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General Admission of Liability

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COLORADO DEPARTMENT OF LABOR & EMPLOYMENT
DIVISION OF WORKERS’ COMPENSATION
GENERAL ADMISSION OF LIABILITY

WC #

Carrier #

TO:

and

DIVISION OF WORKERS’ COMPENSATION

Soc. Sec. #

Employer

Date of Injury

Average Weekly Wage

Date first payment paid TTD

Date first payment PPD

Date of MMI

YOU ARE HEREBY NOTIFIED that the insurance carrier or self-insured employer (named below) admits that the injury or occupational disease reported herein is compensable. YOU ARE ALSO NOTIFIED that if a child-support obligation is owed, compensation benefits may be attached and payment of the child-support obligation may be withheld and forwarded to the obligee pursuant to sections 8-42-124 and 26-13-122(4), C.R.S. YOU ARE FURTHER NOTIFIED that you must provide written notice of any award for social security, pension, disability or other source of income that might reduce your compensation benefits. This notice must be sent to the insurance carrier or self-insured employer within 20 days after learning of the payment or award. Failure to report may result in suspension of your benefits pursuant to section 8-42-113.5, C.R.S.

Liability is admitted for the following benefits: See Reverse Side for Codes

% Disability Age

1.

2.

Complete the following if admitting for disability

Type of Benefit Time Periods Rate per Week Totals
from thru = $ $
from thru = $ $
from thru = $ $
from thru = $ $
from thru = $ $
from thru = $ $
from thru = $ $

The above time periods represent inclusive dates.

Remarks:

Carrier or Self-Insured

Address

Telephone No.

By:

Date

NOTICE TO CLAIMANT: IF YOU DISAGREE WITH THE AMOUNT OR TYPE OF BENEFITS WHICH THE CARRIER HAS AGREED TO PAY, YOU MAY WRITE A LETTER TO THE DIVISION OF WORKERS’ COMPENSATION, 633 17th ST., SUITE 400, DENVER, CO 80202-3660, STATING THAT YOU OBJECT TO THIS ADMISSION OF LIABILITY.

Copies of this admission were mailed this day of , to:

Block #

Adj. Code

BENEFITS

Compensation benefits are paid by insurance carriers for compensable injuries. Temporary disability benefits are paid every 2 weeks.

Temporary Total Disability - Total disability of more than 3 working days. If disability lasts for more than 14 calendar days, compensation shall be paid from the day left work. Compensation is payable at the rate of 66 2/3% average weekly wage in effect at the time the injury/exposure not to exceed the statutory maximum. A loss of fringe benefits specifically enumerated in the statute should be included in the calculation of the average weekly wage.

Permanent Partial Disability - Payable where there is residual impairment, based upon the part of the body affected, or on the extent of medical impairment.

Facial or Bodily Disfigurement - Serious, permanent disfigurement about the head, face or parts of the body normally exposed to public view. Benefits are not to exceed $2000.

Medical Benefits - Current medical benefits for medical, hospital and surgical supplies, prescriptions, crutches, apparatus and vocational rehabilitation.

Temporary Partial Disability - Temporary partial disability of more than 3 working days. Compensation is payable at the rate of 66 2/3% of the difference between the employee’s average weekly wage at the time of injury and said employee’s average weekly wage during the continuance of the temporary partial disability not to exceed a maximum of 91% of the state average weekly wage per week.

MMI - Maximum Medical Improvement means a point in time where any medically determinable physical or mental impairment as a result of injury has become stable and when no further treatment is reasonably expected to improve the condition.

