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Division of Workers' Compensation

Major Medical & Subsequent Injury

Form

Description

Application for Admission to the Colorado Major Medical Insurance Fund

Form # WC70

Fillable  pdf MS Word

 

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.

Request for Offset of Liability to Subsequent Injury Fund

Form # WC63

Fillable  pdf MS Word


 

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