Rule  1           General Definitions and General Provisions

1-1        THE FOLLOWING DEFINITIONS SHALL APPLY UNLESS OTHERWISE INDICATED IN THESE RULES

(A)        “Act” means articles 40 through 47 of title 8 of the Colorado Revised Statutes.

(B)        “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.

(C)        “Director” means the Director of the Division of Workers’ Compensation.

(D)        “Division” means the Division of Workers’ Compensation in the Department of Labor and Employment.

(E)        “Electronically recorded” means a recording made using tape recording, digital recording, or some other generally accepted medium.

(F)        “Employee” means an individual who meets the definition of “employee” in the Act.

(G)        “Employer” means anyone who meets the definition of “employer” in the Act.

(H)        "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.

 (I)        “Notice” means actual or constructive knowledge.

1-2        COMPUTATION OF TIME/DATE OF FILING

Unless a specific rule or statute states to the contrary, the date a document or pleading is filed is the date it is mailed or hand delivered to the Division of Workers’ Compensation or the Office of Administrative Courts.  Computation of days is consistent with Rule 6 of the Colorado Rules of Civil Procedure.

1-3        NOTARIZATION OF AUTHORIZATION FOR RELEASE OF INFORMATION

The claimant’s signature must be notarized on all releases filed with the Division of Workers’ Compensation pursuant to §8-47-203(1)(e), C.R.S.

1-4        SERVICE OF DOCUMENTS

(A)        Whenever a document is filed with the Division, a copy of the document shall be mailed to each party to the claim and attorney(s) of record, if any.

(B)        Any document that is certified as mailed, including admissions, must be placed in the U.S. mail or delivered on the date of certification.

(C)        Vocational reports for claims based upon an injury on or after July 2, 1987 at 4:16 p.m. shall not be filed with the Division except when requested by the Director, when attached to a final admission.  If the claimant participates in a vocational evaluation, or if the insurer offers vocational services and the claimant accepts, written reports must be produced and should be produced within 30 days and a copy of every vocational report not filed with the Division shall be exchanged with all parties within 15 working days of receipt.

1-5        REQUESTS FOR ORDERS UNDER §8-47-203(2), C.R.S.

(A)        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)        be made 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.

(B)        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.

(C)        To protect the confidentiality of the claimant and the employer named in the requested orders:

(1)        requests shall not be accepted for orders based on claimant or employer names, or other uniquely identifying claimant or employer information; and,

(2)        requests shall not be accepted for any criteria resulting in the inclusion of fewer than three claimants or employers in the group of orders inspected, unless approved by the Director or the Director’s designee.

1-6        MEDIATION

 Parties to a dispute may consent to submit any dispute to mediation pursuant to the provisions of  §8-43-205, C.R.S.  Requests for mediation should be filed with the Division of Workers’ Compensation.

1-7        PENALTIES

Whenever any rule in the Workers’ Compensation Rules of Procedure has been violated, the Director may impose penalties authorized by the Act.

1-8        EMPLOYER CREDIT FOR WAGES PAID UNDER §8-42-124(2), C.R.S.

(A)        An employer who wishes to pay salary or wages in lieu of temporary disability benefits may apply to the Director for authorization to proceed pursuant to §8-42-124(2), C.R.S.

(B)        The application to the Director shall contain the following information:

(1)        a reference to the contract, agreement, policy, rule or other plan under which the employer wishes to pay salary or wages in excess of the temporary disability benefits required by the act, and

(2)        a description of the employees covered by the application and a statement that these employees will not be charged with earned vacation leave, sick leave, or other similar benefits during the period the employer is seeking a credit or reimbursement.

(C)        An employer who has received approval from the Director to proceed under §8-42-124(2), C.R.S., shall indicate on the employer’s first report of injury form whether the claim is subject to §8-42-124, C.R.S.   

