Colorado’s Worker’s Claim for Compensation (Form WC 15) is the form an injured employee files with the Colorado Division of Workers’ Compensation to put a work injury on the record and protect the right to medical care and lost-wage benefits. The current version is WC15 Rev 08/22, and you should confirm that revision date in the bottom corner before you start.
This form is the worker’s own voice in a system that otherwise runs through employers and insurance carriers. Filing it within the two-year deadline is the single step that keeps a claim alive, and Colorado law gives an injured worker up to two years from the date of injury to file, with the window stretching to three years when there is a reasonable excuse. The stakes are real: missing the deadline or leaving the wage section blank can cost a worker thousands of dollars in benefits they were owed.
Here is what you will learn in this guide:
- 📋 What Form WC 15 does, who must file it, and the statute that backs it up
- 🧮 How to calculate your Average Weekly Wage on lines A, B, and C so your checks are not shorted
- 🖊️ A line-by-line walkthrough of every box, with sample entries you can copy
- 🚑 Three real filing scenarios, from a sudden injury to a slow occupational disease
- ⚠️ The mistakes that get claims delayed or denied, and how to avoid each one
What Form WC 15 Is and Who Must File It
Form WC 15, the Worker’s Claim for Compensation, is the document an injured Colorado worker files to formally start a workers’ compensation claim with the Division of Workers’ Compensation, the state agency inside the Colorado Department of Labor and Employment that oversees the system. The form tells the state who you are, who you work for, when and how you got hurt, and how much you earn. Without it on file, the Division has no official record that you are claiming benefits, even if your employer already knows about the injury.
Any employee who suffers a work-related injury or occupational disease in Colorado should file this form. The legal duty to do so flows from the Workers’ Compensation Act of Colorado, found in Title 8, Articles 40 through 47 of the Colorado Revised Statutes. Under C.R.S. 8-43-103, a worker must file a claim within two years of the injury, and a failure to file bars recovery. The plain-English meaning is simple: if you do not file in time, you can lose your right to any benefits, no matter how badly you were hurt.
The consequence of skipping the form is steep. A worker who tells a supervisor about a hurt back but never files WC 15 may discover, a year later, that the carrier never opened a claim and the medical bills are now in their name. As a real-world example, Maria Lopez, a hotel housekeeper, assumed her manager’s incident report counted as her claim; it did not, and she had to scramble to file WC 15 before her two years ran out. A common misconception is that the employer files this form for the worker. The employer files its own separate Employer’s First Report of Injury, but the worker’s own claim is what truly protects the worker.
Before You Start: Documents and Information You Need
Filling out Form WC 15 goes faster and cleaner when you gather everything first. Open the form only after you have these items in front of you, because guessing at numbers or dates is what triggers most processing holds.
- Your Social Security number. The Division uses it to index your claim; a wrong or missing number can split your file or delay matching.
- Your full legal name and current mailing address. Notices about your benefits go to this address, so an old one means you miss deadlines.
- Your employer’s legal company name, address, and phone number. The Division routes a copy of your claim to this employer’s carrier; a wrong name can send it to the wrong place.
- Your date of hire and occupation. These confirm you were an employee at the time and help frame the type of work you did.
- Pay records (pay stubs, W-2, or year-end totals). You need gross pay to calculate Average Weekly Wage; without it, your wage line is a guess and your checks may be short.
- Records of any second job held at the time of injury. Concurrent wages raise your benefit rate, and you cannot claim them later if you leave line B blank.
- The exact date, time, and location of the injury. A vague date weakens the link between your work and your harm.
- The name and address of any doctor or facility that treated you. This shows you sought care and gives the carrier a record to verify.
- Names and phone numbers of any witnesses. Witnesses back up your account if the carrier disputes how the injury happened.
If any item is missing, do not leave the form sitting on your kitchen table for weeks. File with what you have, because a filed-but-incomplete claim still beats a missed deadline. You can supplement details later, but you cannot undo a blown statute of limitations.
