laborlaw
05-20-2005, 01:54 PM
NOTICE TO EMPLOYEES
Your employer is insured under the above-named law by:
If you are injured or sustain an occupational disease while at work, you may be entitled to compensation benefits as provided by law. WRITTEN NOTICE MUST BE GIVEN TO YOUR EMPLOYER WITHIN 4 WORKING DAYS OF THE ACCIDENT. If you fail to report your injury or occupational disease promptly, Loss of Benefit penalties may be assessed against you.
No compensation is payable for the first 3 days’ disability unless the period of disability exceeds two weeks. Thereafter, the
compensation rate while disabled is 2/3 of your average weekly wage, subject to a statutory maximum determined annually as provided by law.
You are entitled to reasonable and necessary medical, surgical and hospital
treatment for treatment of injuries or occupational diseases. In all cases of injury, the employer or insurer has the right in the first instance to select the physician. If a physician is not designated by the employer or insurer, you may select the services of a licensed physician or chiropractor.
You are hereby notified that if a child support obligation is owed, compensation
benefits may be attached and payment of the child support obligation may be withheld and forwarded to the obligee pursuant to sections 8-42-124 and 26-13-122 (4), C.R.S.
The physicians designated by your employer’s insurance carrier are:
_____________________________________
_____________________________________
In addition to any reports the employer is required to file, an injured employee may file his own claim for compensation and medical benefits in order to protect his future rights. To obtain claim forms or if your compensation is not paid promptly during your disability, or if you wish any information concerning your rights under the Workers’ Compensation Act, write the Colorado Division of Workers’ Compensation
Your employer is insured under the above-named law by:
If you are injured or sustain an occupational disease while at work, you may be entitled to compensation benefits as provided by law. WRITTEN NOTICE MUST BE GIVEN TO YOUR EMPLOYER WITHIN 4 WORKING DAYS OF THE ACCIDENT. If you fail to report your injury or occupational disease promptly, Loss of Benefit penalties may be assessed against you.
No compensation is payable for the first 3 days’ disability unless the period of disability exceeds two weeks. Thereafter, the
compensation rate while disabled is 2/3 of your average weekly wage, subject to a statutory maximum determined annually as provided by law.
You are entitled to reasonable and necessary medical, surgical and hospital
treatment for treatment of injuries or occupational diseases. In all cases of injury, the employer or insurer has the right in the first instance to select the physician. If a physician is not designated by the employer or insurer, you may select the services of a licensed physician or chiropractor.
You are hereby notified that if a child support obligation is owed, compensation
benefits may be attached and payment of the child support obligation may be withheld and forwarded to the obligee pursuant to sections 8-42-124 and 26-13-122 (4), C.R.S.
The physicians designated by your employer’s insurance carrier are:
_____________________________________
_____________________________________
In addition to any reports the employer is required to file, an injured employee may file his own claim for compensation and medical benefits in order to protect his future rights. To obtain claim forms or if your compensation is not paid promptly during your disability, or if you wish any information concerning your rights under the Workers’ Compensation Act, write the Colorado Division of Workers’ Compensation
