Colorado Workers' Compensation Benefit Limitations
With the exception of medical benefits that pay all expenses connected with treating your on-the-job injury, there are limitations to certain other types of benefits – namely temporary disability and permanent partial disability benefits.
Benefit caps are determined by several factors but fundamentally speaking, caps depend on the impairment rating the physician assigns to you once you reach Maximum Medical Improvement (MMI). Doctors arrive at this impairment rating through a process we described in the previous section outlining permanent partial disability benefits.
Benefit caps do not apply until the doctor assigns your impairment rating but can affect what you ultimately receive in permanent partial disability benefits. For injuries occurring on or after January 1, 2006, benefit rate caps are as follows:
Doctor's impairment rating is 25% or lower - $75,000
Doctor's impairment rating is higher than 25% - $150,000
For injuries occurring before January 1, 2006, benefit caps are $60,000 and $120,000 respectively.
As we said, benefit caps do not take effect until your doctor declares you have reached MMI and assigns an impairment rating.
Just how do these caps apply to how much I ultimately receive?
Say for example you're being treated for an injury for an extended period of time and receive $50,000 in wage loss/temporary disability benefits. You finally reach MMI and the doctor assigns a 15% impairment rating, which may be worth an additional $40,000 is permanent partial disability benefits.
Since you have already received $50,000 and the cap for a 15% impairment rating is $75,000, you will only receive $25,000 in permanent partial disability benefits. In fact, if what you receive in wage loss benefits exceeds the cap before you even reach MMI, you will receive no permanent partial disability benefits.
Colorado workers' compensation caps can even come into play if you have to reopen your case, which you can do provided you retain the right to do so at the conclusion of your case and you're within the applicable time period for reopening. For our example, let's say symptoms stemming from your injury re-appear a couple years after the insurer issues their “final admission of liability” and around four years since the initial injury.
Your impairment rating of 22% caps your benefits at $75,000 – you received $50,000 in wage loss benefits and an additional $25,000 in permanent partial disability benefits.
The resurgence of your condition means you have to miss work again. But since you reached the $75,000 cap, temporary disability/wage loss benefits will not start immediately since the workers' comp insurer will need to “offset” the permanent partial disability benefits you already received.
In the example above, wage loss benefits will not resume for 50 weeks. Insurers arrive at this number by dividing the permanent partial disability award of $25,000 by the weekly wage loss rate of $500 in this example.