What adversely affects a workers’ compensation claim in Colorado?

Jan 10 2016

People filing for workers’ compensation benefits should be aware of the factors that could adversely affect their claim.

Next year, many businesses in Colorado will see lower workers’ compensation premiums, which experts say is due in part to safer workplaces. According to The Daily Sentinel, programs that get injured workers back on the job quicker may also be credited for keeping costs low.

While those improvements are good news, the truth is that injuries do still happen. Employees in Colorado who suffer an on-the-job injury should know the factors that will affect whether or not a claim is accepted or paid in full.

The qualifying injuries and illnesses

The Colorado Department of Labor and Employment notes that workers’ compensation benefits typically are extended to employees who suffer workplace injuries or occupational diseases. In most cases, someone who gets hurt performing a task that is work-related should qualify. However, the following factors could cut lost-time benefits by 50 percent:

  • If the worker had a blood alcohol concentration of 0.10 or higher
  • If the worker failed to use safety devices
  • If the worker did not abide by safety rules

If the injury was found not to have occurred during the scope of the employee’s job, benefits will be completely denied. In some cases, insurers will reject a claim due to a worker’s preexisting condition, though this does not automatically disqualify a claim.

Know the timeline

One of the most important factors in filing for workers’ compensation benefits is to do so in a timely fashion. The DLE points out that any workplace injury should be reported to the employer within four days. Failing to do so may not necessarily mean a claim is rejected, but it could result in a loss of compensation.

Once the employer is notified, the company should alert the insurance provider within 10 days. The insurer then has 20 days to let the injured worker know whether or not the claim has been accepted. Workers can do their part by ensuring that this timeline is adhered to. If, for example, the employer does not report the injury, a worker can file a claim on his or her own.

Complete information

If a claim is missing information or the information is inaccurate, the insurance company may reject benefits. An authorized physician may have misclassified the injury, for example. The DLE points out that workers should be sure to do the following:

  • Include the time and date of the injury or when an illness began.
  • Be specific about how the injury or illness occurred.
  • Provide any other details that may be relevant to the claim.

The more information a worker can provide, the better.

If a claim is denied

Workers are able to appeal a denied workers’ compensation claim, which they will learn about from a notice of contest. The DLE notes that a file for an application for expedited hearing should be filed within 45 days of the time that the notice of contest was mailed.

A workers’ compensation attorney in Colorado can further discuss this issue with anyone who has concerns.