Rule 2            Workers’ Compensation Premium Surcharges

2-1     PREMIUM REPORTING REQUIREMENTS

Every insurance carrier shall semi-annually file a surcharge return with the Division within the time period specified in section 2-4 of this rule. The return shall be verified by affidavits of its president and secretary or other chief officers or agents, and shall state the amount of premiums written, including any policy expense constants, membership fees, finance and service, or other administrative fees charged to the policyholder in connection with the issuance or renewal of a policy, as reported to the Division of Insurance in accordance with  §10-3-208, C.R.S., and regulations promulgated thereunder, during the period covered by such return. With this filing the insurance carrier shall pay the surcharges required by statute. Forms for such returns shall be provided by the Division.

2-2        PAYROLL REPORTING REQUIREMENTS

Every self-insured employer shall semi-annually file a surcharge return with the Division, within the time period specified in section 2-4 of this rule. The return shall be verified by affidavits of its president and secretary or other chief officers or agents, and shall state the total amount of its payroll for the period covered by such return. With this filing the employer shall pay the surcharges required by statute. Forms for such return shall be provided by the Division.

2-3        COMPUTATION OF PAYROLL SURCHARGES PAID BY SELF-INSURED EMPLOYERS

(A)        Surcharges paid by self-insured employers shall be based upon the manual premium, adjusted by Pinnacol Assurance discounts applicable for the surcharge period covered and modified by the experience rating factor as calculated by the National Council on Compensation Insurance (NCCI). No other rating factor shall be allowable. The self-insured employer may elect not to provide such a rating factor; however, failure to submit the required rating factor will result in the premium surcharge being computed on the basis of manual premium only.

(B)        If the self-insured employer is unable to develop the experience rating factor due to the unavailability of reliable and adequate data, the employer may apply to the Director for approval to use a 1.0 experience rating factor for the following two semiannual surcharge periods. If at the conclusion of the two semiannual surcharge periods that the 1.0 factor is used, the NCCI has been unable to develop an experience modification, the Director may permit an extension of time for the 1.0 factor to be used.

(C)        In order that consideration be given to the experience modification, a completed NCCI form setting forth all of the information and methodology used in the calculation of the experience modification shall accompany each corresponding payroll report.

2-4        PAYMENT PERIODS AND CREDITS

(A)        The premium and payroll surcharges for the semiannual period beginning July 1, shall be based upon premiums written, including any policy expense constants, membership fees, finance and service, or other administrative fees charged to the policyholder in connection with the issuance or renewal of a policy, as reported to the Division of Insurance in accordance with  §10-3-208, C.R.S., and regulations promulgated thereunder, for Colorado workers' compensation insurance or the self-insured employer's total payroll during the previous six months, and shall be paid to the Division on or before July 31 of that year, with a return form provided by the Division.

(B)        The premium and payroll surcharges for the semiannual period beginning January 1 shall be based upon premiums written, including any policy expense constants, membership fees, finance and service, or other administrative fees charged to the policyholder in connection with the issuance or renewal of a policy, as reported to the Division of Insurance in accordance with  §10-3-208, C.R.S., and regulations promulgated thereunder, for Colorado workers' compensation insurance or the self-insured employer's total payroll during the previous six months, and shall be paid to the Division on or before January 31 of that year, with a return form provided by the Division.

(C)        An insurance carrier is entitled to a credit for canceled or returned premiums, including any policy expense constants, membership fees, finance and service, or other administrative fees charged to the policyholder in connection with the issuance or renewal of a policy, as reported to the Division of Insurance in accordance with §10-3-208, C.R.S., and regulations promulgated thereunder, actually refunded. The credit must be taken as an offset against surcharges due within one year of the date the premium amount was refunded.

(D)        An insurance carrier or employer is not entitled to offset a credit of one subsidiary against the surcharge owed by another subsidiary.

2-5        SURCHARGE RATE

(A)        For the annual period beginning July 1, 2007 and continuing indefinitely with annual review by the Director, the workers' compensation cash fund premium surcharge rate authorized under §8-44-112(1)(a), C.R.S., shall be .80 percent of the amount of all premiums written, including any policy expense constants, membership fees, finance and service, or other administrative fees charged to the policyholder in connection with the issuance or renewal of a policy, as reported to the Division of Insurance in accordance with §10-3-208, C.R.S., and regulations promulgated thereunder, or the premium equivalent amount established in section 2-3 of this rule, for Colorado workers' compensation insurance during the period of January 1, 2007 continuing indefinitely.