Where to Get the Form and How to Access It
Form WC 15 is a free PDF published by the Colorado Division of Workers’ Compensation on the state’s official forms page. You download it, type or print your answers, and submit it; there is no separate account or login required to obtain the blank form. Always pull the form straight from the state site rather than a random third-party page, because outdated copies float around the internet and may use old field labels.
Confirm you have the current WC15 Rev 08/22 version, shown in the lower corner of each page. The form is two pages: page 1 is the claim you fill out, and page 2 holds the instructions, the Average Weekly Wage rules, and the Division’s mailing address. Read page 2 before you touch page 1, because the wage instructions there change how you fill the most important boxes.
If you cannot download or print the form, the Division’s Customer Service Unit will help. You can call 303-318-8700 or toll-free 1-888-390-7936 to request a copy or to ask for the free Injured Worker Guide, which walks through your rights in more detail. A common misconception is that you must hire a lawyer just to get the form; you do not, and the Division provides it and basic help at no cost.
Step-by-Step: How to Fill Out Form WC 15 Line by Line
Work through the form in the order the boxes appear. Print clearly in black ink or type into the PDF, use the MM/DD/YYYY format for every date, and write your answers in CAPITAL LETTERS where the boxes are small. Every field below gets its own walkthrough, with a sample entry you can model.
Employee’s Name (First, Middle, Last)
This box asks for your full legal name. Write it exactly as it appears on your Social Security card, putting your first name, then middle name, then last name. For example, Maria Elena Lopez writes her name in that order, spelling out the full middle name rather than just an initial when she can.
A nuance comes up if you use a different name day-to-day or recently married and changed your last name. Use the name that matches your Social Security record, because that is what the Division and the carrier cross-check. A common mistake is entering a nickname like Mari instead of the legal name, which can cause the Division to fail to match your file and delay processing. The misconception here is that any version of your name will do; it will not, because mismatched names are a frequent cause of held claims.
Social Security Number
This field asks for your nine-digit Social Security number. Enter all nine digits, double-checking each one, because this number is how the Division indexes your entire claim. For example, Maria Lopez writes 123-45-6789 exactly as printed on her card.
If you do not have a Social Security number, enter the identification number you use for tax purposes and call Customer Service for guidance rather than leaving it blank. The most common mistake is transposing two digits, which can create a duplicate or orphaned file that takes weeks to fix. Many workers wrongly believe this number is optional for privacy reasons; in this state system it is the key field that ties your medical and wage records together.
Employee’s Street Address, City, State, and ZIP Code
These boxes ask where you live and where you want your mail sent. Write your current full mailing address, since every notice about your benefits, including admissions and denials, lands here. For example, Maria Lopez enters 1420 Larimer Street, Apt 3B, Denver, CO 80202.
If you use a P.O. Box for mail, enter the P.O. Box so notices reach you, even if your street address is different. The common mistake is listing an old address after a recent move, which means you never see a denial letter and miss the short window to respond. People often assume the carrier will track them down by phone; in reality the system runs on written notices to the address on file.
Employee’s Phone Number and Email Address
These fields ask for the best phone number and email to reach you. Provide a number you answer and an email you check, because the carrier’s adjuster often calls or writes to schedule exams or ask questions. For example, Maria Lopez lists 720-555-0143 and mlopez.denver@email.com.
If you have no email, leave that line blank rather than inventing one, since a dead address only causes missed messages. A common mistake is giving a disconnected number, which slows the carrier’s investigation and can make you look unresponsive. Some workers think skipping contact info protects their privacy; it mostly delays the benefits they are trying to claim.
Birth Date, Gender, and Marital Status
These boxes ask for your date of birth, gender, and whether you are married, single, separated, or unknown. Enter your birth date as MM/DD/YYYY, check one gender box, and check one marital status box. For example, Maria Lopez writes 03/14/1985, checks Female, and checks Married.
