7 CCR 1101-3-17-6 - Modification, Termination or Suspension of Temporary Disability Benefits
6-1 TERMINATION OF TEMPORARY DISABILITY
BENEFITS IN CLAIMS ARISING FROM INJURIES ON OR AFTER JULY 1, 1991
(A) In all claims based upon an injury or
disease occurring on or after July 1, 1991, an insurer may terminate temporary
disability benefits without a hearing by filing an admission of liability form
with:
(1) a medical report from an authorized
treating physician stating the claimant has reached maximum medical
improvement; provided such admission of liability states a position on
permanent disability benefits. This paragraph shall not apply in cases where
vocational rehabilitation has been offered and accepted, or
(2) a medical report from the authorized
treating physician who has provided the primary care, stating the claimant is
able to return to full or regular duty, or
(3) a written statement from an employer or
the claimant stating the claimant has returned to work at full wages and hours
or setting forth the wages paid for the work to which the claimant has returned
provided such admission of liability admits for temporary partial disability
benefits, if the claimant has not returned to work at full wages, or
(4) A copy of a written offer delivered to
the claimant with a signed certificate of service, containing both an offer of
modified employment, setting forth duties, wages and hours and a statement from
an authorized treating physician that the employment offered is within the
claimant's physical restrictions.
(a) A
written offer of modified duty may only be used to terminate benefits pursuant
to this subsection if:
(i) A copy of the
written inquiry to the treating physician is provided to the claimant by the
insurer or EMPLOYER at the time the authorized treating physician is asked to
provide a statement on the claimant's capacity to perform the offered modified
duty; and
(ii) The claimant is
provided a period of 3 business days from the date of receipt of the offer to
return to work in response to the offer of modified duty.
(5) a copy of a certified letter
to the claimant or a copy of a written notice delivered to the claimant with a
signed certificate of service, advising that temporary disability benefits will
be suspended for failure to appear at a rescheduled medical appointment with an
authorized treating physician, and a statement from the authorized treating
physician documenting the claimant's failure to appear, OR
(6) a letter or death certificate advising of
the death of the claimant with a statement by the insurer as to its liability
for death benefits.
6-2 TERMINATION OF TEMPORARY DISABILITY
BENEFITS BY AN ADMISSION OF LIABILITY IN CLAIMS ARISING AFTER JULY 2, 1987 AT
4:16 P.M. AND BEFORE JULY 1, 1991
(A) In all
claims based upon an injury or disease which occurred after July 2, 1987, at
4:16 p.m., an insurer may terminate disability benefits without a hearing by
filing an admission of liability form with:
(1) a medical report from the authorized
treating physician who has provided the primary care stating the claimant has
reached maximum medical improvement; provided such admission of liability
states a position on permanent disability benefits. This paragraph shall not
apply in cases where vocational rehabilitation has been offered and accepted,
or
(2) a medical report from the
authorized treating physician who has provided the primary care stating the
claimant is able to return to regular employment provided such admission of
liability states a position on permanent partial disability benefits,
or
(3) a written report from the
employer or the claimant stating the claimant has returned to work and setting
forth the wages paid for the work to which the claimant has returned; provided
such admission of liability admits for temporary partial disability benefits,
if any, or
(4) a letter or death
certificate advising of the death of the claimant with a statement by the
insurer as to its liability for death benefits.
6-3 TERMINATION OF TEMPORARY DISABILITY
BENEFITS BY AN ADMISSION OF LIABILITY IN CLAIMS ARISING PRIOR TO JULY 2, 1987,
AT 4:16 P.M.
(A) In all claims based upon an
injury or disease which occurred prior to July 2, 1987, at 4:16 p.m., an
insurer may terminate temporary disability benefits without a hearing by filing
an admission of liability form with:
(1) a
report from the authorized treating physician who has provided the primary care
stating the claimant has reached maximum medical improvement and is released to
return to an occupation which the claimant regularly performed at the time of
the injury, or
(2) a report from
the authorized treating physician who has provided the primary care stating the
claimant has reached maximum medical improvement and a Director's determination
that the claimant is not eligible for vocational rehabilitation services,
or
(3) a written report from the
employer or the claimant stating the claimant has returned to work and setting
forth the wages paid for the work to which the claimant has returned; provided
such admission admits for temporary partial disability benefits, if any,
or
(4) a letter or death
certificate advising of the death of the claimant with a statement by the
insurer as to its liability for death benefits, OR
(5) a report from the authorized treating
physician who has provided the primary care stating the claimant has reached
maximum medical improvement and documentation the claimant has completed an
approved vocational rehabilitation plan.