(B)        For the purpose of funding the direct and indirect costs of the Premium Cost Containment program of the Division as authorized under §8-44-112(1)(b)(I), C.R.S., there is added to the surcharge imposed pursuant to Section 2-5 of this rule, an additional increment for the annual period beginning July 1, 2007 and continuing indefinitely with annual review by the Director, against workers’ compensation insurance premiums written, including any policy expense constants, membership fees, finance and service, or other administrative fees charged to the policyholder in connection with the issuance or renewal of a policy, as reported to the Division of Insurance in accordance with §10-3-208, C.R.S., and regulations promulgated thereunder, during the period of January 1, 2007, continuing indefinitely. The amount of this assessment shall be 0.03 percent. No assessment shall be imposed upon self-insured employers under this subsection.

(C)        For the purposes of funding the financial liabilities of the Subsequent Injury Fund as authorized under §8-46-102(2)(A)(I), C.R.S. And the Major Medical Fund under §8-46-202, C.R.S., for the period beginning July 1, 2007, and continuing indefinitely with annual review by the Director, the tax shall be assessed at 2.988 percent of the amount of Workers’ Compensation premiums written, including any policy expense constants, membership fees, finance and service, or other administrative fees charged to the policyholder in connection with the issuance or renewal of a policy, as reported to the Division of Insurance in accordance with §10-3-208, C.R.S., and regulations promulgated thereunder, or the premium equivalent amount established in Section 2-3 of this rule, for Colorado Workers' Compensation insurance during the period of January 1, 2007, continuing indefinitely.

Rule 3            Insurance Coverage

3-1        REPORTING REQUIREMENTS FOR INSURANCE CARRIERS AND EMPLOYERS

(A)        The Division designates the National Council on Compensation Insurance, Inc. (NCCI) as its agent to receive, process, and make available to the Division, all the required notices. Insurance carriers shall transmit this data and all other data elements in the electronic format as directed by the Division through NCCI.

(B)        Every insurance carrier shall advise the Division, by filing with NCCI, notice of the issuance or renewal of insurance coverage within thirty (30) calendar days of the effective date of coverage.

(C)        Every insurance carrier shall advise the Division, by filing with NCCI, final notice of the cancellation of insurance coverage no later than thirty (30) calendar days after coverage is actually canceled.  This subsection does not pertain to the preliminary notice of cancellation referenced in §8-44-110, C.R.S.

(D)        Every employer shall provide on request to its insurance carrier all federal employer identification number(s) (“FEINS”) or other taxpayer identification number(s) for all the employer’s business operations, client companies, and/or any other similar employing entities, in Colorado to which the insurance applies.  All changes in FEIN or other taxpayer I.D. numbers shall be reported immediately to the insurance carrier.  The insurance carrier shall report all changes in FEINS and taxpayer I.D. numbers to NCCI within thirty (30) calendar days of receipt.

(E)        For purposes of the performance of the Director’s responsibilities under §8-43-409, the prehearing conference and any hearing that the Director may determine necessary as referenced in §8-43-409(1), may be conducted, as determined by the Director, by any competent person appointed by the Director under § 8-43-208 or § 8-47-101 or by such other person as the Director may designate.

3-2        CARRIER REPRESENTATIVE

Every insurance carrier shall notify the Division’s designated agent of the name, address and telephone number of its representative responsible for reporting coverage information. This information shall be provided within thirty (30) days upon request of either the Division or its agent, or within thirty (30) days of a change in the information.      

3-3        SELF-INSURED EMPLOYERS

(A)        Any pool authorized to self-insure shall advise the Division in writing of the effective date      of self-insurance, the name and address of the pool administrator and the federal             employer identification number of each covered member. This information shall be   provided within thirty (30) days upon request of either the Division or its agent, or within             thirty (30) days of a change in the information.

