Division of Workers’ Compensation Claims Unit · Workers’ Claim for Compensation, ... Final...
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Division of Workers’ Compensation Claims Unit
Transcript of Division of Workers’ Compensation Claims Unit · Workers’ Claim for Compensation, ... Final...
Division of Workers’ Compensation Claims Unit
Filing an Admissionor“How to Avoid an Error Letter”
Filing a Position Statement
A position statement (either a Notice of Contest or an Admission) must be filed within 20 days after the date of the First Report of Injury.
It is a legal statement of the carrier’s liability for workers’ compensation benefits defined by statute.
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▪ The Division carefully reviews admissions for completeness, accuracy, and supporting documentation.
▪ If an admission is deficient in one or more of these areas, an Error Letter is sent to the claims handler to correct the deficiency.
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General Admission of LiabilityForm WC2 Rev 07/14
1 - Average Weekly Wage (AWW)
2 - Benefit History
3 - Adjuster Contact Information
4 - Certificate of mailing
5 – Carrier Block #, Adjuster Code
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• If an AWW is different from what is listed on the Employer’s First Report of Injury and/or the Workers’ Claim for Compensation, include wages and calculations to support the admitted AWW with the first admission for benefits.
o Use the AWW calculation worksheet.
1AVERAGE WEEKLY WAGE (AWW)
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Check all TTD dates and totals twice to confirm accuracy.
Document termination of temporary benefits (TTD or TPD) pursuant to Rule 6. If terminating per one of the subsections, all components of
that subsection must be satisfied and sent with the admission. If applying an offset, the documentation for the offset and the
calculations must be included with the admission. Once admitted, DO NOT omit or reduce the TTD rate without
petitioning per Rule 6 or documenting the basis for an offset. Verify that the time period admitted corresponds to the time
period listed on the supplemental report of return to work and that the date of return is not later than the date signed.
Send written documentation of the TPD rates and periods. Use a TPD worksheet to document the TPD benefits admitted
and paid.
2BENEFIT HISTORY
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The name, address, telephone number and e-mail address of the administrator(s) responsible for its claims adjusting.
If you sign your name, please print your name next to the signature.
3ADJUSTER INFORMATION
4CERTIFICATE OF MAILING
Must be current
5CARRIER BLOCK #, ADJUSTERS CODE
Cross reference for reports
“ Once you have admitted liability, you cannot file a Notice of Contest (NOC) without an Order. The GA or FA supersede the NOC.
You can; however, file a GA after a NOC.
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Final Admission of LiabilityWC4 Rev 03/19
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The admission shall state the insurer’s position on the provision of medical benefits after maximum medical improvement.
The admission shall make specific reference to the medical report by listing the physician's name and the date of the report in the remarks section of the admission.
CALCULATIONSREMARKS
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When the final admission is predicated upon medical reports; the following shall accompany the admission:
1. A completed Physician’s Report of Workers’ Compensation Injury form WC164,
2. A narrative report 3. Appropriate worksheets
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WC1641. Date of MMI
2. Post MMI Care
3. Permanent Medical Impairment
4. Authorized Treating Physician (ATP) signature or countersignature
5. Date of the Report
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NARRATIVE
IMPAIRMENT RATING WORKSHEET
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Subsequent AdmissionsSubsequent admissions must reflect all benefits previously admitted. Only benefits that are statutorily owed should be listed in the Benefit History section of the admission.Every new admission supersedes / replaces the previous and stands on its own. If you are responding to an error letter, particularly Final Admissions, you should attach all required supporting documents again.
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CLAIMS MANAGEMENT UNIT
If you have any questions, please contact your Claims Manager
Joyce Meaux [email protected]
David Clark [email protected]
William Quinones [email protected]
Kimberly Joyce [email protected]
Liz Urrutia [email protected]
Stephanie Nichols [email protected]
Claims Supervisor:Bert Sandoval [email protected]
303-318-8768Manager of Compensation Services:Amy Kingston [email protected]
303-318-8627
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RESOURCES AND
REFERENCESAll forms filed with the Division need the following minimum requirements or they cannot be processed:
▪ Type or print legibly in blue or black ink.▪ Complete all applicable fields.▪ Please include remarks.
The Division will assign a WC# upon receipt of a FROI.▪ List WC# on all position statements.▪ Include assigned Block Numbers and TPA codes.
DIVISION FORMS on our Websitehttps://www.colorado.gov/cdle/dwc/forms
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Rule 5 Claims Adjusting Requirements
Rule 6 Modification, Termination or Suspension of Disability Benefits
Rule 7 Closure of Claims and Petitions to Reopen
2019 Workers' Compensation Act
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Thanks!Any questions?
