Among the most contentious insurance bills of the 2025 Colorado legislative session was a bill impacting workers’ compensation, HB 25-1300, Workers’ Compensation Benefits Proof of Entitlement. The bill requires an employer or its insurer to use the Division of Workers’ Compensation (DWC) utilization standards and provides injured workers much greater control over the selection of their primary treating physician in workers’ compensation cases.
Bill Summary
Utilization Standards
Under current law, the DWC adopts utilization standards for the delivery of medical benefits for workers’ compensation claims. HB 25-1300 requires an employer or their insurer to use the DWC’s utilization standards when responding to a request for authorization from a treating physician. If an employer or the employer’s insurer fails to meet the DWC’s utilization standards when reviewing a request for authorization, the DWC may deem the services provided by an authorized treating physician as authorized, reasonable, and necessary and require payment for the services by the employer or the employer’s insurer.
Doctor Choice
Under current law, an employer or insurer must provide an injured worker a list of at least four accredited physicians who can provide treatment. HB 25-1300 repeals this provision and requires that, within seven days of being notified of a workplace injury, an employer or insurer notify the injured employee of the employee’s right to designate a treating physician and where to access the list of level I and level II accredited physicians maintained by the DWC. If the employee fails to designate a primary physician, the employer or insurer may select from the list of accredited physicians.
Change of Physician Process
The bill also extends the period of time for an injured employee to notify the carrier of a change of physician from 90 to 120 days after the date of the first physician designation, but before the injured employee reaches maximum medical improvement.
Context and Probable Impact of HB 25-1300
HB 25-1300 follows in the footsteps of negotiations over physician choice in workers’ compensation that took place in 2014. Those negotiations led to a longstanding agreement between labor and the business community to expand the number of physicians from two to four. This approach balanced a worker’s flexibility to choose his or her own doctor but prevented abuse of the system (as well as overabundance of choice).
HB 25-1300 eliminates the existing paradigm, and it remains to be seen how HB 25-1300 will ultimately affect the workers’ compensation system in Colorado.
Among many criticisms of this bill, the most significant expressed by the business community include:
- The new doctor choice policy expands the number of physicians that injured workers may choose from the four under current law, to over 1,000 level I and level II physicians. This expansion of choice will require workers to sift through more than 1,000 options, which has the potential to cause unnecessary delays in care. Consequently, the new policy may hinder medical recovery, increase cost of care, and possibly lead to longer worker absences.
- Extending the timeline on changes of physicians from 90 to 120 days has the potential to delay diagnosis or treatment for an injured worker. This policy could lead to delays and inconsistent medical care while increasing litigation and premiums paid by employers.
Governor Polis’s Signing Statement
Ultimately, the bill passed along party lines. While there was some hope that Governor Polis would veto the bill, ultimately, he signed the bill into law on June 4. Governor Polis issued a corresponding signing statement calling for the creation of a working group to develop recommendations around the implementation of the bill and legislation for the 2026 legislative session.
Governor Polis encouraged the working group to consider all topics raised by opponents and proponents, and specifically address:
- The permissibility of in-house clinics that employ level I or level II accredited physicians as an option available to injured workers;
- That nothing precludes an employer or insurer from selecting any number of level I or level II accredited physicians to provide as a list of recommendations;
- The functionality of the DWC’s provider directory and clarifications around appropriate provider types to serve as a designated provider;
- The accreditation process for providers, including DWC tracking of licensure and malpractice status;
- The applicability of the premium credit described in the Division of Insurance’s Amended Regulation 5-1-1 Section 5€;
- Any timelines, including around designation of and change of physician, or other legislative provisions to ensure workers receive prompt care; and
- Identify mechanisms to lower costs.
Effective Date
The new law will take effect on January 1, 2028, and applies to workers’ compensation claims filed on or after that date.