Colorado Required Postings and Forms
Please print and post the following notices, both in English and Spanish, in a conspicuous location frequented by employees such as the break room, lunch room or time clock. If you have multiple business locations, be sure to post the notices at each location.
- Notice to Employer of Injury Poster (Form WC50): This poster must be a minimum of 14 inches high and 11 inches wide. Each letter must measure 1/2 inch high.
- Colorado Workers Compensation Information Poster (Form WC49) (English and Spanish)
The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:
- Form WC 1 Employer’s First Report of Injury: All injuries or occupational diseases that result in lost time from work in excess of three shifts or calendar days or from permanent physical impairment must be reported to EMPLOYERS® on this form within 10 days after notice or knowledge of the injury or disease. Fatalities must be reported to EMPLOYERS immediately. You must use this form to notify EMPLOYERS of every work-related injury or disease suffered by an employee, regardless of severity.
- Form WC 12 Supplemental Report of Return to Work: This form is to provide information to EMPLOYERS to determine the accurate payment of temporary disability benefits. This form may be completed by the employee or the employer. The form should be completed and forwarded to EMPLOYERS each time the employee returns to work at full or reduced wages.
- Form WC 15 Workers Claim for Compensation: This form should be completed by the employee. Two copies of the completed form must be sent to the Colorado Division of Workers’ Compensation. The Division of Workers’ Compensation will then provide a copy to EMPLOYERS. EMPLOYERS will have 20 days from receipt of the form to advise in writing if it is accepted or denied.
- Form WC 18 Dependent’s Notice and Claim for Compensation: This form should be completed by the dependent. Two copies of the completed form must be sent to the Colorado Division of Workers’ Compensation. The Division of Workers’ Compensation will then provide a copy to EMPLOYERS. EMPLOYERS will have 20 days from receipt of the form to advise in writing if it is accepted or denied.
- Designated Provider Letter. The Designated Provider List must be provided to the injured employee within seven days from the notification of the injury. Failure to do so will allow the injured employee to seek treatment with any provider he/she chooses. This Designated Provider List is created by you and must include the names of at least four physicians or corporate medical providers. You may designate these medical providers in advance by going to www.employers.com and clicking on the Provider Locator link. The Designated Provider List must also contain the name of your company’s representative and the name of an insurance company representative. The Designated Provider List with the employee’s selection of providers and his/her signature will need to be sent in to EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should keep a copy on file for your records. Please reference the SAMPLE Designated Provider List for information required by your Designated Provider List.
- First Fill Form. This form provides your employees with basic information about our Pharmacy Benefit Program, including such things as the phone number to call to locate a First Fill participating pharmacy. When your employee becomes injured, please print and complete this form and provide it to your injured employee. Your employee will need to provide this completed form along with the prescription for his/her work-related injury or illness to the pharmacist. Using this form will help enable quick authorization for your employee’s initial medication and ensure that the initial prescription is provided at no cost to the injured employee.
- Accident Investigation Report. This basic accident form is completed by the employee’s supervisor/manager as soon after the accident as possible. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should keep a copy on file for your records.
- Off-Site Transitional Duty Program - Helping Your Injured Employees Get Back to Work
A successful transition back to work relies on the collaborative efforts of the manager/supervisor, the injured employee and their adjuster. As a manager/supervisor, learn what you can do to help facilitate a successful return to work.