(B)        All individual self-insurance permit holders shall advise the Division in writing of the federal employer identification number of the permit holder as well as of all covered subsidiaries.  This information shall be provided within thirty (30) days upon request of either the Division or its agent, or within thirty (30) days of a change in the information.

3-4        ELECTION TO REJECT COVERAGE

(A)        An officer of a corporation or a member of a Limited Liability Company who elects to reject the provisions of the Act under §8-41-202, C.R.S., shall complete the Division prescribed form and send it or a substantial equivalent, to the insurance carrier for the corporation’s or company’s other employees, if any, by certified mail.  An agricultural corporation electing to reject coverage for its corporate officers pursuant to §8-40-302(6), C.R.S., shall notify the insurance carrier in writing.  If there is no insurance carrier, such documents shall be provided, by certified mail, to the Division.

(B)        The Notice of Election to Reject Coverage shall become effective the next business day following receipt of the notice by the insurance carrier or, if none, by the Division.

3-5        NOTICES TO EMPLOYEES

(A)        Every employer shall continuously post a notice to employees in one or more conspicuous places on the employer’s work site advising employees that the employer is insured for workers’ compensation as required by law, identifying the name of the employer’s insurance carrier or stating that the employer is self-insured, and containing information about the Colorado workers’ compensation system on a form prescribed or approved by the Division and furnished by the carrier or self-insured.

(B)        Every employer also shall continuously post a notice to employees in one or more conspicuous places on the employer’s work site advising employees that written notice must be given to an employer within 4 working days after an injury as set forth in §8-43-102(1) or (1.5), C.R.S.

3-6        FINES FOR DEFAULTING EMPLOYER

(A)        Following the Director’s determination that an employer has failed to obtain the required insurance or has failed to keep such insurance in force or has allowed the insurance to lapse or has failed to renew such insurance, the Director will impose fines on the defaulting employer and/or will compel the employer to cease and desist its business operations.

(B)        For the Director’s initial finding that an employer is or was in default of its insurance obligations, daily fines up to $250/day for each day of default will be assessed in accordance with the following schedule of fines until the employer complies with the requirements of the Workers’ Compensation Act regarding insurance or until further order of the Director:

Class I             1-20 Days                     $ 5/Day

Class II             21-25 Days                    $10/Day

Class III             26-30 Days                    $30/Day

Class IV            31-35 Days                    $50/Day

Class V            36-40 Days                    $100/Day

Class VI            41 Days >                     $250/Day

(C)        Where the Director determines that an employer was required to but did not have a policy of workers’ compensation insurance in place during any period between July 1, 2005 and the date the employer is sent a Notice to Show Compliance and where such employer has not previously been sent a Notice to Show Compliance, the Director may regard such violation as a Class I violation under Rule 3-6 (B) and impose the fine therein provided for each day of the employer’s default during such period.

 (D)       For the Director’s finding of an employer’s second and all subsequent defaults in its insurance obligations, daily fines from $250/day up to $500/day for each day of default will be assessed in accordance with the following schedule of fines until the employer complies with the requirements of the Workers’ Compensation Act regarding insurance or until further order of the Director:

Class VII                       1- 20 Days        $250/Day         

Class VIII                      21-25 Days        $260/Day

Class IX                        26-30 Days        $280/Day

Class X                         31-35 Days        $300/Day

Class XI                        36-40 Days        $400/Day

Class XII                            41 Days >     $500/Day

Rule 4            Carrier Compliance

 4-1       COMPLIANCE AUDITS

(A)                Every insurer shall submit to compliance audits of its claims by the Division of Workers’ Compensation. The purpose of compliance audits is to examine whether claims are adjusted in accordance with the Workers’ Compensation Act and the Workers’ Compensation Rules of Procedure. Compliance audits are a method for the Division to regulate and oversee the Workers’ Compensation System. A compliance audit conducted pursuant to this Rule 4 is intended to be an autonomous process. 

(1)                 Identifying and underlying claim information examined as part of a compliance audit is accessible only to the insurer under review and shall not otherwise be open to any person except upon order of the Director.  If the Director issues an order in a specific claim the order will be sent to all parties.