Marital status matters because it can affect dependent and death-benefit calculations, so answer it even though it feels personal. The common mistake is leaving marital status blank, which can slow review if dependency benefits ever come into play. A misconception is that these fields are just demographics; they actually feed into how certain benefits are figured.
Dependents
This field asks whether you have dependents and is a simple Yes or No checkbox. Check Yes if anyone relies on you for support, such as a child or spouse, and No if not. For example, Maria Lopez, who has two children, checks Yes.
The nuance is that dependent status can raise death benefits if a work injury proves fatal, so it is worth answering carefully. The common mistake is checking No out of habit when you do support a child, which could understate benefits in a serious case. Some workers think dependents only matter for taxes; in workers’ comp they can change the value of a claim.
Date of Hire, Occupation, and Employment Status
These boxes ask when you started the job, what you do, and whether you work full-time, part-time, or other. Enter your hire date as MM/DD/YYYY, write your job title plainly, and check one employment status box. For example, Carlos Mendoza writes 06/01/2021, lists Warehouse Associate, and checks Full-time.
If you are not sure of the exact hire date, give your best honest estimate rather than leaving it blank. The common mistake is writing a vague occupation like worker, which hides the physical demands that make your injury believable. A misconception is that occupation is a throwaway field; adjusters use it to judge whether the injury fits the job.
Employer’s Name, Mailing Address, City, State, ZIP, and Phone
These fields ask for your employer’s legal company name and full contact information. Write the exact business name on your pay stub, not a store nickname, plus the mailing address and phone. For example, Carlos Mendoza enters Front Range Logistics LLC, 250 Industrial Way, Aurora, CO 80011, with the company phone.
If your employer uses a staffing agency, list the agency that issues your paycheck and note the worksite separately. The common mistake is writing a brand name instead of the legal entity, which can send your claim to the wrong carrier and stall it for weeks. Many workers assume the Division already knows their employer; it relies on what you write to route the claim.
Average Weekly Wage, Lines A, B, and C
This is the most important money section, and it asks how much you earned around the time of injury. To calculate it, take your total gross pay (before taxes) over a set number of weeks and divide by that number of weeks; gross pay includes regular wages, overtime, vacation, sick leave, tips, commissions, piecework, mileage, and employer-provided board, rent, or housing. On line A, enter the Average Weekly Wage from the job where you got hurt; on line B, enter the wage from any other job you held at the same time; on line C, add A and B for your total. For example, Carlos Mendoza earns $960 weekly at the warehouse and writes $960.00 on line A, has no second job so writes $0 on line B, and writes $960.00 on line C.
You can also use the Division’s online Average Weekly Wage calculator to check your math. The nuance is line B: if you worked a second job when you were hurt, those wages count too, and including them raises the two-thirds benefit you receive. The most damaging mistake on the whole form is lowballing or skipping this section, because your wage-loss checks are based on it, and a too-low number means smaller checks for the life of the claim. A widespread misconception is that only your base hourly wage counts; in fact overtime, tips, and other gross income belong in the figure.
Date of Injury/Disease
This box asks for the date you were hurt or, for a disease, the date you were last exposed to the hazard. Enter a single date in MM/DD/YYYY format; for a sudden injury use the accident date, and for an occupational disease use the last date you were exposed. For example, Carlos Mendoza writes 04/18/2026 for the day he hurt his back, while Aisha Bello, who developed carpal tunnel over years, writes the date of her last day of keyboard work.
The nuance trips up disease claims: there is often no single accident, so the last-exposure rule gives you the date to use. The common mistake is leaving this blank or guessing wildly, which weakens the link between your work and your harm and can start the statute-of-limitations clock at the wrong point. Some workers think the date they first felt pain is what goes here; for diseases it is the last exposure date that controls.
Time Employee Began Work and Injury Time
These fields ask what time your shift started and what time the injury happened. Enter both in a.m. or p.m. form, and check Unknown for the injury time only if you truly cannot say. For example, Carlos Mendoza writes that he began work at 7:00 a.m. and was injured at 2:30 p.m.
