Final Admission Of Liability {WC4}

WC4 - FINAL ADMISSION OF LIABILITY. This form is used in Colorado workers’ compensation cases to formally document the benefits that an insurance carrier or self-insured employer is admitting it has paid or will pay to an injured worker. This legal document outlines key claim information, such as the injured worker’s average weekly wage, dates of temporary total disability (TTD) payments, the date of maximum medical improvement (MMI), and any permanent partial disability (PPD) or other benefits being awarded, such as disfigurement, vocational rehabilitation, or maintenance care. It serves as a notice to the claimant that the carrier is finalizing its responsibilities regarding the claim, and it warns the claimant that they must file an objection within 30 calendar days if they disagree with any part of the admission. If no objection is filed in time, the case will automatically close based on the terms outlined in the form. The form also includes a section for disputing issues through a Division Independent Medical Examination (DIME) or by requesting a hearing. www.FormsWorkflow.com