PHYSICIANS REPORT OF WORKERS COMPENSATION INJURY - colorado 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by selecting the report type: Initial, Progress, or Closing. Fill in the Exam Date and ensure all case information is accurate, including the Date of Injury, Injured Worker’s details, and Insurer information.
  3. In the Initial Visit section, provide a description of the accident as narrated by the injured worker. Confirm if your objective findings align with their account.
  4. Document the Current Work Status based on what the injured worker reports. Specify any work-related medical diagnoses in the designated section.
  5. Outline a comprehensive Plan of Care that includes treatment plans, work status options, and any limitations or restrictions applicable to the injured worker.
  6. For Follow-up Care and Referrals, indicate any future appointments and referrals made to other providers. Ensure compliance with notification requirements for discharges.
  7. Complete sections regarding Maximum Medical Improvement (MMI) and Permanent Medical Impairment as necessary. Finally, sign off with your details in the Physician’s Information section.

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Report the Situation: It is crucial to report the accident to your immediate supervisor or manager as soon as possible. They need to be kept updated and informed of the situation from start to finish.
If your employer does not provide you with the written list within seven business days of you notifying your employer about your injury, you may choose your own doctor. If you receive the written list, you should keep a copy of the list along with any other claim-related documents.
First Report of Injury/Notice of Contests When a worker is injured or has an occupational disease that results in more than three days/shifts of lost time, permanent impairment, or death, the insurance carrier must file a First Report of Injury (FROI) with the Division of Workers Compensation (DOWC) within 10 days.
The Employers First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimants employment and circumstances surrounding the injury or illness are also requested.
If you are unable to work as the result of a work-related injury or occupational disease, compensation (wage replacement) benefits will be based on 2/3 of your average weekly wage up to a maximum set by law. No compensation is payable for the first 3 days disability unless the period of disability exceeds two weeks.
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Make sure your supervisor is notified of your injury as soon as possible. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care.
Within 10 working days of the injury, the injured worker must let their employer know about the injury. This must be done in writing. If the worker was injured more than 10 days ago, they should still notify their employer in writing as soon as possible.
Exaggerating or Lying About the Workers Injuries Workers should be transparent and honest about the nature and extent of their injury. Rather than bolstering a workers compensation claim, exaggerations can undermine the credibility of the worker and thus the workers claim.

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