the acceptance of the claim. That written acceptance is not necessary for situations where the employee did not lose at least three shifts of work due to the injury. In that case, the employee can confer directly with the adjuster on his claim for information.
If for some reason an employee gets a medical bill, the employee should send it to the carrier, along with the claim number it relates to. The carrier must then pay the bill within 30 days or issue a valid reason for not paying it.
If the insurance carrier denies the claim, then the worker will want to consider using his or her rights to take additional legal action in pursuit of workers’ compensation coverage.