Reopening a Workers’ Compensation Claim & the Legal Process
Sometimes an injured worker finds that their condition worsens unexpectedly after their workers’ compensation claim has been closed. They may be able to reopen their claim and pursue additional benefits if they can produce medical evidence to show their increased disability. In other situations, they might be able to ask for a modification of their benefits. Seeking to reopen your claim or modify your benefits usually involves submitting a form to the workers’ compensation agency in your state and notifying the employer or insurer. With your submission, you should provide medical documents that support your request to reopen. You should check the deadline in your state for reopening a claim.
If your claim was previously denied, you may not be able to reopen it. A motion to reopen may be granted only if you can produce substantial medical evidence that was not available when your claim was previously denied.
Reopening the Claim
After a final decision in your claim, the workers’ compensation judge will retain the authority for a certain time to alter the award of benefits if there is a sufficient reason. Producing evidence that your condition has worsened is usually a sufficient reason to reopen the claim. The specific requirements and guidelines vary depending on the state. In some states, you also may have a sufficient reason to reopen the claim if you can identify a legal or factual error by the court in issuing the award. Fraud by the insurer is another possible reason to reopen.
Seeking More Benefits After a Settlement
An injured worker who accepted a settlement of their workers’ compensation claim may face greater challenges in reopening it. You should be wary of signing a full and final release of your claims related to a work injury in exchange for a lump sum settlement. This likely will prevent you from seeking any further benefits if your condition worsens in the future.
Aware of these potentially harsh results, some states do not allow workers to waive the right to receive payments for future medical care. If you live in one of these states, you still can get reimbursed from the insurer for medical treatment after you agreed to a lump sum settlement.
It may be easier to seek additional benefits if you received a structured settlement that issues payments over time, rather than a single lump sum. Setting aside the settlement still may be more complicated than reopening a claim that resulted in regular payments. The worker may need to prove deception or a mistake.
Filing a New Claim
If you cannot reopen the original claim, you may be able to file a new claim based on an aggravation of a pre-existing condition. (You also can file this type of claim based on an aggravation of a condition that arose outside your employment, as long as the aggravation was work-related.) Sometimes an injury while working for a previous employer will be aggravated by an event that occurs while you are working for your current employer. This would be classified as a new injury, so you would need to file a new claim, following the applicable rules in your state for reporting the injury and submitting the claim.
