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What Benefits Are Available in a Colorado Workers' Compensation Claim?

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What workers' comp benefits can you receive, and how much?

Experienced Denver work injury attorneys explain the different types of workers' comp benefits available to injured workers, and their limits.

Workers who are injured on the job or diagnosed with an occupational disease are entitled to certain benefits under Colorado's workers' compensation laws.

These benefits fall into 4 categories:

Medical benefits
Lost wage and disability (temporary and permanent) benefits
Disfigurement
Death benefits

What specific workers' compensation benefits you are eligible for largely depends on the severity of your injury, how long it takes to treat it, what care is required for the long term and whether it causes permanent impairment or not.

What's more, with the exception of medical benefits, which pay all expenses for your medical care and treatment, there are limitations on how much compensation you can receive—chiefly temporary disability and permanent partial disability benefits.

Most full and part-time employees who work for the state of Colorado or in the private sector are covered by workers' compensation insurance from the first day they start working. However, there are a few instances where folks are not eligible for benefits. Examples include:

Part-time maintenance/repair workers performing less than $2,000 in work for a business in a year
Licensed real estate agents working on commissions
Independent contractors who perform specific jobs
Federal and railroad employees (subject to federal workers' comp laws)

If you're a full or part-time employee at a business in Colorado, then you're likely covered by workers' compensation and eligible for benefits.

Continue reading or contact our Denver work injury attorneys to better understand these limitations on workers' compensation benefits in Colorado.

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1. Medical Benefits Under Workers' Compensation

In Colorado, nearly all employers are required to provide medical benefits needed to care for and treat the effects of a work-related injury or occupational disease suffered by an employee. These medical benefits must be provided without any deductible, co-pay, co-insurance or other financial obligation from the injured worker.

In other words:

Medical benefits must be provided at no charge to the injured employee.

The medical benefits provided under workers' compensation typically include all of the medical treatment you would expect in connection with an injury, such as doctor's appointments, hospitalizations, medications, therapy, x-rays, MRIs, surgery, etc.

The definition of the medical benefits an employer is required to provide has historically been interpreted broadly by Colorado's courts and judges. It has been determined to include medical treatment you may not commonly think of in connection with a workers' compensation claim.

For example, in one case, an employer was required to treat an injured worker's cancer that was preventing the worker from undergoing a back surgery needed due to a work injury. Another employer had to treat injuries sustained in a car accident an employee was involved in while driving to a medical appointment for a different work-related injury.

Unlike other workers' compensation benefits, there is no time limit or monetary cap on the medical benefits provided under a workers' compensation claim. Medical treatment can be as short as a single appointment or as long as an entire lifetime, and benefits can pay anywhere from a few dollars to several millions.

There are no ifs, ands or buts here – most Coloradoans are entitled to medical benefits under Colorado law. Don't believe your employer or their workers' comp insurer if they tell you they're not responsible for paying your medical bills for an injury sustained in the course of your employment.

Travel Expenses To and From Medical Appointments

Another important but often overlooked medical benefit provided by workers' compensation is transportation to and from medical appointments. Your employer must either provide you with transportation in the form of a shuttle service, bus or cab vouchers, or they must reimburse you for vehicle mileage if you drive yourself.

2. Lost Wage & Disability Benefits Under Workers' Compensation

During the course of your treatment, you may have to miss work and/or your physician will restrict your job duties. If these restrictions prevent you from performing your pre-injury job and earning your pre-injury wage, you are entitled to receive wage loss or disability benefits.

Under Colorado law, an injured worker is only entitled to workers' compensation disability benefits if their period of disability lasts for longer than 3 days or shifts. This initial 3-day/shift waiting period is not compensated unless the injured worker is out of work for longer than 2 weeks.

Furthermore, the state of Colorado places limits or "caps" on the category of compensation known as "lost wages" or "indemnity benefits." This category can be further broken down into subcategories depending on the severity of the injury:

Temporary partial disability (TPD)

Temporary total disability (TTD)

Permanent partial disability (PPD)

Permanent total disability (PTD)

What Are Temporary Disability (TPD and TTD) Benefits?