For an occupational disease with no single moment, it is fine to mark the injury time Unknown. The common mistake is inventing a precise time you do not remember, which can clash with witness accounts and hurt your credibility. A misconception is that the exact minute matters most; what matters is honesty and consistency with the rest of your account.
Last Date Worked, Date Employer Notified, and Date Returned to Work
These boxes ask the last day you worked before the injury affected you, the date you told your employer, and the date you came back, if you have. Enter each as MM/DD/YYYY and leave the return date blank if you have not gone back. For example, Carlos Mendoza writes 04/18/2026 as his last day worked, 04/20/2026 as the date he notified his supervisor, and leaves the return-to-work box blank.
The notification date is the field that quietly carries legal weight. Colorado law expects written notice to your employer, and failing to report in writing within ten days can cost you one day’s compensation for each day you delay. The common mistake is reporting only by word of mouth and entering a fuzzy date, which the carrier can use to argue late notice. The misconception is that telling a coworker counts; written notice to the employer is what protects you.
Permanent Disability, Scar or Disfigurement Claims
These fields ask whether you believe you have a permanent disability and whether you have a scar or disfigurement. Check Yes, No, or Unknown for permanent disability, and Yes or No for scarring. For example, Carlos Mendoza, early in treatment, checks Unknown for permanent disability and No for scarring.
The nuance is that checking Unknown early on does not waive anything; doctors decide permanency later through impairment ratings. The common mistake is checking No to seem agreeable when you actually have lasting limits, which can muddy a later disability claim. Many workers think these boxes lock in their final answer; they are a snapshot, not a binding statement.
Body Part Affected and Nature of the Injury/Illness
These boxes ask which body part was hurt and what kind of injury it is. Name the body part and specify upper or lower for arms, legs, and back, then describe the injury type such as sprain, strain, laceration, contusion, or fracture. For example, Carlos Mendoza writes lower back and strain.
The nuance is precision: writing lower back rather than just back helps the carrier match treatment and avoid disputes over scope. The common mistake is vague terms like hurt all over, which give the carrier room to narrow what it will pay for. The misconception is that a broad description protects you; specific, accurate language actually does.
Describe the Accident in Detail
This box asks you to explain what happened in your own words. Tell what you were doing, how the accident occurred, and what object harmed you, in plain specific language. The Division’s own good examples include “When ladder slipped on the wet floor, I fell 20 feet” and “I developed soreness in my wrist over time”; Carlos Mendoza writes “While lifting a 60-pound box from a low shelf, I felt a sharp pull in my lower back.”
The nuance is that detail wins claims, so name the weight, the surface, the tool, and the motion. The most common mistake is one-word answers like hurt, pain, sore, or fell, which the form expressly lists as incomplete and which give an adjuster easy grounds to question the claim. The misconception is that less detail avoids self-incrimination; here, a thin description is what invites denial.
Where the Accident Occurred and To Whom It Was Reported
These fields ask for the location of the accident and the person you reported it to. Give the street address, city, state, and county of the accident, then name the supervisor or person you told. For example, Carlos Mendoza writes 250 Industrial Way, Aurora, CO, Arapahoe County and reports it to Shift Lead Devon Price.
The nuance is that naming a real person you reported to corroborates your notice and timing. The common mistake is leaving the county blank, which can slow Division routing, or naming no one, which makes notice hard to prove. The misconception is that the location is obvious; the form needs it spelled out to tie the injury to a workplace.
Initial Treatment and Treating Doctor and Facility
These fields ask what care you first received and where. Check one initial-treatment box (none, minor on-site, emergency room, clinic or hospital, or hospital stay over 24 hours) and write the name and address of the treating doctor and the facility. For example, Carlos Mendoza checks Clinic/hospital and lists Dr. Helen Park, Aurora Occupational Health, 300 Medical Park Dr, Aurora, CO 80012.
