This is one of the official Workers' Compensation forms for the state of Colorado
Colorado Springs Colorado Physician Report for Workers' Compensation
State:
Colorado
City:
Colorado Springs
Control #:
CO-WC164P-1-WC
Format:
Word;
PDF;
Rich Text
Instant download
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Public form
Description
How to fill out Colorado Physician Report For Workers' Compensation?
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FAQ
Colorado law does not allow you to see your doctor when you are injured on the job, but there is an exception to this general rule. You can choose your doctor if they are on the list of providers from your employer or if your employer does not specify which doctors you can see.
Please call Customer Service at 303-318-8700 or 1-888-390-7936 or email cdlewccustomerservice@state.co.us if you need to update your contact information.
Once you have been placed at Maximum Medical Improvement (MMI), your doctor determines the amount of loss in the form of a percentage. If your doctor is unable to do this, they may refer you to another doctor who can. Impairment is a permanent loss of function of a body part or system.
How are we doing? Within 10 working days of your injury, you should let your employer know about the injury. This must be done in writing. If you were injured more than 10 days ago, you should still notify your employer in writing as soon as possible.
File a Worker's Claim for Compensation (WC 15) with the Division within two years of your injury. Even if your employer did not carry workers' compensation insurance, you should still file the Worker's Claim for Compensation as you may qualify for benefits through the Colorado Uninsured Employer Fund.
In most cases, injured workers in Colorado have two years from the date of an accident to do file their claims. In certain cases, a judge may extend the statute of limitations to three years.
After the injury, go directly to your supervisor or boss and tell them exactly what happened. You can tell your boss in person, if you are in the same location, or over the phone if you're in a different location. You'll want to tell them the order of events and the names of anyone who saw the injury occur.
Workers' comp can help make up a portion of their missed wages. In Colorado, employees can receive two-thirds of their average weekly wage. Ongoing care that an employee may need to recover from a work-related injury or illness. Some work-related injuries require more than one treatment session.
$100,000 per occurrence for bodily injury: This coverage is for any one employee. $100,000 per employee for bodily disease: This coverage is for any one employee. $500,000 policy limit for injury by bodily disease: This coverage is the total per policy term for all claims in a policy term.
