Workers' comp claim denied in Colorado: what to do next

If your claim is denied or delayed in Colorado

Who decides

Office of Administrative Courts (OAC), administrative law judges

First step

Call DOWC Customer Service (free, English and Spanish) at 303-318-8700 or 1-888-390-7936 for directions. Make sure your Worker's Claim for Compensation (WC15) is on file. If the insurer denied your claim with a Notice of Contest, you can file an Application for Expedited Hearing within 45 days, or an Application for Hearing, with the Office of Administrative Courts.

Form

Application for Hearing (Office of Administrative Courts)

Deadline

To get an expedited hearing on whether your claim is covered, apply within 45 days after the date the insurer mailed its Notice of Contest. A standard hearing can be requested later, but the Worker's Claim for Compensation must be filed within 2 years of the injury. If the insurer files a Final Admission of Liability you disagree with, you must object in writing and request a hearing on the disputed issues (or a Division Independent Medical Examination) within 30 days after the date of the Final Admission, or the admitted issues close.

Source: Form WC4

Medical disagreements

Within 90 days of the injury you can switch once to another doctor on the designated list (WC3); later changes need a Request for Change of Physician (WC197). If you disagree with the date of maximum medical improvement or your impairment rating in a Final Admission, object and request a Division Independent Medical Examination within 30 days of the Final Admission; the side that requests a DIME pays for it, and a worker who cannot pay can apply for an indigent determination (WC35).

Source: DIME, Form WC77

• Notice of One-Time Change of Physician (WC3)
• Request for Change of Physician (WC197)
• Notice and Proposal and Application for a Division Independent Medical Examination (WC77)

Appealing the decision

Petition to Review, filed within 20 days after the date of the certificate of mailing of the judge's order, for review by the Industrial Claim Appeals Office; then the Colorado Court of Appeals.

1. File the Worker's Claim for Compensation (WC15) with the Division within 2 years of the injury.
2. File an Application for Hearing (or an Application for Expedited Hearing within 45 days after the Notice of Contest was mailed) with the Office of Administrative Courts.
3. Prehearing conferences at the Division handle procedural issues; a settlement conference or mediation can be held if both sides agree.
4. An administrative law judge holds the hearing and issues a written decision.
5. If you disagree, file a Petition to Review within 20 days after the order was mailed; it goes to the Industrial Claim Appeals Office.

Law: C.R.S. §§ 8-43-203(1)(a), 8-43-203(2)(b)(II), 8-43-301(2), 8-42-107.2

Source: cdle.colorado.gov