Why Insurance Companies Fight Workers Comp Claims: A Look at Certain Colorado Cases

Fast Answers: Why Your Colorado Workers’ Comp Case Is Being Fought So Hard

Not all colorado workers compensation claims are treated equally. If you’re an injured worker in Pueblo or Southern Colorado and suddenly find yourself facing aggressive pushback from an insurance company, you’re not imagining things. Some claims get flagged for dispute mode from day one.

Why do insurers dig in harder on certain cases?

• High medical costs — Surgeries, extended treatment, and expensive diagnostics trigger immediate scrutiny

• Long-term disability potential — Claims that could lead to permanent disability ratings draw extra resistance

• Pre-existing conditions — Any prior back problems, arthritis, or old injuries become ammunition

• Credibility concerns — Late reporting, inconsistent statements, or gaps in treatment invite attack

• Multiple prior claims — Workers with past workers comp claims face heightened suspicion

• Alleged safety violations — Claims of intoxication or broken rules can be used to reduce benefits

Here’s what matters most: even a heavily contested claim can still succeed under Colorado law when you have the right evidence and representation.

If your claim has been denied, your checks have suddenly stopped, or you’ve been sent to an IME doctor who seemed more interested in cutting you off than helping you heal, it’s time to get real answers.

Call Johnston Law Firm, LLC at (719) 309-9484 or message us online for a free workers’ comp case review. We represent injured workers throughout Pueblo, Otero, Fremont, Custer, Huerfano, Las Animas, and Crowley Counties.

How Colorado Workers’ Comp Insurance Really Works (And Why Insurers Push Back)

Colorado operates a no-fault workers compensation system, meaning you don’t have to prove your employer was negligent to receive benefits. Workers' compensation insurance is a state-mandated insurance program that provides benefits to employees who suffer job-related injuries and illnesses in Colorado.

Employers operating in Colorado with one or more employees must carry workers compensation insurance or obtain approval to self insure. In fact, workers' compensation insurance is required for all employers in Colorado, regardless of the number of employees, and Colorado businesses must comply with this legal requirement. When you’re injured on the job, your claim is handled by the insurance carrier — not your employer directly. Workers' compensation benefits are paid by the employer's workers' comp insurer.

Here’s what most injured workers don’t realize: insurance companies are for-profit businesses. They make money by collecting premiums and limiting payouts. Every dollar they pay for your medical treatment, lost wages, or permanent disability comes directly off their bottom line.

Workers in Pueblo and surrounding counties often interact with adjusters from large regional or national carriers. These aren’t local decision-makers who know your community. They work from checklists and cost-control strategies that can make the process feel impersonal and hostile.

Under Colorado law, insurers control critical steps in your claim:

Insurer Power	What It Means For You
Selecting designated providers	They choose which doctors you see initially
Ordering Independent Medical Examinations	They pick and pay the IME doctor
Admitting or contesting liability	They decide whether to accept your claim
Approving treatment	They control authorization for MRIs, surgeries, referrals

The Colorado Division of Workers Compensation (DOWC), which is part of the Colorado Department of Labor and Employment, and Administrative Law Judges oversee disputes, but insurers still hold substantial leverage early in your case — before you ever get to a hearing. The Department of Labor manages the state's workers' compensation program, including setting rates and handling claims for employees injured on the job.

Johnston Law Firm, LLC routinely deals with these carriers across Colorado and understands their internal strategies, typical arguments, and the pressure points that make them pay what they owe.

Key Reasons Insurance Companies Fight Some Colorado Workers’ Comp Cases Harder

This section walks through the main red flags that cause insurers to dig in, delay, or deny workers compensation benefits — especially as Colorado prepares for 2026 law changes that may shift the landscape even further.

Cases suggesting long-term exposure, permanent impairment, or expensive future medical care draw extra scrutiny because they affect an insurer’s long-term financial reserves. When Pinnacol Assurance or another major insurance carrier sees a claim that could cost six figures over time, they deploy their full arsenal. Insurers closely examine whether the claim involves a work related injury that occurred within the scope of employment, as only injuries arising out of employment are eligible for workers' compensation benefits under Colorado law.