(2)                 Division personnel shall give advance written notice of the compliance audit to the insurer and provide an initial list of claims to be audited.  If additional information is requested for the compliance audit, it must be provided.  Unless the Division determines that circumstances warrant otherwise, the insurer will be given at least 15 calendar days notice. 

(3)                 The insurer shall make the claims selected for the compliance audit and any requested information, including training and procedure manuals, available to the auditor at the time and place designated by the auditor.  If the audit requires out-of-state travel by the auditor, the insurer may be required to pay travel costs.

(4)                 Failure to make claims and/or information requested by the auditor available to the auditor for audit shall be considered willful refusal to comply with Division efforts.

(5)        The insurer shall indicate the dates of its receipt on all documents it files with the Division as well as on all medical bills and reports. For those documents required to be exchanged, the insurer shall indicate on the face of the documents or by some other verifiable method, the date the documents were mailed or delivered and to whom they were mailed or delivered.

(B)                A compliance level will be determined for each category examined during the audit. A compliance level is the ratio of deficiencies found within a category in relation to the total number of applicable audit inquiries reviewed in that category. A deficiency is a failure to comply with statute or rule. The categories to be examined during the compliance audit may include but are not limited to the following:

(1)                 Reporting of claims.

(2)                 Initial positions on liability.

(3)                 Timeliness of compensation payments.

(4)                 Accuracy of compensation payments.

(5)                 Medical benefit payments.

(6)                 Termination of temporary disability benefits.

(7)                 Final Admissions.

(8)                 Average Weekly Wage.

(9)                 Waiting period.

(10)             Document exchange.

(C)                For the categories listed in subparagraphs 1 through 7 in paragraph (B) of this Rule 4-1, fines will be imposed for the repeated failure to demonstrate satisfactory compliance. A compliance level of 90% or higher is considered satisfactory compliance.  No fine will be imposed for deficiencies in any category in which satisfactory compliance is determined in the compliance audit.  For the categories listed in subparagraphs 8 through 10 in paragraph (B) of this Rule 4-1, the auditor will comment upon the insurer’s adjusting practices but fines will not be imposed for deficiencies found on compliance audits in those categories.

(D)                After reviewing the insurer’s procedures and examining the claims selected for audit and other information requested, the auditor will provide the insurer with preliminary audit findings, including compliance levels.  Thereafter:

(1)                 The insurer will have thirty (30) calendar days within which to agree in writing with the preliminary audit findings.  If the insurer does not agree with the preliminary audit findings it shall, within the same 30 calendar days, state with particularity and in writing to the auditor its reasons for all disagreements and provide therewith in writing all relevant legal authority, and/or other relevant proof upon which it relies in support of its position(s) concerning its disagreements with the preliminary findings.   

An extension of time not to exceed 30 additional days may be granted to the insurer to submit its written reasons for disagreement and to provide the authority and/or proof upon which it relies as is required by this rule by filing a written request for such extension of time with the auditor prior to the expiration of the 30 calendar days afforded to the insurer to agree with the preliminary findings.  Any disagreement not so submitted to the auditor within the 30 day period or within such additional time as was granted in response to the insurer’s written request for an extension of time is waived.

(2)                 The auditor, the auditor’s manager and the insurer shall have twenty (20) calendar days after submission of the written disagreement with the preliminary audit findings within which to resolve those disagreements and to agree to the preliminary audit findings.

(3)                 If the auditor, the auditor’s manager, and the insurer are unable to agree on the preliminary findings within the 20 day period afforded in paragraph (D)(2) of this Rule 4-1, the preliminary audit findings along with the insurer’s written disagreements will be referred to the Director for the Director’s determination regarding the audit findings. The final determination of the relevance and/or weight given to any authority or proof submitted in connection with the insurer’s disagreements regarding audit findings is reserved to the Director.

(4)                 When a determination regarding audit findings has been made by the Director, the Director will thereafter cause the Final Audit Report to be prepared and/or order such other action as the Director may determine warranted.