Codes for scheduled ratings:

01 Arm @ Shoulder

03 Hand @ Wrist

04 Thumb @ Metacarpal

05 Thumb @ Proximal

06 Thumb @ Distal

07 Index @ Metacarpal

08 Index @ Proximal

09 Index @ Second

10 Index @ Distal

11 Middle @ Metacarpal

12 Middle @ Proximal

13 Middle @ Second

14 Middle @ Distal

15 Ring @ Metacarpal

16 Ring @ Proximal

17 Ring @ Second

18 Ring @ Distal

19 Little @ Metacarpal

20 Little @ Proximal

21 Little @ Second

22 Little @ Distal

23 Leg @ Hip

25 Leg @ Foot, Heel, Ankle

26 Great Toe @ Metatarsal

27 Great Toe @ Proximal

28 Great Toe @ Distal

29 Other Toe @ Metatarsal

30 Other Toe @ Proximal

31 Other Toe @ Distal

32 Eye Enucleation

33 Blindness One Eye

34 Deafness Both Ears

35 Deafness One Ear

36 Total Hearing 2nd Ear

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What the General Admission of Liability Is and When It’s Used

A General Admission of Liability is a written statement in which a party acknowledges responsibility for loss, injury, damage, or breach arising from a discrete event or series of actions. It can be standalone or incorporated into a settlement, release, or insurance claim file. The document typically allocates fault, describes the scope of liability, and may propose remedial steps, payment amounts, or mutual releases. Properly drafted admissions can simplify claims resolution but also change litigation posture and insurance coverage positions, so clarity and accuracy are essential.

Why a Clear Admission Matters for Risk and Resolution

A precise General Admission of Liability clarifies responsibility, narrows disputed issues, and can accelerate settlement or insurance adjustment. From a legal perspective, an electronically executed admission is enforceable under the federal ESIGN Act (15 U.S.C. ch. 96) and most state UETA statutes when intent, consent, attribution, and retention are satisfied; exceptions such as wills and certain court filings still apply. Accurate wording limits ambiguity that can lead to counterclaims or coverage disputes.

Why a Clear Admission Matters for Risk and Resolution

Who Typically Prepares or Signs an Admission

Use the correct signatory role and, when required, follow notarization, witness, or corporate authorization formalities to ensure enforceability.

  • Insured parties and insurers during claim negotiations to document fault and payment terms.
  • Contract counterparties after defects, delays, or performance failures to avoid litigation.
  • Legal counsel preparing settlement packages or corporate representatives with delegated authority to bind the entity.

Step-by-Step: Preparing and Executing the Document

Follow these core steps to create a clear, enforceable admission and minimize downstream disputes.

  • 01
    Draft: Record facts, scope, and proposed remedies.
  • 02
    Review: Have legal counsel and insurer review language.
  • 03
    Authenticate: Choose appropriate signer authentication method.
  • 04
    Execute: Sign, notarize if required, and distribute copies.

Essential Elements to Include in a Professional Admission

A well-structured General Admission of Liability contains standardized clauses that make obligations, scope, and remedies clear to contracting parties, insurers, and third parties.

Admission Clause

An explicit sentence stating the party accepts liability for specified acts or omissions, limited to defined events to prevent overbroad interpretation.

Fact Summary

A concise factual recital identifying dates, locations, and actions that form the basis for the admission without extraneous assertions or hearsay.

Remedies and Payments

Clear statement of monetary amounts, payment schedule, or corrective actions, including whether payments are without admission of further liability.

Release and Reservation

Define which claims are released and which are reserved, including carve-outs for punitive damages, fraud, or subrogation rights.

Authority Statement

Confirmation that signers have authority to bind themselves or the entity; include title and corporate resolution references when needed.

Execution Details

Signature block, dates, witness or notary fields, and any electronic signature instructions required for valid execution.

Key Administrative and Compliance Data to Capture

Signer Identity: Full name and capacity
Signature Timestamp: Date and time of signing
Authentication Method: Email, SMS, KBA, or 2FA
Document Version: Version number or revision date
Notary Details: Notary name, commission, state
Audit Trail: IP, action log retained

Common Legal and Practical Risks to Avoid

Unclear Scope: May trigger further litigation
Unauthorized Signer: Admission may be voidable
Insurance Denial: Coverage dispute or reservation
Waived Defenses: Unintended forfeiture of rights
Statute Issues: Limitations may be affected
Public Disclosure: Reputational or regulatory exposure

Frequent Preparation Errors That Cause Delays

  • Vague language that leaves key obligations undefined, forcing parties to renegotiate or litigate interpretation.
  • Missing signatory capacity details, such as title or corporate resolution, which lead insurers or courts to question authority.
  • Failing to coordinate with insurance carriers before execution, resulting in coverage disputes or delayed payments.
  • Incorrect dates or inconsistent incident descriptions across documents, which undermine credibility and admissibility.