Injured workers are commonly given work restrictions while they are undergoing medical treatment for an occupational injury or disease. If these restrictions prevent you from performing pre-injury employment and earning pre-injury wages, you will be entitled to wage loss benefits called "temporary disability" benefits.

Temporary disability benefits are compensation for wages you are losing if you're unable to work during treatment for an injury or occupational disease. Generally, you receive 2/3 of your average weekly wage for the duration of your treatment.

If you or a loved one are completely prevented from working, you will receive temporary total disability (or TTD) benefits equal to two-thirds of your average weekly wage.

If the injured worker is able to work part-time or if the employer offers modified duty within the worker's restrictions—and the injured worker is earning less than their pre-injury income—then the injured worker will be entitled to temporary partial disability (or TPD) benefits equal to two-thirds of the difference between the injured worker's pre-injury average weekly wage and what they are earning from the part-time or modified employment. Temporary partial disability means you can still work, but in a limited role.

What Are Permanent Disability (PPD and PTD) Benefits?

Permanent disability benefits are awarded after your treating physician determines you have achieved maximum medical improvement (MMI)—or the point where your medical condition quits improving and stabilizes.

Once an injured worker reaches MMI, their treating physician will determine if they have reached their pre-injury condition or if the injured has permanent impairment. If the injured worker has permanent impairment, they will be entitled to permanent disability benefits. Permanent disability benefits fall into one of 2 categories.

If you have a permanent impairment but can work in some capacity, you are considered permanently partially disabled and entitled to certain benefits up to a limit. This shouldn't be confused with permanent total disability, which means you're fully disabled and cannot return to any kind of job whatsoever.

A vast majority of cases where an injured worker is entitled to permanent disability benefits involve permanent partial disability (or PPD) benefits. Permanent partial disability means you have some condition that will be a permanent part of your life but you are still able to hold down a job.

Permanent Disability Benefits (PPD and PTD)

In these cases, the treating physician assigns a percentage for the permanent impairment the person has sustained. The impairment percentage is calculated using the latest Guides to the Evaluation of Permanent Impairment issued by the American Medical Association and generally includes amounts for range of motion loss and for specific disorders or conditions.

The percentage assigned by the physician is then plugged into one of 2 mathematical equations to get the amount of PPD benefits the injured worker is entitled to. PPD awards can be as little as a few hundred dollars and as large as $150,000– it all depends on the whole person rating.

If an injured worker is unable to return to any gainful employment of any kind as a result of a work injury or illness, then they are considered permanently and totally disabled—and therefore eligible for permanent total disability (or PTD) benefits. Permanent total disability means your condition is so severe that you are unable to work at all.

An injured worker who is permanently and totally disabled will receive two-thirds of their average weekly wage for the rest of their life—or until they are no longer permanently and totally disabled.

While a worker's long-term work restrictions as a result of an injury weigh heavily in determining whether they are permanently and totally disabled, other factors also influence this determination. For example, a judge might also look at their education and work experience, as well as the labor market, to determine what jobs are realistically available to the disabled worker.

Generally, an injured worker with limited education and experience who lives in an area with less available jobs is more likely to be classified as permanently and totally disabled. Both permanent partial and permanent total disability awards are payable in weekly installments, a lump sum payment or some combination of the two.

Maximum Compensation for Weekly Disability Benefits

Caps for disability benefits change each year and are determined by several factors but, in principle, the cap depends on the impairment rating the treating physician assigns to you once you reach MMI. It's important to note that benefit caps do not take effect until the treating physician declares you have reached MMI.

Temporary disability benefits should equal two-thirds of your average weekly wage at the time of your injury or sickness, but this compensation is capped at a certain limit that is set by the Colorado Division of Workers' Compensation. This limit is updated each year based on the cost of living and inflation, as well as the statewide average wages.

The maximum temporary disability benefit rate for injuries that occur between July 1, 2021 and June 30, 2022 is $1,158.92 per week. In order to receive this amount, you must have earned $1,738.36 per week or more at the time of your injury illness.

