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Why did my workplace not cover all medical expenses after an accident in Denver?

This legal question related to workers compensation & disability in DenverColorado has been answered.

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I’m in a real bind here and could use some guidance. I work for a small construction company in Denver, and last month I had a nasty fall off a ladder, broke my leg in two places - the tibia and fibula. The doc says I need surgery, and it's going to be a long road to recovery with physical therapy and all.

Isn’t workers' comp supposed to cover everything?

My employer's workers' comp insurance is covering the surgery, thank God, but they're balking at the cost of the physical therapy sessions the doctor says I need. They're saying it's not all necessary. I’m sitting here with a broken leg, wondering how am I supposed to get better without proper rehab?

  • What can I do if workers' comp won't cover all my medical expenses?
  • Is there a way to appeal their decision?

What about my missed work and wages?

Since I’m a roofer, there’s no way I can work with a leg like this. Workers' comp is paying something, but it’s not even half of my usual pay. I’ve got a family to support, and the bills don’t stop just because I’m hurt.

  • How can I make sure I get my full wages during recovery?
  • Are there other benefits or compensation I should be looking at?

Can my employer retaliate if I push back?

I’m worried that if I fight too hard on this, there could be some blowback from my boss. I can't afford to lose my job, especially not right now when I can't just go out and get another one with my leg in this condition.

  • Can my employer fire me for seeking full workers' comp benefits?
  • What are my protections against workplace retaliation in Colorado?

I’m trying to get my ducks in a row here and could really use some advice from anyone who’s dealt with something similar. If you've got experience with Colorado workers' comp laws or have been through the ringer with this stuff before, I’d really appreciate your input. Thanks in advance!

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Legal Solution

The response provided below is specific to workers compensation & disability in the jurisdiction of Denver. If the response is inadequate, please submit a detailed inquiry.

Workers' Compensation Coverage

Legal Framework for Workers' Compensation in Colorado

Workers' Compensation in Colorado is governed by the Colorado Workers' Compensation Act (Sections 8-40-101 to 8-47-209 of the Colorado Revised Statutes). For authoritative information and resources, the Colorado Department of Labor and Employment’s Division of Workers' Compensation website is the principal government source. It offers comprehensive information about workers' compensation laws and procedures. Unfortunately, without more specific sections relevant to your case, providing direct links to statutes is not feasible in this format. However, for a general understanding and further details, please visit Colorado Department of Labor and Employment’s Division of Workers' Compensation.

Appealing Workers' Compensation Decisions

If workers' compensation does not cover certain expenses like physical therapy, you can file an appeal. Colorado's workers' compensation process provides an avenue for disputes through the Office of Administrative Courts. An appeal must be made within a specific timeframe, and it’s recommended to seek legal assistance for this process. For a detailed understanding and potentially to compare lawyers in your area, please visit Explore Lawyers.

Recovering Full Wages and Additional Benefits

The workers' compensation insurance is supposed to cover medical expenses and a portion of your lost wages. In Colorado, the wage-replacement benefit is typically two-thirds of your average weekly wage up to a maximum limit. To ensure you are receiving the correct amount, you can find the right lawyer who specializes in workers' compensation to review your case. For further assistance, ask a free legal question online.

Protections Against Retaliation

Your employer cannot legally fire you for claiming workers' compensation benefits. Retaliation against an employee for filing a workers' compensation claim is prohibited under Colorado law. If you believe you are being retaliated against, it would be prudent to consult with labor and employment lawyers who can help protect your rights.

Costs of Services in Denver

Colorado may have different average costs for medical services compared to national averages. Specific figures would require current market research, which is beyond the scope of this response. It is also important to note that prices can vary significantly based on specific procedures, the severity of the injury, and individual provider rates. Hence, a detailed table of costs cannot be provided here.

Complexity of Workers' Compensation Cases

These cases can become complex due to disputes over the necessity of certain medical treatments, the calculation of wage replacement benefits, and potential employer retaliation. It is crucial to have clear communication with your medical provider, insurer, and legal counsel to navigate these issues.

Relevant Questions for the User

  1. Have you received a written explanation from the insurance company regarding the denial of physical therapy sessions?
  2. Did you report the accident immediately to your employer and file a workers' compensation claim timely?
  3. Can you provide documentation from your physician stating that the physical therapy is medically necessary for your recovery?

Common Questions from Clients

Q1: What can I do if my workers' comp claim is denied?

The first step is to understand the reason for the denial. You can request a written explanation from the insurer. If the denial is based on a medical necessity or a dispute over the extent of your injuries, you may need to provide additional medical evidence or seek an independent medical examination. For a claim dispute, you may file an appeal with the Colorado Office of Administrative Courts.

Q2: How long do I have to file a workers' compensation claim in Colorado?

In Colorado, you must report the injury to your employer within four days of the accident. However, the actual claim for benefits must be filed within two years. It is advisable to file as soon as possible to avoid any delays in coverage.

Q3: Can I see my own doctor for treatment?

Under Colorado law, your employer or their insurance company has the right to choose the medical provider for your workers' compensation claim. However, you may apply for a change of physician after a certain period or under specific conditions.

Q4: What if my employer does not have workers' compensation insurance?

Employers in Colorado are required by law to carry workers' compensation insurance. If your employer does not have coverage, you may seek benefits through the Uninsured Employers Fund and should consult with a workers' compensation attorney for guidance.

Q5: How do I ensure I'm getting the maximum wage replacement benefits?

Calculating wage replacement should take into account your average weekly wage, including overtime and bonuses. If you believe that the benefit amount is incorrect, you should consult with an attorney who can assess the calculation and advocate on your behalf if necessary.

Disclaimer

This content is for informational purposes only and does not establish an attorney-client relationship. It's always recommended to consult with a local attorney about your specific situation.

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Legal question "Why did my workplace not cover all medical expenses after an accident in Denver?" has been changed 7 months 2 weeks ago. Demonstrate your legal skills and willingness to help and answer right now! Issue is related to the location of Denver & area of law: workers compensation & disability.
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A realistic and professional photograph reflecting a legal advisory context on workers' compensation disputes in Denver. The first image shows a worker in a construction setting with safety gear on, looking at paperwork with a concerned expression. The worker is a middle-aged Caucasian man. The background includes construction materials and safety cones to indicate the workplace environment. The second image features a close-up of hands exchanging a document labeled 'Workers' Comp Claim' across a table, wit
A realistic and professional photograph reflecting a legal advisory context on workers' compensation disputes in Denver. The first image shows a worker in a construction setting with safety gear on, looking at paperwork with a concerned expression. The worker is a middle-aged Caucasian man. The background includes construction materials and safety cones to indicate the workplace environment. The second image features a close-up of hands exchanging a document labeled 'Workers' Comp Claim' across a table, wit...

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