Major Medical and Subsequent Injury Funds

 Form

 Description

 Formats

 Request for Offset of Liability to Subsequent Injury Fund

Form # WC63

 This form is used by the insurer to request that the Subsequent Injury Fund assume responsibility for payment of compensation and/or medical benefits.

  PDF

 MS Word

 Application for Admission to the Colorado Major Medical Insurance Fund

Form # WC70

 This application is used by the insurer to request that the Major Medical Insurance Fund assume responsibility for payment of medical benefits, following expenditures of $20,000.00 or more in medical benefits by the insurer.  It is applicable to injuries occurring on or after 7/1/71 to 7/1/81.

  PDF

 MS Word