We’ll cover:

• High-value cases involving serious injuries

• Disputed causation and pre-existing conditions

• Late reporting and documentation gaps

• Credibility attacks, surveillance, and social media

• Alleged safety violations or misconduct

Missed reporting deadlines often leads to an automatic denial. Workers' compensation claims are commonly disputed or denied due to delayed reporting, lack of medical evidence linking the injury to work, pre-existing conditions, or inconsistencies in the claimant's story.

None of these insurer concerns automatically defeat your claim. They simply signal that you need to be especially careful, organized, and ideally represented by a workers compensation attorney.

If your claim seems stalled or you’re facing aggressive questioning, call (719) 309-9484 or message us online before giving recorded statements or attending IMEs alone.

High-Value Cases: Serious Injuries, Surgeries, and Lifetime Costs

Insurers fight hardest when the projected value of a claim is high. These are the cases that keep adjusters up at night:

• Spinal fusions and multi-level disc surgeries

• Shoulder or knee reconstructions

• Traumatic brain injuries

• Complex regional pain syndrome (CRPS)

• Injuries requiring multiple surgeries over years

Under Colorado law, long-term temporary total disability (TTD), permanent partial disability (PPD) ratings, and potential permanent total disability (PTD) can reach six figures or more. These benefits are designed to replace an employee's wages during recovery, in addition to covering medical expenses. That’s why insurers resist so hard.

Real examples from Southern Colorado:

• Pueblo steelworkers whose repetitive lifting injuries require fusion surgery

• Construction workers in Fremont County with falls that prevent return to heavy labor

• Oil and gas workers in Las Animas County with crush injuries and permanent limitations

In these high-value cases, insurers typically:

1. Push for early return-to-work even when your treating physician recommends caution

2. Send you to IMEs aimed at minimizing your impairment rating

3. Heavily scrutinize every medical recommendation, diagnostic test, and therapy session

How quickly costs add up:

Injury Type	Potential Combined Exposure (Medical + Wage Loss)
Back surgery with complications	$100,000 - $250,000+
Shoulder reconstruction	$75,000 - $150,000
TBI with cognitive deficits	$200,000 - $500,000+
Amputation	$300,000+

A “simple” back injury requiring surgery can easily exceed $100,000 in combined medical and wage-loss exposure over several years. If an employee dies as a result of a work-related injury or illness, workers' compensation insurance provides death benefits to the employee's dependents. That’s why your claim is being fought so hard.

Disputed Causation and Pre-Existing Conditions

One of the most common insurer tactics is arguing that your condition isn’t really from work — it’s from pre-existing degenerative disc disease, arthritis, or that old sports injury from college. A lack of documentation from a doctor linking the injury directly to job duties is a major cause for denial.

Here’s what Colorado law actually says: Work-related aggravation of a pre-existing condition is still compensable if the job activities or incident made the condition materially worse.

You don’t need a perfect spine to have a valid workers compensation claim. What matters is whether your work injury aggravated, accelerated, or combined with a pre-existing condition to create your current disability. If causation is established, workers' compensation benefits should cover all reasonable medical expenses related to the injury, including necessary treatments like hospital stays and surgeries.

What insurers do to fight causation:

• Dig through years of medical records to find any prior complaint about the same body part

• Claim your injury arose from hobbies or non-work activities (skiing, weekend sports, home projects)

• Use IME doctors to opine that your condition is purely degenerative

• Argue that your symptoms would have happened anyway without the work incident

How to protect yourself:

Be honest about prior injuries — but clear about how the work incident changed your symptoms. Did you have occasional back stiffness before, but now you can’t stand for more than 10 minutes? Could you work full duty before, but now you need surgery? That’s what matters.

Johnston Law Firm, LLC often works with treating doctors and, when necessary, independent specialists to provide clear medical opinions on causation and aggravation that hold up under scrutiny.

Late Reporting, Incomplete Forms, and Documentation Gaps

In Colorado, workers must report workplace injuries to their employer within four working days of the accident. Under Colorado law, workers are generally expected to provide written notification of injury within four working days. Delays are commonly used by insurers to question credibility or outright deny workers compensation benefits.

Typical real-life situations we see:

• Pueblo or Otero County workers who “tough it out” for a few weeks, only to realize the back pain is serious

• Night-shift workers who verbally tell a supervisor but never fill out formal written reports

• Employees who report to one supervisor but the company claims they never received notice

• Workers who can’t afford to go to the doctor, creating treatment gaps

Employers in Colorado have ten days to report the injury to their insurance company after being notified by the employee. If the injury results in more than 3 days or shifts where the employee is unable to work, the insurance carrier has up to 10 days to file a First Report of Injury.