(5)                 When the insurer has agreed to the preliminary audit findings without disagreement, or when the insurer fails to disagree therewith in the manner provided in this Rule 4-1(D) or, when the insurer agrees to the preliminary findings before the time for referral to the Director under Rule 4-1(D)(4) has occurred, or when the Director has made a determination regarding audit findings as provided in paragraph (D) of this Rule 4-1, the Final Audit Report will issue. The Final Audit Report will contain a summary of the final audit findings, comments on the insurer’s adjusting practices, and a determination of the insurer’s compliance levels. Fines will be ordered as determined by the Director in accordance with Rule 4-2.

(6)                 Insurers may be required to correct deficiencies in all claims covered by the audit period if the compliance level for any identified category is below 90%.  Insurers may also be required to undergo training if indicated by audit results or for such other reasons as may be determined by the Director.

4-2        FINES

(A)                An insurer’s first audit conducted after January 1, 2006 measures and establishes the insurer’s levels of compliance with applicable statutes and rules in identified categories.  A compliance level below 90% in any compliance category is considered unsatisfactory. A compliance level below 90% in a compliance category listed in subparagraphs 1 through 7 in paragraph (B) of Rule 4-1, on consecutive compliance audits is considered repeated non-compliance.  Repeated non-compliance in any category set out in Rule 4-1(B)(1) through (7) shall result in the insurer being ordered to pay a fine.

(B)                In order for an insurer’s unsatisfactory performance to result in fines for failure to meet the 90% compliance standard in any category set out in Rule 4-1(B)(1) through (7), its compliance level in that category must be below 90% on at least two consecutive audits.

(C)                Each category for which a fine may be imposed has a fine schedule. The amount of any fine will be determined in accordance with the findings in the Final Audit Report and in accordance with this Rule 4-2. Fines for repeated violations in any category set out in Rule 4-1(B)(1) through (7) are based on the compliance level for that category and as set out in this Rule 4-2. 

(D)                The dollar amount of a fine is arrived at by first locating the insurer’s compliance level on the appropriate schedule found in paragraph (E) of this Rule 4-2. The number of identified deficiencies in the relevant category is multiplied by the “per deficiency” dollar amount for the appropriately numbered finable occurrence indicated in the schedule to arrive at a fine amount for that category.

(E)                The fine schedule for each finable compliance category is as follows:

(1)                 For the categories listed in Rule 4-1(B) subparagraphs 1,5,7:

(2)        For the categories listed in Rule 4-1(B) subparagraphs 2,3,4,6:

Rule 5            Claims Adjusting Requirements

5-1        COMPLETION OF DIVISION FORMS

(A)        Information required on Division forms shall be typed or legibly written in black or blue ink, completed in full and in accordance with Division requirements as to form and content.  Forms that do not comply with this rule may not be accepted for filing.  Position statements relative to liability which do not meet Division requirements will be returned to the insurer. 

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

(C)        Effective July 1, 2006, all first reports of injury and notices of contest that are required to be filed with the Division shall be transmitted electronically. Transmitted electronically includes either 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.

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) In the event of an injury that results in a fatality, or an accident in which three or more employees are injured, the Division shall be notified immediately.

(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 a 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)        No statement regarding liability is required unless a Workers’ Compensation claim number is assigned or a First Report of Injury should have been filed pursuant to paragraph (B) of this rule.  The Division cannot accept a statement regarding liability without a First Report of Injury, Worker’s Claim for Compensation, or Dependents Notice and claim having been successfully filed and assigned a claim number.

 (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.

5-3        INITIAL NOTICE TO CLAIMANT

At the time an insurer notifies the Division of its position on a claim, the insurer shall notify the claimant in writing of the insurer’s claim number, the name and address of the individual assigned to the adjustment of the claim, and the toll-free telephone number of the adjuster.

5-4        MEDICAL REPORTS AND RECORDS

(A)        Medical reports on claims that have been reported to the Division shall be filed with the Division under the following circumstances:

(1)        When attached to an admission of liability form, or a petition to suspend benefits, or

(2)        In connection with a request to the Division to determine the claimant’s eligibility for vocational rehabilitation benefits or to review a vocational rehabilitation plan, or to review requests regarding the provision of vocational rehabilitation services, or

(3)        When otherwise required by any other rule or the Act, or

(4)        At the request of the director.

