Get Workers' Claim For Compensation - Colorado Department Of Labor

Filling out the Workers' Claim For Compensation form online is an essential step for users seeking compensation for injuries or illnesses related to work. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to fill out your claim form properly.

1. Click ‘Get Form’ button to obtain the form and open it on your device.
2. Begin by entering the employee’s name in the designated box, ensuring you respect the character limits provided. Use the tab key to navigate through the fields after entering your information.
3. Enter your Social Security Number and phone numbers using numbers only. Avoid using dashes or parentheses; the form will fill in the formatting automatically when you tab out of the field.
4. Complete the employee’s address, including street address, city, state, and zip code. Ensure accuracy as this information is crucial for correspondence.
5. Indicate your age and birthdate in the specified fields, using the drop-down menus or typing as required.
6. Fill in details regarding dependents and marital status as applicable.
7. Enter the duration of employment with the current employer and provide the job title or position held at the time of the injury or exposure.
8. Specify the date and time of the accident, along with any relevant details regarding how the injury occurred.
9. If applicable, state if you received any pay for overtime, commissions, or piecework, along with the average weekly wages at the time of injury.
10. Describe your injury in detail, including specifics about the body part affected and the circumstances surrounding the injury.
11. If there were witnesses, provide their names and addresses. Also, include your healthcare provider's information if treatment was sought.
12. Review all filled sections to ensure no errors. If changes are necessary in any field, use the backspace or delete key to modify the information.
13. Once completed and reviewed, users can print the form for submission or click the 'Clear Entire Form' button if you wish to start over.

Complete your Workers' Claim For Compensation form online today to ensure your claim is filed properly and promptly.