Here are the maximum weekly disability benefit rates for previous years:

Date of injury or illness	Maximum weekly disability benefits
July 1, 2020 – June 31, 2021	$1,074.22
July 1, 2019 – June 31, 2020	$1,022.56
July 1, 2018 – June 31, 2019	$987.84
July 1, 2017 – June 31, 2018	$948.15
July 1, 2016 – June 31, 2017	$939.82

Maximum Compensation for Combined Total Disability Benefits

In addition to placing limits on how much an injured worker can receive in weekly disability benefits, Colorado caps the amount you can receive for total combined temporary and permanent disability.

For injuries that occurred between July 1, 2020 and June 30, 2021, the cap for combined temporary and permanent partial disability benefits is $99,094.93 if your impairment rating is 25% or less and $198,187.35 if your impairment rating is higher than 25%.

How Are Impairment Ratings Assigned?

Doctors assign an impairment rating based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, 3rd Edition (Revised)—or more commonly known as the "AMA Guides." Doctors assign ratings to the parts of your body affected by your injury. For example, they may assign an injured arm, shoulder, neck or psychological rating.

Once assigned, this rating is converted to your "whole person" equivalent using the appropriate tables in the AMA Guide. Once the whole person equivalent is determined for each extremity rating, those figures are added together to generate your impairment rating.

3. Disfigurement Awards Under Workers' Compensation

An injured worker who has permanent and visible scarring as a result of a work-related injury or accident will be entitled to a lump sum disfigurement award.

For injuries occurring after July 1, 2007, the maximum standard disfigurement award is $4,000. For injuries prior to that date, the maximum cap is $2,000. Extensive disfigurement is capped at $8,000 for injuries occurring on or after July 1, 2007.

However, you know that disfigurement awards change each year to adjust for inflation, which is why it's important to consult with a knowledgeable attorney near you to determine how much you may be owed.

4. Death Benefits Under Workers' Compensation

Workers' compensation death benefits were put in place in Colorado so that family members and other dependents would not be left out in the cold if their loved one tragically died in a workplace accident. These benefits often serve as an important lifeline for individuals and families when the unthinkable happens.

Unfortunately, obtaining these vital benefits can sometimes be a challenge in itself.

Losing a loved one in a workplace accident is difficult enough without the hassles of obtaining compensation. Just when you thought things couldn't get any lower, you find out that the workers' comp insurer is denying you and your family much needed benefits you're entitled to under the law.

If someone is killed in a work accident or dies as a result of a work-related injury or occupational disease, the deceased person's dependents are entitled to death benefits. Death benefits generally equal two-thirds of the injured worker's average weekly wage and continue for different periods of time depending on who the surviving dependents are.

How long death benefits last depends on your relationship to the deceased. A surviving spouse receives death benefits for the rest of their life or until they remarry. Dependent children, including adopted children, receive death benefits until they turn 18 years old (or 21 years old if they are in school full-time when they become an adult).

Surviving spouses and children under 18 years old are presumed to be dependents of a deceased worker.

Parents, grandparents, siblings, and adult children can also be entitled to death benefits if they can show they were either wholly or partially dependent on the deceased worker. Partial dependents will receive benefits equal to the amount they were dependent on the worker.

In the event a worker leaves more than 1 surviving dependent, the death benefits should be fairly divided between the surviving benefits for the period they are entitled to benefits. How the benefits are divided among the dependents is within the discretion of the Director of the Division of Workers' Compensation or a judge.

If a worker's death was not caused by a work accident or injury, then the dependents are not entitled to death benefits. However, these dependents may be entitled to some benefits if the worker was receiving workers' compensation benefits at the time of his or her death.

In these cases, the dependents can receive a portion of the benefits that have already been awarded to the injured worker prior to their death.

Maximum Compensation for Death Benefits

Eligible dependents who have lost a spouse, parent or other loved one due to a fatal work accident or illness in Colorado can receive two-thirds of the deceased worker's average weekly wage at the time of his or her death up to a certain limit.