A nuance specific to Colorado is that your employer should give you a list of at least four designated providers; seeing one of them protects your right to have care paid. The common mistake is naming your own family doctor instead of an authorized provider, which the carrier may refuse to pay. The misconception is that you can see any doctor you like from day one; in this system the employer’s designated providers usually control early care.
Occupational Disease Section: Employers and Dates of Exposure
This section asks, for disease claims like asbestos exposure, repetitive motion, or hearing loss, where the exposure happened and when. List each employer where you were exposed and the dates of employment, attaching an extra sheet if you need more room. For example, Aisha Bello lists two data-entry employers with their respective employment dates, since her carpal tunnel built up across both jobs.
The nuance is that diseases often span multiple jobs, and naming each employer helps assign responsibility correctly. The common mistake is listing only the current employer, which can shift or muddy liability and reduce what you recover. The misconception is that this section is only for dramatic exposures like asbestos; repetitive-motion injuries like carpal tunnel belong here too.
Witnesses, Completed By, and Date Completed
These final fields ask for any witnesses, who completed the form, and the date. Write the names and phone numbers of witnesses, then sign or print your name in the Completed by box and enter the date as MM/DD/YYYY. For example, Carlos Mendoza lists coworker Devon Price, 720-555-0199, prints his own name in Completed by, and dates it 04/22/2026.
The nuance is that the Completed by line is your acknowledgment that the information is true, so it carries the form’s fraud warning that knowingly false statements can bring fines or imprisonment. The common mistake is leaving the date blank, which can muddy proof of when you filed. The misconception is that a witness must have seen the whole accident; someone who saw you in pain right after, or who knew the conditions, can still help.
Three Filled-Out Examples Using Real Scenarios
Below are three named workers carried through the key sections of Form WC 15 so you can see how different situations look on paper. Each table shows the form section and what that person enters.
Scenario 1: Carlos Mendoza, Sudden Warehouse Back Injury
| Form Section | What Carlos Enters |
|---|---|
| Employee’s name | Carlos Mendoza |
| Occupation | Warehouse Associate |
| Employer’s name | Front Range Logistics LLC |
| Average Weekly Wage (line A) | $960.00 |
| Average Weekly Wage (line C total) | $960.00 |
| Date of injury/disease | 04/18/2026 |
| Body part affected | Lower back |
| Describe the accident | Lifting a 60-pound box, felt a sharp pull in lower back |
| Date employer notified | 04/20/2026 |
Scenario 2: Aisha Bello, Occupational Disease (Carpal Tunnel)
| Form Section | What Aisha Enters |
|---|---|
| Employee’s name | Aisha Bello |
| Occupation | Data Entry Clerk |
| Date of injury/disease | Last date of keyboard work (last exposure) |
| Injury time | Unknown |
| Body part affected | Both wrists, lower (forearms) |
| Nature of injury/illness | Repetitive strain (carpal tunnel) |
| Describe the accident | Developed wrist soreness over time from daily key-entry |
| Occupational disease employers | Two data-entry employers with employment dates |
| Permanent disability | Unknown |
Scenario 3: Janet Reyes, Worker With a Concurrent Second Job
| Form Section | What Janet Enters |
|---|---|
| Employee’s name | Janet Reyes |
| Occupation | Restaurant Server |
| Average Weekly Wage (line A) | $540.00 (server job where injury occurred) |
| Average Weekly Wage (line B) | $320.00 (weekend retail job) |
| Average Weekly Wage (line C total) | $860.00 |
| Date of injury/disease | 05/02/2026 |
| Body part affected | Right wrist (lower) |
| Describe the accident | Slipped on wet kitchen floor, landed on right wrist |
| Witnesses | Coworker name and phone |
How to File the Completed Form WC 15
Once your form is complete, you submit it directly to the Colorado Division of Workers’ Compensation, and the Division then sends a copy to your employer’s insurance carrier. There is no online filing portal for the worker’s claim itself; the two accepted channels are mail or hand delivery and email. Keep a full copy of the signed form and proof of how you sent it, because that proof is how you show you met the two-year deadline.
