Fillable Monthly Summary Instructions for Completing the (Colorado DORA)

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Monthly Summary Instructions for Completing the (Colorado DORA)

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Colorado Department of Regulatory Agencies (DORA) is responsible for professional licensing and consumer protection in Colorado USA.

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1
Instructions for Completing the
Monthly Summary
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Go to Form
WC098 Rev 01/06
DEPARTMENT OF LABOR AND EMPLOYMENT
Division of Workers’ Compensation
Research and Statistics Unit
633 17
th
Street, Suite 400
Denver, CO 80202-3626
MONTHLY SUMMARY
Date Completed ___________________________
Carrier Number ______________________________
Carrier Name __________________________________________________________________________
Summary of injuries reported pursuant to Section 8 -43-101(2) C.R.S. as amended.
Total number of medical-only cases accepted
for payment (no lost time in excess of 3 days,
etc.) including occupational disease not listed
Rule 5-2(B).
1
Total number of exposures to
injurious substances
Totals
January
February
March
April
May
June
July
August
September
October
November
December
1
List of exposures to injurious substances: ___________________________________________________________
_______________________________________________________________________________________________
Remarks: _______________________________________________________________________________________
______________________________________________________________________________________
Contact:
Address:
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Monthly Summary Instructions for Completing the (Colorado DORA)

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Completed 27 January 2021

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