Documentation problems insurers attack:

• Inconsistent accident descriptions between the First Report of Injury, clinic intake forms, and recorded statements

• Missing witness names or incomplete accident site details

• Gaps in medical treatment where you couldn’t afford to see a doctor

• Discrepancies in dates, times, or how the accident occurred

These are fixable problems with careful explanation and supporting evidence. A workers compensation attorney can help correct the record through sworn testimony, additional documentation, and witness statements.

Missed a deadline or made paperwork mistakes? Contact Johnston Law Firm at (719) 309-9484 or message us online to discuss whether statutory exceptions or factual clarifications can salvage your claim.

Credibility Attacks, Surveillance, and Social Media

In contested cases, insurers may deploy aggressive investigation tactics:

• Hire private investigators to conduct video surveillance outside your home, at doctor appointments, or at public events. Insurance companies often use surveillance to find inconsistencies in a claimant's story and may hire private investigators to film claimants or scan social media for activities that contradict reported injuries.

• Monitor social media for posts that appear inconsistent with your claimed restrictions

• Question co-workers and supervisors about your activities and statements

Claims for injuries that occur without witnesses or video surveillance are frequently scrutinized for potential fraud. If you are unable to provide details or written notice due to physical or mental incapacity, someone else can act on your behalf to ensure the necessary information is submitted.

Even harmless activities can be misrepresented when recorded out of context. Carrying a bag of groceries for 30 seconds doesn’t mean you can lift 50 pounds repeatedly. Attending your child’s soccer game doesn’t mean you can work an 8-hour shift.

A real example: A Colorado worker’s surveillance footage showed him moving furniture. The insurer claimed this proved he was faking. In reality, he was helping during a divorce move, paid for it with a week of increased pain, and his doctor confirmed the activity was consistent with occasional “good days” that chronic pain patients experience. With proper medical testimony and context, the claim survived.

How to protect yourself:

• Follow medical restrictions carefully and document when you push yourself for therapy or necessary daily tasks

• Avoid posting about injuries, vacations, or physical activities online during an open claim

• Assume anything public can be used by the defense at hearing

• Keep a pain journal documenting your daily limitations

Alleged Safety Violations, Intoxication, or Misconduct

Insurers may argue that your own misconduct should limit or bar benefits under Colorado workers compensation statutes. Common allegations include:

• Intoxication at the time of injury

• Violating clear safety rules

• Horseplay or intentional misconduct

• Failure to use required safety equipment

• Injuries resulting from horseplay, fighting, or the violation of safety policies are often excluded from coverage

Certain exclusions apply, such as injuries that occur during breaks, off-duty hours, or due to intoxication. A failed or refused drug/alcohol test immediately after an accident is grounds for automatic denial.

Here’s the reality: Intoxication or deliberate self-harm can reduce or eliminate some benefits. But reasonable mistakes, poor training, or pressure to work fast often still allow full coverage under the workers compensation act.

Examples:

• A Pueblo warehouse employee injured while bypassing a safety guard because production quotas were unrealistic and supervisors looked the other way

• A road crew in Custer County working with inadequate safety equipment provided by the employer who suffers a fall

It’s important to note that negligence caused by third parties—such as contractors or equipment manufacturers—can lead to separate legal claims for personal injury, which is distinct from employer-related negligence.

Johnston Law Firm investigates whether safety policies were actually enforced, whether supervisors encouraged shortcuts, and whether OSHA standards were followed. Often the “safety violation” excuse falls apart under scrutiny.

Critical advice: Do not admit to “violating rules” before speaking with an attorney. Insurers can twist casual comments into formal defenses that cost you thousands in benefits.

What Insurers Actually Do to Fight Colorado Workers’ Comp Claims

Once an insurance company flags your claim as “high exposure” or “questionable,” they deploy specific tactics designed to reduce payouts or push you into giving up. Although insurers are obligated to provide coverage for valid workers' compensation claims, they often try to minimize their financial responsibility. By stalling on decisions or medical approvals, insurers pressure injured workers to accept lower settlements. Insurers also frequently dispute claims based on procedural errors, lack of evidence, or the nature of the injury itself. Workers' compensation claims can be denied for various reasons, many of which can be challenged with the right evidence and approach.