By mail or in person: Send or deliver the form to the Division of Workers’ Compensation, Data Entry Unit, 633 17th Street, Suite 400, Denver, CO 80202-3626. There is no filing fee for a worker’s claim. Use certified mail with a return receipt so you have dated proof of filing; processing typically takes a few weeks, after which the carrier’s 20-day clock to admit or deny begins.
By email: Send a clear scan or PDF of the completed form to cdle_workers_compensation@state.co.us. There is no fee, and the email timestamp serves as your proof of filing, so save the sent message and any confirmation. If you need help before sending, call the Division’s Customer Service Unit at 303-318-8700 or toll-free at 1-888-390-7936.
What Happens After You File
After the Division receives your Form WC 15, it logs the claim and forwards a copy to your employer’s insurance carrier. The carrier then has 20 days from receipt to respond in writing by filing either a General Admission of Liability, which accepts the claim and starts benefits, or a Notice of Contest, which denies it. If the carrier admits, your medical bills should route to the insurer and any wage-loss checks begin.
If your injury keeps you off work for more than three days or three shifts, you may receive temporary disability benefits equal to roughly two-thirds of your Average Weekly Wage, paid every two weeks. This is exactly why the wage section matters so much, because that two-thirds figure is built on the number you entered on line C. As a real-world example, Janet Reyes, who correctly listed both her server and retail wages, received checks based on her full $860 combined wage rather than just her server pay.
If the carrier denies the claim or fails to respond in time, you have the right to dispute it by filing an Application for Hearing with the Division. A common misconception is that a denial is the end of the road; it is not, and many denied claims are later resolved through the Division’s hearing and mediation process before an administrative law judge.
Mistakes to Avoid When Filling Out Form WC 15
Small errors on this form cause big delays, so review this list before you submit. Each mistake below is paired with what it costs you.
- Leaving the Average Weekly Wage blank or too low. Your wage-loss checks shrink because benefits are calculated from this number.
- Skipping line B when you held a second job. You lose the higher benefit rate that concurrent wages would have given you.
- Using a nickname instead of your legal name. The Division may fail to match your file, holding up processing.
- Entering the wrong or partial Social Security number. Your records can split into duplicate files that take weeks to fix.
- Writing a vague accident description like “hurt” or “fell.” The carrier gains easy grounds to question or deny the claim.
- Reporting the injury only verbally and guessing the notice date. The carrier can argue you gave late notice and dock compensation.
- Listing an old mailing address. You miss the denial letter and the short window to respond.
- Using your own family doctor instead of a designated provider. The carrier may refuse to pay for that early treatment.
- Naming a store brand instead of the legal employer entity. The claim routes to the wrong carrier and stalls.
- Using the first-pain date instead of last-exposure date for a disease. Your filing clock and claim link can start at the wrong point.
- Forgetting to sign or date the Completed by box. You weaken proof of when and by whom the claim was filed.
- Filing after the two-year deadline. Under C.R.S. 8-43-103 your right to benefits can be barred entirely.
Do’s and Don’ts
These quick rules keep your claim clean and credible.
Do:
- Do file within two years, because the statute of limitations can bar a late claim completely.
- Do report the injury to your employer in writing, since late notice can cost a day’s pay for each day delayed.
- Do include all gross income in your wage figure, because overtime and tips raise your benefit rate.
- Do keep a signed copy and proof of filing, so you can prove you met the deadline.
- Do describe the accident in concrete detail, because specifics make the claim believable.
- Do see an employer-designated provider first, so your early treatment gets paid.
Don’t:
- Don’t leave the wage section blank, because that guarantees lower or delayed checks.
- Don’t exaggerate or invent facts, since the form carries a fraud warning with fines and jail.
- Don’t guess at dates you cannot verify, because clashing dates hurt your credibility.
- Don’t ignore a denial, since you can dispute it through a hearing.
- Don’t use an old address or dead phone number, because you will miss key notices.