The maximum weekly amount dependents can receive for lost wages is $1,074.22.

The maximum disability benefits lump sum a sole dependent can receive for a fatal injury that occurred on or after January 1, 2014 is $99,094.93. If there are multiple dependents (spouse and children, for example), the aggregate of all lump sums cannot exceed $198,187.35.

In Colorado, an employer or their workers' compensation insurance company must also pay funeral or burial expenses up to a maximum of $7,000. In addition, the employer is responsible for the medical bills in connection with the worker's death.

Calculating Your Workers' Compensation Benefits is Confusing

Getting the right number when calculating what disability benefits you are owed after a work-related injury or illness is complicated—in part because it depends on so many individual and variable factors.

For example, let's say you're being treated for an injury for an extended period of time before the physician declares you have reached MMI. Over the course of your treatment, you have received $50,000 in wage loss/temporary disability benefits. Your final impairment rating is 15%, which may be worth an additional $40,000. But because of the $75,000 cap for impairment ratings under 25%, you will only receive $25,000 in permanent partial disability benefits.

It's theoretically possible for you to be eligible for no permanent partial disability benefits because the amount you have already received in temporary disability benefits exceeds the cap. For instance, if you receive $85,000 in temporary disability benefits before you reach MMI but your impairment rating comes in below 25%, this means you have exceeded $75,000 the cap and will not receive any permanent partial disability benefits.

Also, if you receive benefits up to or exceeding the cap, your future benefits can be affected. Colorado workers' compensation caps can even come into play if you have to reopen your case, which you can do provided you retain the right to do so at the conclusion of your case and you're within the applicable time period for reopening.

For example, let's say you reach MMI and receive the benefits you're entitled to up to the limit. Your case isn't completely settled, however, so you retain your right to reopen the case within 6 years of the original injury.

A couple of years after your initial MMI declaration, problems stemming from the original injury get worse or reappear. But in the original case, you had an impairment rating of 22% and received the maximum payout of $75,000. The additional treatment takes you away from your job once again, but since you already exceeded the cap your employer will be able to offset the permanent partial disability benefits you have already received against future temporary disability benefits.

Here's another example:

Let's say you were injured in January 2019 and out of work for 2 years, during which time you received $52,000 in temporary benefits before the treating physician declared you reached MMI and assigned an impairment rating of 20%. Because of the $75,000 cap, you received $23,000 in permanent partial disability benefits and returned to work, perhaps in a limited role. The insurer filed a "final admission of liability" and the case was closed for the time being.

But after a year back on the job, you start experiencing the same kind of pain again and have to miss work to seek treatment. Since you have reached the $75,000 cap, however, the temporary disability/wage loss benefits you enjoyed before will not kick in for a while. In fact, these benefits will not resume for 46 weeks after you reopen your case.

The 46 weeks figure is determined by dividing the permanent partial disability award of $23,000 by the weekly wage loss rate of $500, which gives you the magic number of 46. Therefore, you will not receive any further temporary disability/wage loss benefits until the insurer "offsets" the previously paid permanent partial disability award.

Confused yet?

Many injured workers are at this stage, which is why you should contact our knowledgeable Colorado work injury attorneys if you're having trouble obtaining the Colorado workers' compensation benefits you're entitled to.

Talk With Us Today – A Free, No-Risk Consultation

Discuss the details of your claim with a Denver workers' compensation lawyer at The Babcock Firm today. No matter where you are in the state of Colorado, if your case falls within our practice area and we feel our representation can benefit you, an attorney will conduct an in-depth consultation at no charge. We are here to help you secure a successful outcome.

Serving Injured Workers Throughout Colorado

From our office in Denver, we represent injured workers across the state—including in Colorado Springs, Littleton, Boulder, Aurora, Broomfield, Louisville, Lafayette, Lakewood, Golden, Thornton, Westminster, Longmont, Loveland, Fort Collins and many other Colorado cities.

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Source: https://www.injurylawcolorado.com/workers-compensation-attorney/workers-compensation-benefits/