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Rule 5: Claims Adjusting Requirements (Option 1)

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5-1 COMPLETION OF DIVISION FORMS

(B) Insurers may transmit data in an electronic format only as directed by the Division.

(C) All first reports of injury and notices of contest filed with the Division shall be transmitted electronically via electronic data interchange (EDI) or via the Division's internet filing process. First Reports of Injury and Notices of Contest cannot be submitted via electronic mail.

(D) The Director may grant an exemption to an insurer from filing electronically because of a small number of filings or financial hardship. Any insurer requesting an exemption from electronic filing may do so in letter form addressed to the Director. The request should provide specific justification(s) for the requested exemption. The letter should address whether an exemption is sought for only EDI or also for internet filing.

(E) In the event compliance with 5-1(C) is prevented by technological errors beyond the control of the filing party, a waiver may be requested by submitting the division-issued paper form along with a cover letter addressed to the Director identifying the reason for the request. Upon receipt of a request the Division will either accept the paper form or notify the filing party that electronic submission will be required.

5-2 FILING OF EMPLOYERS’ FIRST REPORTS OF INJURY

(A) Within ten days of notice or knowledge an employer shall report any work-related injury, illness or exposure to an injurious substance as described in subsection (F), to the
employer's insurer. An employer who does not provide the required notice may be
subject to penalties or other sanctions.

(B) A First Report of Injury shall be filed with the Division in a timely manner whenever any of
the following apply. The insurer or third-party administrator may file the First Report of
Injury on behalf of the employer.

(1) If an injury results in a fatality, or three or more employees are injured in the
same accident, in addition to filing a first report, the Division customer service
unit shall be notified via telephone within twenty four (24) hours of notice of such
an occurrence.

(2) Within ten days after notice or knowledge by an employer that an employee has
contracted an occupational disease listed below, or the occurrence of a
permanently physically impairing injury, or that an injury or occupational disease
has resulted in lost time from work for the injured employee in excess of three
shifts or calendar days. An occupational disease that falls into any of the
following categories requires the filing of a First Report of Injury:

(a) Chronic respiratory disease;

(b) Cancer;

(c) Pneumoconiosis, including but not limited to Coal worker’s lung,
Asbestosis, Silicosis, and Berylliosis;

(d) Nervous system diseases;

(e) Blood borne infectious, contagious diseases.

(3) Within ten days after notice or knowledge of any claim for benefits, including
medical benefits only, that is denied for any reason.

(C) The insurer shall state whether liability is admitted or contested within 20 days after the
date the employer's First Report of Injury is filed with the Division. If an Employer's First
Report of Injury should have been filed with the Division, but wasn't, the insurer's
statement concerning liability is considered to be due within 20 days from the date the
Employer's First Report of Injury should have been filed. The date a First Report of Injury
should have been filed with the Division is the last day it could have been timely filed in
compliance with paragraph (B) above.

(D) The insurer shall state whether liability is admitted or contested within 20 days after the
date the Division mails to the insurer a Worker's Claim for Compensation or Dependent's
Notice and Claim for Compensation.

(E) A statement regarding liability is required for any claim in which a division-issued workers'
compensation claim number is assigned or a First Report of Injury should have been filed
pursuant to paragraph (B) of this rule. A statement regarding liability shall not be filed
without a First Report of Injury, Worker's Claim for Compensation, or Dependents Notice
and claim having been successfully filed and assigned a workers’ compensation claim
number. A first report of injury must be filed prior to a notice of contest being accepted by
the division.

(F) In the format required by the Director, each insurer shall submit a monthly summary
report to the Division containing the following:

(1) Injuries to employees that result in no more than three days' or three shifts' loss
of time from work, no permanent physical impairment, no fatality, or contraction
of an occupational disease not listed in subsection (B) of the rule; and

(2) Exposures by employees to injurious substances, energy levels, or atmospheric
conditions when the employer requires the use of methods or equipment
designed to prevent such exposures and where such methods or equipment
failed, was not properly used, or was not used at all.

(A)

(B) Insurers may transmit data in an electronic format only as directed by the Division.

(C) All first reports of injury and notices of contest filed with the Division shall be transmitted
electronically via electronic data interchange (EDI) or via the Division's internet filing
process. First Reports of Injury and Notices of Contest cannot be submitted via electronic
mail.

(D) The Director may grant an exemption to an insurer from filing electronically because of a
small number of filings or financial hardship. Any insurer requesting an exemption from
electronic filing may do so in letter form addressed to the Director. The request should
provide specific justification(s) for the requested exemption. The letter should address
whether an exemption is sought for only EDI or also for internet filing.