These tactics are common across Colorado — from Pueblo to the Western Slope to the Front Range. Johnston Law Firm has seen the same patterns repeated for decades, and we know how to counter them.

Before you agree to a DIME, sign settlement documents, or return to work against medical advice, consult with a workers compensation attorney who can protect your interests.

Using Independent Medical Examinations (IMEs) to Cut Off Care

An Independent Medical Examination is a one-time exam by a doctor chosen and paid by the insurance company. The purpose isn’t to treat you — it’s to give opinions on causation, impairment, and whether you need more treatment. For non-emergency injuries, you may be required to select a healthcare provider from a list provided by your employer. If your employer fails to provide this information, you may have the right to choose your own healthcare provider.

While called “independent,” many IME doctors have ongoing relationships with insurers and are known for conservative opinions that:

• Declare you at maximum medical improvement (MMI) too early

• Minimize your impairment rating (which directly affects your settlement)

• Dispute the need for surgeries, injections, or extended physical therapy

• Attribute your condition to pre-existing degeneration

Insurance companies often argue that medical records do not adequately link the injury to the workplace accident, using this as a basis to dispute or deny claims.

The numbers don’t lie: Studies show IME reports favor insurers in approximately 70% of disputes.

Colorado’s DIME process (Division-sponsored Independent Medical Examination) is a key tool to challenge biased IME opinions. But deadlines and procedures are strict — and upcoming 2026 rule changes may tighten these requirements further.

If your claim is denied after an IME, claimants typically have the right to appeal the decision.

Never treat an IME as a routine doctor visit. Prepare carefully, be truthful but concise, and consider speaking to Johnston Law Firm before attending. Call (719) 309-9484 or message us online to discuss your upcoming IME.

Nurse Case Managers, Return-to-Work Pressure, and “Light Duty” Jobs

Nurse case managers hired by the insurer may:

• Accompany you to doctor visits

• Push for faster releases to work

• Report directly to the adjuster about everything you say

Employers in Pueblo and surrounding counties are required to provide workers compensation coverage to protect employees and comply with Colorado law. Sometimes, they offer “light duty” jobs designed to cut off your wage loss benefits. Watch for assignments that are:

• Outside your actual medical restrictions

• Temporary, punitive, or designed to force resignation

• Inconsistent with your commute, medical schedule, or treatment needs

• Make-work positions that disappear once you accept

Colorado law allows modified work within medical restrictions — but not assignments that endanger you or ignore your doctor’s orders.

Filing a claim after being fired or laid off can lead to a presumption that the claim is retaliatory rather than legitimate, which may affect how your case is handled.

Get legal advice before refusing a light-duty offer or signing any new job description. These decisions directly affect your workers compensation benefits.

Delays, Denials, and Low-Ball Settlement Offers

Many insurers intentionally:

• Delay authorizing MRIs, specialist referrals, or surgery for weeks or months

• Interrupt TTD checks over minor paperwork issues

• Send low settlement offers before you reach MMI or know your true impairment

Employers have a legal obligation to provide workers compensation insurance to protect employees’ health and financial well-being, as well as to safeguard their business from legal liabilities and penalties.

If your claim is denied, the denial letter from the insurance company will outline the specific reasons your claim was rejected.

The emotional and financial pressure on injured workers can be crushing. In Pueblo, La Junta, and rural counties, an injured employee who falls behind on rent or car payments when checks stop unexpectedly may feel forced to accept whatever the insurance company offers.

That’s exactly what they’re counting on.

Settlement should generally not occur until:

1. You’ve reached maximum medical improvement

2. You have an accurate impairment rating

3. Future medical needs are evaluated

4. Potential 2026 Colorado law changes are considered

Don’t accept a settlement just to “get it over with.” Contact Johnston Law Firm at (719) 309-9484 or message us online before signing anything.

How Johnston Law Firm, LLC Levels the Playing Field Against Insurance Companies

Steve Johnston represents injured individuals — not insurance carriers — across Pueblo and the rest of Colorado. His practice focuses on workers’ compensation, personal injury, automobile accidents, estate planning, criminal law, social security law, and labor and employment law.