- Don’t assume your employer filed for you, since your own WC 15 is what protects your rights.
Pros and Cons of Filing on Your Own vs. With Help
Many Colorado workers file Form WC 15 themselves, while others hire a workers’ compensation attorney. Here is how the two paths compare.
Pros of filing on your own:
- No legal fees, so you keep all of your benefits.
- Speed, because you can download, complete, and email the form the same day.
- Free Division help, since Customer Service answers basic questions at no cost.
- Control, because you handle your own timeline and communication.
- Simplicity for clear claims, since a straightforward injury with an admitting carrier may need no lawyer.
Cons of filing on your own (and pros of getting help):
- Wage errors, because an attorney can catch missed concurrent wages or overtime that raise your benefit.
- Denial handling, since a lawyer knows how to file and argue an Application for Hearing.
- Permanency disputes, because impairment ratings are technical and easy to undervalue alone.
- Deadline protection, since a professional tracks the statute and response windows for you.
- Leverage in settlement, because represented workers often negotiate from a stronger position.
Frequently Asked Questions
Do I have to file Form WC 15 myself, or does my employer do it?
Yes, you should file your own WC 15. Your employer files a separate First Report of Injury, but only your worker’s claim protects your right to benefits with the Division.
How long do I have to file a Colorado workers’ comp claim?
Yes, there is a deadline: generally two years from the date of injury, extendable to three years with a reasonable excuse under C.R.S. 8-43-103.
Is there a fee to file Form WC 15?
No, the worker’s claim has no filing fee. You submit it free by mail, in person, or email to the Division of Workers’ Compensation.
Can I file the form by email?
Yes, you can email a scan of the completed form to the Division at cdle_workers_compensation@state.co.us, and the email timestamp serves as your proof of filing.
Do I put my base pay or my total pay in the Average Weekly Wage box?
Yes, use total gross pay. Line A includes regular wages, overtime, tips, commissions, and other gross income, not just your base hourly rate.
What do I write in line B if I had a second job when I was hurt?
Yes, list it. Enter your Average Weekly Wage from the concurrent second job on line B, because those wages raise your total benefit rate on line C.
What date do I use for an occupational disease like carpal tunnel?
Yes, use the last-exposure date. For diseases with no single accident, enter the last date you were exposed to the hazard, not the first day you felt pain.
Can I see my own doctor instead of the employer’s provider?
No, not at first. Your employer should offer at least four designated providers, and seeing one protects your right to have early treatment paid.
What happens if I leave the date employer notified blank?
No, do not leave it blank. A missing or late notice date lets the carrier argue late reporting, which can cost one day’s pay for each day of delay.
Will I lose my claim if my form is missing some details?
No, an incomplete but timely filing still protects your deadline. File with what you have, then supplement details, rather than missing the two-year statute.
What does the carrier do after I file?
Yes, the carrier must respond. It has 20 days from receiving your claim to file a General Admission of Liability or a Notice of Contest in writing.
Can I reopen my claim later if my condition gets worse?
Yes, often you can. Colorado generally allows reopening up to six years from the date of injury or two years from the last benefit paid, whichever is later.
Do I need a lawyer to fill out Form WC 15?
No, you do not. Many workers file on their own with free Division help, though a lawyer can help if your claim is denied or disputed.
What do I write in the “Completed by” box?
Yes, sign or print your own name there. This box is your statement that the information is true, and it carries a warning against knowingly false answers.
Related reading
- Do Workers’ Compensation Claims Expire? (w/Examples) + FAQs
- How to Fill Out Washington L&I Accident Report (w/Examples) + FAQs
- How to Fill Out the Colorado WC Application for Hearing (w/ Examples) + FAQs
- How to Fill Out Colorado WC Employer’s First Report of Injury + FAQs
- How to Fill Out Colorado WC Final Admission of Liability + FAQs
- How to Fill Out a Colorado Workers’ Compensation Settlement Agreement (w/ Examples) + FAQs