How an Admission Moves From Draft to Finalized Record

A typical workflow moves through drafting, internal approvals, signature, and secure distribution while preserving the audit trail.

  • Upload: Store draft in secure repository.
  • Place Fields: Add signature, date, and witness fields.
  • Authenticate Signer: Use email, SMS, or stronger methods.
  • Complete and Archive: Generate signed PDF and save audit trail.

Recommended Digital Workflow Settings

Configure your digital workflow to capture identity, sequence signing, and retain verifiable records for compliance and claims handling.

Field Configuration
Signature Authentication Email link with optional SMS code
Signing Order Sequential or parallel as required
Document Retention Keep PDF + full audit trail
Notarization Option Enable RON or in-person notary fields

Technology and Delivery Considerations

Ensure the solution meets HIPAA or other industry requirements when handling sensitive data and that retention meets regulatory standards.

  • File Formats: PDF and DOCX supported
  • Integrations: CRM and cloud-storage links
  • Authentication: Email, SMS, KBA, SSO

Timing Expectations and Typical Deadlines

There is no universal filing deadline for a General Admission of Liability, but timeliness affects insurance notice requirements and limitation periods.

Immediate Reporting:

Notify insurer as soon as practical to preserve coverage.

Contractual Deadlines:

Some contracts require notice or admission within 30–60 days.

Statute of Limitations:

Admission may affect accrual dates for limitations.

RON Retention:

Audio-video RON recordings often retained 5–10 years.

Document Archival:

Keep executed records for the full exposure period.

Common eSignature Options and Pricing for Executing Admissions

Comparison of representative starting prices and key capabilities for common eSignature providers; signNow is listed first in the table as required.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Real-World Examples of Admissions and Outcomes

Two real customer perspectives illustrate practical uses of clear admissions and digital execution.

Optica Ventures — COO

The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers.

  • Easier customer signing workflows reduced delays.
  • Brian Fitzgibbons, COO at Optica Ventures LLC, reported faster turnaround and fewer follow-ups after adopting a digital execution process for settlement documents.

Martin Properties — Founder

I can process and execute all of these documents online with 100% compliance and built-in security.

  • Mobile and offline signing supported.
  • Tim Martin, Founder at Martin Properties, said online execution enabled property teams to close repairs and settlements without in-person meetings, improving tenant relations and speed to resolution.

Who May Have Authority to Sign

Authorized Individual

An individual with personal liability signs for themselves and must identify capacity; the admission binds only the signer unless an agent relationship or corporate authorization is expressly stated.

Corporate Officer

An officer signing on behalf of a corporation should include title and reference a board resolution or delegated authority to ensure the admission binds the entity and to avoid later challenges to authority.

Practical Tips for Accurate and Efficient Completion

Follow these practices to reduce execution errors and downstream disputes when preparing an admission.

Use Precise Language
Draft facts and liability language narrowly to avoid unintended admissions; avoid terms like 'all claims' unless intended.
Confirm Signatory Authority
Verify corporate authorization, power of attorney, or board resolutions before signing to prevent challenges to enforceability.
Coordinate with Insurers
Notify and, where appropriate, obtain insurer input before executing to reduce coverage disputes and reserve issues.
Preserve Audit Trails
Retain signed PDFs, timestamps, IP logs, and any authentication evidence to support attribution and record retention obligations.

Key Milestones From Draft to Closed File

A typical milestone sequence helps track responsibilities and evidence preservation from admission drafting through long-term retention.

01

Draft Approval

Legal and insurer review completed before signature.

02

Execution

Signatures, witness, or notarization completed.

03

Distribution

Send executed copies to all stakeholders and insurers.

04

Archive

Store signed file and audit trail for required retention period.

Frequently Asked Questions About Admissions

Answers to common questions include authentication, enforceability, and recordkeeping when using electronic workflows for admissions.


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