6-4 SUSPENSION, MODIFICATION OR TERMINATION
OF TEMPORARY DISABILITY BENEFITS BY A PETITION
(A) When an insurer seeks to suspend, modify
or terminate temporary disability benefits pursuant to a provision of the Act,
and Rules 6-1, 6-2, 6-3, 6-5, 6-6, 6-7 or 6-9 are not applicable, the insurer
may file a petition to suspend, modify or terminate temporary disability
benefits on a form prescribed by the Division. All documentation upon which the
petition is based shall be attached to the petition. The petition shall
indicate the type, amount and time period of compensation for which the
petition has been filed and shall set forth the facts and law upon which the
petitioner relies.
(B) When an
insurer seeks to retroactively decrease temporary benefits after the first
indemnity admission of liability is filed. The petition must be filed within
thirty (30) days of the initial indemnity admission. This section shall not be
used to retroactively claim a safety rule violation.
(C) A copy of a response form prescribed by
the Division shall be included with a copy of the petition to the claimant and
claimant's attorney and the Division. Certification of this mailing shall be
filed with the petition.
(D) If the
claimant does not file a written objection with the Division within twenty (20)
days of the date of mailing of the petition and response form, the Director may
grant the insurer's request to suspend, modify or terminate disability benefits
as of the date of the petition.
(E)
When a claimant files a timely objection to a petition, the insurer shall
continue temporary disability benefits at the previously admitted rate until an
application for hearing is filed with the Office of Administrative Courts, and
the matter is resolved by order. The Director finds that good cause exists to
expedite a hearing to be held within sixty (60) days from the date of the
setting, because overpayment of benefits may result if the suspension,
modification or termination is granted.
(F) When a hearing is continued at the
request of the claimant, the prehearing administrative law judge shall
temporarily grant the relief requested in the petition, pending the continued
hearing, if the reports and evidence attached to the petition and objection
indicate a reasonable probability of success by the insurer. The continued
hearing shall be held no later than thirty (30) days from the date of the
request for continuance.
(G) When a
hearing is continued at the request of the insurer, temporary disability
benefits shall continue until the matter is resolved by order after the
hearing.
6-5
MODIFICATION OF TEMPORARY DISABILITY BENEFITS PURSUANT TO STATUTORY OFFSET
An insurer may modify temporary disability benefits to offset social security, disability pension or similar benefits pursuant to statute by filing an admission of liability form with the Division, with documentation which substantiates the offset and figures showing how the amount of the offset was calculated pursuant to statute.
6-6 TERMINATION OR MODIFICATION OF TEMPORARY
DISABILITY BENEFITS DUE TO CONFINEMENT
An insurer may terminate or modify temporary disability benefits pursuant to statute, by filing an admission of liability form with the Division with a document issued by a court of criminal jurisdiction, which establishes that the claimant is confined in a jail, prison, or any department of corrections facility as a result of a criminal conviction.
6-7 TERMINATION OF TEMPORARY DISABILITY
BENEFITS PURSUANT TO THIRD-PARTY SETTLEMENT
An insurer may terminate temporary disability benefits pursuant to statute, by filing an admission of liability form with the Division with a copy of a document substantiating the claimant received money damages from a third-party claim arising from the worker's compensation injury and the amount of the award that may be offset pursuant to § 8-41-203, C.R.S.
6-8 FAILURE TO COMPLY WITH REQUIREMENTS OF
RULE 6
(A) Temporary disability benefits may
not be suspended, modified or terminated except pursuant to the provisions of
this rule; pursuant to an order from the Director or pursuant to
an order of the Office of Administrative Courts.
(B) If the Director concludes the insurer has
not met the applicable requirements of this rule, the Director may order the
insurer to continue payment of temporary disability benefits, pursuant to
§
§
8-42-105(3) and
8-42-106(2),
C.R.S., until the requirements of this rule are followed or until a hearing is
held and further order entered.
6-9 TERMINATION OF TEMPORARY DISABILITY
BENEFITS DUE TO FAILURE TO RESPOND TO AN OFFER OF MODIFIED EMPLOYMENT FROM A
TEMPORARY HELP CONTRACTING FIRM IN CLAIMS FOR INJURIES OCCURRING ON OR AFTER
JULY 1, 1996
(A) An insurer may terminate
temporary disability benefits by filing an admission of liability with:
(1) a copy of the initial written offer of
modified employment provided to the claimant, which clearly states that future
offers of employment need not be in writing, a description of the policy of the
temporary help contracting firm regarding how and when employees are expected
to learn of such future offers, and a statement that benefits shall be
terminated if an employee fails to timely respond to an offer of modified
employment;
(2) a written statement
from the employer representative giving the date, time, and method of
notification which forms the basis for the termination of temporary disability
benefits; and
(3) a statement from
the attending physician that the employment offered is within the claimant's
restrictions.
(B) The
claimant is allowed a period of at least twenty-four hours, not including any
part of a Saturday, Sunday, or legal holiday within which to respond to any
such offer.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.