(5)        A copy of every medical report not filed with the Division shall be exchanged with all parties within fifteen (15) working days of receipt.

(B)        For claims which are not required to be reported to the Division, the parties shall exchange medical information immediately upon request for such information by any interested party.  Five (5) working days is considered to be a reasonable time within which to exchange information.

(C)        A party shall have 15 days from the date of mailing to complete, sign, and return a release of medical and/or other relevant information.  If a written request for names and addresses of health care providers accompanies the medical release(s), a claimant shall also provide a list of names and addresses of health care providers reasonably necessary to evaluate/adjust the claim along with the completed and signed release(s).  Medical information from health care providers who have treated the part(s) of the body or conditions(s) alleged by the claimant to be related to the claim, during the period five years before the date of injury and thereafter through the date of the request, will generally be considered reasonable.  If a party disputes that such request is reasonable or that information sought is reasonably necessary, that party may file a motion with the Office of Administrative Courts or schedule a prehearing conference.  The request for and release of medical information as well as informal disclosures necessary to evaluate/adjust the claim are not considered discovery.

(D)        A party shall have 15 days from the date of mailing to respond to a reasonable request for information regarding wages paid at the time of injury and for a reasonable time prior to the date of injury, and other relevant information necessary to determine the average weekly wage. Any dispute regarding such a request may be resolved by the Director or an Administrative Law Judge. The
request for and exchange of information under this Rule 5-4(D) is not considered discovery.
 

5-5        ADMISSIONS OF LIABILITY

(A)        When the final admission is predicated upon medical reports, such reports shall accompany the admission along with the worksheets or other evaluation information associated with an impairment rating. The admission shall specify and describe the insurer’s position on the provision of medical benefits after MMI, as may be reasonable and necessary within the meaning of the Act.  The admission shall make specific reference to the medical report by listing the physician's name and the date of the report.

(1)        The objection form prescribed by the Division as part of the final admission form  shall precede any attachment.

(B)        An admission filed for medical benefits only, shall include remarks outlining the basis for denial of temporary and permanent disability benefits.

(C)        Admissions shall be filed with supporting attachments immediately upon termination or reduction in the amount of compensation benefits. An admission shall be filed within 30 days of resumption or increase of benefits. 

(D)        For all injuries required to be filed with the Division with dates of injury on or after July 1, 1991:

(1)        Where the claimant is a state resident at the time of MMI:

(a)        When an authorized treating physician providing primary care is not Level II accredited and has determined the claimant has reached MMI and has sustained any permanent impairment, such physician shall, within 20 days after the determination of MMI, refer the claimant to a Level II accredited physician for a medical impairment rating. If the referral is not timely made, the insurer shall refer the claimant to a Level II accredited physician for a medical impairment rating within 40 days after the determination of MMI.

(b)        If the authorized treating physician determining MMI is Level II accredited, within 20 days after the determination of MMI, such physician shall determine the claimant’s permanent impairment, if any.

(2)        Where the claimant is not a state resident at the time of MMI:

(a)        When an authorized treating physician providing primary care is not Level II accredited and has determined the claimant has reached MMI and has sustained any permanent impairment, within 20 days after the determination of MMI, such physician shall conduct tests to evaluate impairment and shall transmit to the insurer all test results and relevant medical information. Within 20 days of receipt of the medical information, the insurer shall appoint a Level II accredited physician to determine the claimant’s medical impairment rating from the information that was transmitted.

(b)        When the claimant chooses not to have the treating physician providing primary care conduct tests to evaluate impairment, or if the information is not transmitted in a timely manner, the insurer shall arrange and pay for the claimant to return to Colorado for examination, testing, and rating, at the expense of the insurer. The insurer shall provide to the claimant at least 20 days advance written notice of the date and time of the impairment rating examination, and a warning that refusal to return for examination may result in the loss of benefits. Such notification shall also include information identifying travel and accommodation arrangements.

(E)  &