(E) In the event compliance with 5-1(C) is prevented by technological errors beyond the
control of the filing party, a waiver may be requested by submitting the division-issued
paper form along with a cover letter addressed to the Director identifying the reason for
the request. Upon receipt of a request the Division will either accept the paper form or
notify the filing party that electronic submission will be required.

(A) Within ten days of notice or knowledge an employer shall report any work-related injury,
illness or exposure to an injurious substance as described in subsection (F), to the
employer's insurer. An employer who does not provide the required notice may be
subject to penalties or other sanctions.

(B) A First Report of Injury shall be filed with the Division in a timely manner whenever any of
the following apply. The insurer or third-party administrator may file the First Report of
Injury on behalf of the employer.
(1) If an injury results in a fatality, or three or more employees are injured in the
same accident, in addition to filing a first report, the Division customer service
unit shall be notified via telephone within twenty four (24) hours of notice of such
an occurrence.
(2) Within ten days after notice or knowledge by an employer that an employee has
contracted an occupational disease listed below, or the occurrence of a
permanently physically impairing injury, or that an injury or occupational disease 
has resulted in lost time from work for the injured employee in excess of three
shifts or calendar days. An occupational disease that falls into any of the
following categories requires the filing of a First Report of Injury:
(a) Chronic respiratory disease;
(b) Cancer;
(c) Pneumoconiosis, including but not limited to Coal worker’s lung,
Asbestosis, Silicosis, and Berylliosis;
(d) Nervous system diseases;
(e) Blood borne infectious, contagious diseases.
(3) Within ten days after notice or knowledge of any claim for benefits, including
medical benefits only, that is denied for any reason.

(C) The insurer shall state whether liability is admitted or contested within 20 days after the date the employer's First Report of Injury is filed with the Division. If an Employer's First Report of Injury should have been filed with the Division, but wasn't, the insurer's statement concerning liability is considered to be due within 20 days from the date the
Employer's First Report of Injury should have been filed. The date a First Report of Injury
should have been filed with the Division is the last day it could have been timely filed in
compliance with paragraph (B) above.

  1. “Act” means articles 40 through 47 of title 8 of the Colorado Revised Statutes.
  2. “Claimant” means an employee or dependent(s) of a deceased employee claiming entitlement to benefits under the Act. For the purpose of notification and pleadings, the term claimant shall include the claimant’s legal representative.
  3. “Director” means the Director of the Division of Workers’ Compensation.
  4. “Division” means the Division of Workers’ Compensation in the Department of Labor and Employment.
  5. “Electronically recorded” means a recording made using tape recording, digital recording, or some other generally accepted medium.
  6. “Employee” means an individual who meets the definition of “employee” in the Act.
  7. “Employer” means anyone who meets the definition of “employer” in the Act.
  8. "Insurer” means every mutual company or association, every captive insurance company, and every other insurance carrier, including Pinnacol Assurance, providing workers’ compensation insurance in Colorado and every employer authorized by the Executive Director of the Department of Labor and Employment to act as its own insurance carrier as well as any workers’ compensation self-insurance pool authorized pursuant to statute.
  9. “Notice” means actual or constructive knowledge.
  10. “Service” means delivery via United States mail, hand delivery, facsimile or, with consent of the party upon whom the documents are being served, electronic mail.
  1. be made in writing and addressed to the Director
  1. “Claimant” means an employee or dependent(s) of a deceased employee claiming entitlement to benefits under the Act. For the purpose of notification and pleadings, the term claimant shall include the claimant’s legal representative.
  1. “Director” means the Director of the Division of Workers’ Compensation.
  2. “Division” means the Division of Workers’ Compensation in the Department of Labor and Employment.

  1. Requests made to the Division of Workers’ Compensation pursuant to §8-47-203(2), C.R.S., for copies or inspection of orders entered by the Director or an administrative law judge shall:
    1. de in writing and addressed to the Director and,
    2. state the name of the requester and include the requester’s mailing address and phone number; and,
    3. specifically identify the criteria for orders being requested. For example, all orders on the merits from a specific time period or all orders involving specified issues or injuries, etc.; and
    4. state the purpose for reviewing the orders.

  2. The requester shall provide any additional information required by the Division. After receiving such a request the Division will provide a cost estimate for processing the request. The requester may agree to pay the costs involved or decline further processing of the request. At the discretion of the Division payment may be required prior to the work being performed.