This broad experience helps when injuries overlap. Many workplace injuries lead to SSDI claims. Some accidents involve potential criminal charges. Catastrophic injuries affect estate planning and family finances. Having one attorney who understands all these areas means nothing falls through the cracks.

Specific workers’ comp services Johnston Law Firm provides:

Service	How It Helps You
Challenging denied claims	Fight back against wrongful denials with evidence and legal arguments
Contesting adverse IME opinions	Use the DIME process and medical experts to overcome biased exams
Hearing preparation	Present your case effectively before Colorado Administrative Law Judges
SSDI coordination	Avoid benefit offsets and maximize total recovery
Third-party claims	Identify claims against negligent drivers, equipment manufacturers, or subcontractors
Worker classification issues	Address disputes over employee status, including independent contractors, and ensure correct classification for proper coverage

Johnston Law Firm provides personal attention and timely communication. The firm handles cases throughout Colorado, including Otero, Fremont, Custer, Huerfano, Las Animas, and Crowley Counties. Colorado law requires that all employers operating in the state carry workers' compensation insurance, making compliance and proper worker classification essential.

Initial consultations are free for injured workers. Many workers’ comp cases are handled on a contingency-fee basis — no attorney fee unless money is recovered, subject to Colorado rules.

What You Should Do Right Now If Your Colorado Workers’ Comp Claim Is Being Fought

Strict Colorado deadlines apply to reporting injuries, objecting to MMI, requesting hearings, and pursuing DIMEs. Waiting too long can permanently harm your claim — or destroy it entirely.

Step 1: Gather and Organize All Paperwork

Collect everything related to your claim:

• Accident reports and First Report of Injury forms

• All employer communications (emails, texts, letters)

• Every letter from the insurance carrier

• Medical records from all treatment providers

• Prescription records and imaging reports

This is especially important for repair workers and those involved in casual maintenance, as these categories of employees may have unique documentation or reporting requirements under workers' compensation laws.

Step 2: Continue Following Medical Restrictions

Keep every doctor appointment. Document any missed appointments with legitimate reasons (transportation issues, scheduling conflicts). In Colorado, employees can select a healthcare provider for non-emergency injuries from a list provided by their employer. Follow all restrictions — and document when you push yourself for physical therapy or necessary daily activities. Some employers, especially larger ones with significant financial resources, may use self insurance instead of purchasing workers' compensation insurance from private carriers.

Step 3: Stop Talking to the Insurance Company Without Representation

Avoid giving additional recorded statements or signing settlement papers before speaking to a lawyer. Everything you say can be used to minimize or deny your claim.

Step 4: Create a Detailed Timeline

Write down a timeline from your injury date to present, including:

• Exact date and circumstances of injury

• Every symptom and how it’s changed over time

• Work status (working, off work, light duty, terminated)

• Conversations with supervisors, adjusters, and nurse case managers

• Dates of all medical appointments

Ready to fight back? Call Johnston Law Firm, LLC at (719) 309-9484 or message us online for a free, confidential evaluation of your Colorado workers’ comp case.

The firm can advise workers even if you already have an admitted claim but are facing an impending IME, MMI determination, or 2026 law changes that might affect your benefits.

Serving Pueblo and Injured Workers Across Colorado

Johnston Law Firm is based in Pueblo, Colorado, but represents injured workers throughout the state — including Otero, Fremont, Custer, Huerfano, Las Animas, and Crowley Counties.

Industries and workers the firm regularly helps:

• Construction and building trades

• Oil and gas field workers

• Mining and extraction

• Manufacturing and food processing

• Healthcare and nursing

• Warehouse and distribution

• Transportation and trucking

• Public employees and first responders

Steve Johnston understands the realities facing working-class families in Southern Colorado. He knows the challenges of accessing specialized medical care in rural counties, dealing with employers who pressure workers to return too soon, and fighting insurance companies that have armies of adjusters and lawyers.

Whether your claim involves a denied back surgery, a contested PTSD diagnosis, repetitive trauma to your hands and shoulders, or catastrophic injuries from a vehicle crash on the job, Johnston Law Firm is prepared to fight insurers who refuse to pay fairly.

Don’t let insurance company tactics cost you the compensation you’ve earned. Call (719) 309-9484 now or send a secure message through the Johnston Law Firm website to schedule a free consultation and learn how upcoming Colorado workers’ comp law changes through 2026 could affect your rights and settlement options.