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Claims adjusting in the Colorado workers’ compensation system requires extensive knowledge of and compliance with all statute and rule requirements governing the handling of claims. It is the first point at which the facts of a claim are reviewed in light of thresholds established by law. Reviewing all available information, the adjuster must timely state a position and either assign liability to its insurer, or deny liability for the payment of benefits in the first instance.
2017 Legislative Advisory
Important Rules of Procedure
Rule 4 Carrier Compliance
Rule 5 Claims Adjusting Requirements
Rule 6 Modifications, Termination or Suspension of Temporary Disability Benefits
Rule 7 Closure of Claims and Petitions to Reopen
Rule 8 Authorized Treating Physician
Rule 9 Division of Workers' Compensation Dispute Resolution
Rule 10 Medical Utilization Review
Rule 11 Division Independent Medical Examinations
Rule 16 Utilization Standards
Rule 17 Medical Treatment Guidelines
Rule 18 Medical Fee Schedule
The Adjuster’s Guide was developed by the Division of Workers' Compensation as an informational tool for claims adjusting in Colorado. Generally, the information pertains to claims with dates of injury on or after July 1, 1991, when significant reform legislation was signed into law. The Workers’ Compensation Act of Colorado can be accessed through our website or a copy may be obtained from Customer Service. If this Guide does not answer a specific question or if you would like to schedule tailored training to meet the specific needs of your organization, contact us at 303-318-8700.
These calculators can assist your through the claims adjustment process.
In an effort to determine an injured worker’s satisfaction with the handling of his or her claim, insurers are required to conduct a survey within 30 days after a claim is closed. The survey asks injured workers to respond to questions on courtesy, promptness of medical care, promptness of handling and resolving the claim, as well as overall satisfaction with the insurer.
Injured workers are asked to grade the insurer on a scale of 1 to 5, with 1 being the least satisfied and 5 being the most satisfied. For survey requirements, see Rule 5-14>
Send in first reports and subsequent injuries online and access trading partner forms.
At the time a position statement is mailed, the insurer must provide the claimant with a copy of the Claimant Brochure describing the claims process and informing the claimant of his or her rights.
Division of Workers' Compensation
633 17th Street, Suite 400
Denver, CO 80202
303-318-8700 (Metro Area)