Understanding Your Workers’ Compensation Claim

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Understanding Your Workers’ Compensation Claim

It is the intent of the general assembly that the “Workers’ Compensation Act of Colorado” be interpreted so as to assure the quick and efficient delivery of disability and medical benefits to injured workers at a reasonable cost to employers, without the necessity of any litigation, recognizing that the workers’ compensation system in Colorado is based on a mutual renunciation of common law rights and defenses by employers and employees alike.

Colorado Workers’ Compensation Act, C.R.S. § 8-40-102

Introduction

The above statute can be considered the mantra of the Colorado Workers’ Compen-sation system. However, it isn’t as simple as getting hurt, getting treatment, and getting back to work.

Workers’ Compensation is a niche area of law, complete with its own set of rules, procedures, and deadlines. If you’re not careful, you can forfeit medical care and money that you’re entitled to, as there are many of pitfalls for the inexperienced participant. At a minimum, every injured worker should have an attorney look over their case; more often than not, there will be at least one issue that needs to be corrected. Our goal is to maximize your monetary benefits, monitor your medical care, obtain reimbursements, and to help you complete your claim in a timely and effective manner.

You’ve already been injured once; don’t let an insurance carrier or physician hurt you again.

Timeline

Every case is unique and there are always exceptions, but the following chart will help you know how claims are generally conducted from start to finish. It includes some of the most commonly used “terms of art” and their acronyms, allowing you to better understand the information you receive from those handling your claim.

What are Pre-Hearing Conferences and Hearings?

Many cases resolve without the need of significant legal action, but sometimes disagreements arise at various points in a claim. This can be for a variety of reasons, such as compensability, reasonable and necessary care, injury classification, and wage calculation. If parties are unable to agree on a resolution on their own, the need for a PHC or hearing might be the best course of action.

Here is an easy way to differentiate the two: a PHC resolves administrative disputes, whereas a hearing resolves factual disputes. What’s great about a PHC is it’s quick, almost always free of charge, and doesn’t require Claimant attendance, which means it won’t disrupt your life.

On the other hand, hearings are more in-depth and can cost you thousands of dollars, in large part because of related testimony fees. It will also require your participation through “discovery” (basically an early opportunity for parties to find facts), followed by your live testimony.

Hearings look a lot like the trials you see on television, but without a jury. At a hearing, a randomly-selected judge makes all judicial decisions. If a party is unhappy with any part of a decision, they have the opportunity to appeal.

Because of the high costs and the unpredictable nature of judges, we will always discuss whether going to a hearing is the best option for you, given the choice. Other options may be available, such as further negotiation, mediation, or arbitration. However, if we determine after that discussion that a hearing is necessary, take comfort in knowing we have the court experience necessary to zealously represent you.

Important Tips

After handling hundreds of cases, here are some of the most important pieces of advice we want to share with you to help your life run smoothly during the claim:

#1: Adjust Your Budget

Life is not easy when you’ve been injured on the job. Not only are you dealing with constant pain, your wage income is about to undergo a significant change if it hasn’t already.

Under Colorado law, an injured worker who misses work in a compensable claim is entitled to 66% of their gross pay, based upon the calculation of their Average Weekly Wage (AWW). Although this amount is calculated before taxes, many individuals will receive less in wages than what they are used to. If you’re off of work for an extended period of time, this will start to become an unnecessary stress if you don’t plan accordingly.

#2: Report All Injuries

After someone is initially injured, their body focuses on the primary injury. As time goes by, a person may notice that other “lesser” injuries also occurred during the incident, or that their primary injury is causing radicular pain or secondary injury.

In personal injury cases, if it isn’t written on the provider’s medical report, it didn’t happen. That’s why it’s important to report all of your accident-related symptoms and injuries each and every time you walk into an appointment. If you find that your injuries are being under-reported or not addressed, be sure to hand that medical provider a written report of your problems. This can be an entry from your pain dairy or even a separate letter. Either way, it is critical to your health and claim that everything is being reported.

#3: Don’t Miss Appointments

Conversely, medical care is a two-way endeavor. You expect the best care available to you under the law, so it’s important to put your best effort into getting well. There are of course emergencies and other life events that unexpectedly arise, but missing appointments stalls your recovery and can lead to the termination of your wage benefits.

#4: No “Pain & Suffering” Damages

As mentioned previously, workers’ compensation is unique in the world of personal injury, which is both good and bad. One of the unfortunate aspects of workers’ compensation is that you will not be awarded any pain and suffering damages.

This means that despite all the hardships you may endure during the life of the claim, you won’t receive compensation for it in a settlement. Along those lines, you won’t be entitled to any negligence damages either. That’s not to say that there isn’t money to be had at the end, it’ll just be based on other factors.

#5: Fees vs. Costs

There are two main expenses you will incur during your claim – fees and costs. A good way to understand the difference is to imagine you hire a contractor to remodel your kitchen. Ultimately, you will pay the contractor for his or her time (fees), but you will also pay for the supplies (costs).

The great news is we are a contingency-based firm. We understand that this is a financially difficult period of your life, and we don’t charge clients up front for either fees or costs. Instead, we essentially open what can be compared to as a credit card account, funding necessary costs through a financing company and upon resolution of your claim, pay the outstanding expenses from your recovery.

Contact a Workers’ Compensation Attorney Today

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