It’s an unfortunate reality: workplace accidents happen. The U.S. Bureau of Labor Statistics (BLS) reported that there were approximately 2.9 million nonfatal workplace injuries and illnesses reported by private industry employers in 2015. While this is fewer than in the previous year, and continues a trend of decline over the last decade, the fact remains that despite everyone’s best efforts to avoid them, workplace accidents happen.
Enter, Colorado’s workers’ compensation program.
Workers’ compensation is a form of no-fault insurance that exists to ensure that financial hardship doesn’t cause added pain for an individual who is recovering from a workplace injury or illness. For employers, workers’ compensation provides some protection against liability.
If an employee is injured on the job, or develops an occupational disease, workers’ compensation insurance pays for any medical expenses the employee incurs as a result of that injury or illness. Workers’ compensation insurance also pays for partial wage replacement when a sick or injured worker is unable to work and, in some cases, it may also provide permanent impairment benefits for those who qualify.
The State of Colorado requires all public and private employers, with limited exceptions, to provide workers’ compensation coverage for their employees if they employ one or more full or part-time employees, including family members.
Navigating the waters of workers’ compensation can be challenging in the best of situations and can seem near impossible when a particularly devastating injury, or a denied claim, makes the water even choppier. Seeking advice from a Robinson & Henry disability attorney can help you get to calmer seas. During an initial consultation, we can answer your questions and talk about what to expect from the process as it relates to your unique situation. Our disability practice is based out of our headquarters in Castle Rock, Colorado, but we can handle cases anywhere in Colorado. Call 303-688-0944 or click here to schedule a consultation today.
Our legal guide, “Injured at Work: Your Guide to Colorado Workers’ Compensation” answers frequently asked questions about workers’ compensation such as: I got hurt at work, but the accident was my fault. Does that make me ineligible to receive workers’ compensation benefits?
Types of Injuries and Illnesses Covered by Workers’ Compensation
Generally, if the task or job you were performing when you became sick or injured had to do with your job, then it should be covered by workers’ compensation. This usually means that you were physically on your employer’s premises when the accident occurred, though there are some exceptions, for example, if you were driving for work-related duties.
Injuries sustained at company-sponsored events, including social gatherings like a holiday party also may be covered. Lunch breaks, however, are typically not covered; the one exception is a cafeteria on company premises. Accidents that happen on a lunch break in a company cafeteria may be covered by workers’ compensation.
Injuries that may be covered by workers’ compensation include the obvious: a serious injury resulting from a one-time accident. For example, broken bones, amputation or loss of limb, paralysis, traumatic brain or spinal cord injury, burns and permanent scarring or disfigurement.
And then there are those injuries that result from repetitive stress or motion, think: carpal tunnel syndrome, nerve damage or ligament, tendon and muscle injury. Joint and connective tissue injuries, like foot, ankle, leg and hip trauma, may also be covered.
Illness can refer to either a physical illness or a mental illness. Occupational disease, such as mesothelioma, silicosis and heart disease are examples of physical illnesses which may result from workplace conditions. On the mental health side, examples include depression, stress and anxiety.
It can be difficult to prove that your mental illness is a result of your job, which makes it easy for insurance companies to deny coverage. This is also the case with a pre-existing condition that has been exacerbated by a job-related task or workplace condition. The insurance company will argue that the fact that your condition has worsened has nothing to do with your job. In situations like these, documentation and witness statements become critical and an attorney becomes invaluable.
Ultimately, while at first thought workers’ compensation seems straightforward – you get hurt at work and workers’ compensation covers your medical bills and provides wage replacement – the system is actually incredibly nuanced, which is why hiring an attorney can be beneficial. A workers’ compensation attorney can help you determine whether your illness or injury qualifies for workers’ compensation and help you figure out your next steps.
If you miss three or more shifts or days of work due to an injury or illness sustained in the workplace, you may be eligible for temporary disability benefits. These benefits are equal to two-thirds of the average weekly wage you were receiving on the date of your injury, up to the maximum amount set by the State of Colorado, which is currently $939.82 per week (as of July 1, 2016).
Temporary disability benefits become available when an employee is temporarily unable to work due an injury or illness sustained in the workplace. There are two types of temporary disability: temporary partial disability and temporary total disability.
Temporary total disability applies when a sick or injured worker is temporarily but totally disabled and unable to earn wages.
Temporary partial disability applies when a sick or injured worker:
- returns to work before receiving what is called maximum medical improvement (which is when the treating physician determines that the injured worker has reached a state where his or her medical condition is stable and no additional treatment can further improve the condition);
- is not released to usual duties or returns to modified duty with reduced wages or hours; or
- is earning less than the average weekly wage.
Permanent Partial Disability
A permanent partial disability is a permanent loss of function to a body part or body system. This is broken down into two categories: scheduled impairment and whole person impairment.
- Scheduled Impairment: Loss of function affecting the toes, feet, legs, fingers, hands, arms, eyes, vision or hearing. Compensation is based on a schedule of values, defined by the State of Colorado, related to each body part.
- Whole Person Impairment: Also called Non-Scheduled Impairment. Loss of function affecting a body part or system not included on the list of scheduled impairments.
Our legal guide, “Injured at Work: Your Guide to Colorado Workers’ Compensation” includes detailed information about how permanent partial disability benefits are calculated by the State of Colorado.
Permanent Total Disability
Permanent total disability benefits become available when a sick or injured worker’s doctor declares that the worker is no longer able to work in any capacity due to a permanent and total disability.
If your doctor determines you have reached maximum medical improvement, you will be evaluated for a permanent disability. If it is determined that you have a permanent disability that prevents you from working altogether, you will be entitled to permanent total disability benefits. These benefits are calculated in the same way as temporary total disability benefits (two-thirds of your weekly salary at the time of your injury).
Robinson & Henry’s workers’ compensation attorneys can help you calculate your total potential benefits, whether permanent or temporary.
Workers’ Compensation Claim Denials and Appeals
The insurance company has 20 days from when your employer informs them of your injury to notify you of whether your claim has been approved or denied. If your claim is denied, you have 45 days from the date on the denial letter to file an appeal. The evidence you file in your initial appeal hearing is of paramount importance to your case; you’ll want to include testimonies from witnesses like co-workers who saw your accident and from your doctor(s), medical records and other documents that support your claim.
Ultimately, the appeal process can be lengthy and complicated, which is why the attorneys at Robinson & Henry are here to help. If you’ve been injured at work the first thing you should do is seek medical attention, the second is notify your employer of your injury, and the third is call Robinson & Henry at 303-688-0944 to schedule a consultation.