department of labor and employment
Division of Workers’ Compensation
7 ccr 1101-3
workers’ compensation rules of procedure
           Rule 11	Division Independent Medical Examination
	11-11	 INDIGENT CLAIMANT
            (A)	
		 INCOME ELIGIBILITY GUIDELINES

Family Size	Monthly Income Guidelines	Monthly Income Guideline 
plus 25%	Yearly Income Guideline	Yearly Income Guideline plus 25%	
1	$1,128	$1,410	$13,538	$16,922	
2	$1,518	$1,897	$18,213	$22,766	
3	$1,907	$2,384	$22,888	$28,609	
4	$2,297	$2,871	$27,563	$34,453	
5	$2,686	$3,358	$32,238	$40,297	
6	$3,076	$3,845	$36,913	$46,141	
7	$3,466	$4,332	$41,588	$51,984	
8	$3,855	$4,819	$46,263	$57,828	
       For family units with more than eight members, add $390 per month to “monthly income” or $4,675 per                                                                                                                                                                                                                                        year to “yearly income” for each additional family member.