Workers' Comp and Personal Injury

Click here to visit the provider page of the Colorado Department of Workers’ Compensation website.

Helpful forms for physicians

Discharge or Refusal Form Letter with Flow Chart
This is a new requirement of physicians treating injured workers.

Designated Health Care Provider Disclosure (WC030)
This form is used by a designated health care provider when a request is made for information on ownership interests and employment relationships.
PDF | Word

Physician’s Reports (WC164)
This form is used by the physician to provide information on the status, progress and medical treatment of the injured worker. It is also used to provide information on the date of maximum medical improvement and permanent impairment. A copy of the completed report is provided to both the insurer and the claimant. Revised 11/14.
PDF | Word

Permanent Mental Impairment Rating Worksheet (WC-M3 Psych)
This worksheet is used by Level II Accredited Physicians to assign permanent mental impairment ratings.
PDF | Word

Pharmacy Billing Statement (WC-M4 Psych)
This form is used by the Pharmacy to bill the carrier for payment.
PDF | Word

Other links and resources

Upcoming events

CMS policies

CMS Workers’ Compensation and Personal Injury Committee (WCPIC)

WCPIC is the CMS committee tasked with the issue of workers’ compensation in Colorado. Click here to go to the event calendar to view the next meeting. Click here to see current members of WCPIC. Contact WCPIC by emailing