If you’ve settled your workers’ comp claim or received a final award, you may assume that you won’t be able to get more benefits, no matter what happens in the future. “Case closed” means it’s all over, right? This may be true in many situations, but there are exceptions. The most common is when your work-related injury or occupational disease has worsened significantly. But the rules and the deadlines are quite different from state to state. What follows are some general guidelines and examples of when, why, and how you can get your case reopened.
Can I Reopen My Workers’ Comp Case?
Generally, your eligibility to reopen a workers’ comp case depends on the reason for your request, how you resolved your case, and how much time has passed.
Qualifying Reasons for Reopening Workers’ Comp Claims
In most states, you may have your case reopened if you can show that your medical condition or disability has changed significantly since you resolved your claim, and the change is due to the original work-related injury or illness. Several states have variations on the changed-condition requirement. For example:
- Arizona allows reopening a claim for a “new, additional or previously undiscovered temporary or permanent condition.” The state’s supreme court has held that changed conditions include new medical treatment or “the evolution of medical opinion” that more surgery is required for the original injury, even when the injured employee’s physical condition hasn’t changed. (Ariz. Rev. Stats. Ann. § 23-1062 (2018); Stainless Specialty Mgf. Co. v. Industrial Com’n of Arizona, 695 P.2d 261 (Ariz. 1985).)
- Minnesota requires that the substantial change in your medical condition wasn’t anticipated at the time of the award, and that there wouldn’t have been reason to expect the change (Minn. Stats. Ann. § 176.461 (2018)).
- In some states, the change must have affected your physical ability to earn a living. For example, a Washington court found that an injured employee couldn’t reopen her workers’ comp claim after she had voluntarily retired, because the aggravation of her work injury hadn’t caused any loss in earnings (Energy Northwest v. Harje, 199 P.3d 1043 (Wash. Ct. App. 2009)).
Depending on the law in your state, you may also request a reopening for other reasons, including when:
- your employer or the insurance company committed fraud
- the workers’ comp judge made a legal or factual mistake, or
- both sides made a mistake about the facts of the case.
How Settlements May Affect Your Right to Reopen a Workers’ Comp Claim
Typically, you may reopen your case for a qualifying reason if a workers’ comp judge issued an order or award after a hearing. But the situation could be different if you settled your case, depending on your state's laws and the type of workers' comp settlement agreement you signed. If the agreement provided for installment payments and left open the right to collect additional benefits, you might be allowed to reopen your case (although some states limit the qualifying reasons). However, insurance companies often insist on a “full and final” settlement; this means that, in exchange for a lump-sum payment, you agree to give up (or “waive”) the right to make any future claims arising out of the injury. If you agreed to this kind of settlement (sometimes called a “compromise and release”), you usually can't reopen your claim unless the insurance company committed fraud. However, you may request reimbursement for additional medical treatment if you live in a state that doesn’t allow waivers of the right to future medical treatment.
Time Limits for Reopening Workers’ Comp Cases or Modifying Awards
States have different deadlines for requesting a reopening or a change in your previous workers’ comp award, ranging widely from one to several years. The time limits usually start from the date of your injury or when you last received benefits. In New York, the deadline is generally seven years after the injury and three years after the last benefit payment, but you may request additional workers’ comp benefits from a special fund up to 18 years after your injury and eight years after the last payment (N.Y. Workers’ Comp. Law § 25-a (2018)).
A few states, like Arizona, don’t have any deadline for requests to reopen, as long as you meet the other requirements (Ariz. Rev. Stats. § 23-1061(H)). In Nevada, there’s no outside time limit on reopening applications, but if you make your request more than a year after your case was closed, you must have evidence showing that changed circumstances justify increased benefits for the rest of your life (Nev. Rev. Stats. §616C.390 (2018)).
Applying to Reopen a Workers’ Comp Claim
The procedures for reopening also vary from state to state, but you usually will file a form (sometimes called a petition or application to reopen) with the workers’ compensation agency in your state. Along with your petition, you’ll need to attach medical evidence supporting your request. This usually means that a doctor will write a report, or fill out a designated form, explaining your condition. You state may have specific requirements for the doctor’s report, but it usually must include:
- how your condition has worsened
- a medical finding that the change is due to your original injury, and
- an explanation of the medical treatment you need.
Your state may have restrictions on which doctors can submit these reports.
Once your application is received, the process is generally similar to any dispute over a workers’ comp claim. Usually, your case will be set for a hearing before a workers’ comp judge. At the hearing, you will need to prove why your case should be reopened and what benefits you should receive. The judge will then decide whether you’re entitled to reopen your case and receive additional benefits.
Getting Legal Help
It can be difficult to reopen a closed workers’ comp case. Insurance companies usually deny requests to reopen, and workers’ comp judges are reluctant to reopen old claims unless there’s strong evidence that the settlement or award was unfair. Depending on how much time has passed, you could have a hard time convincing a judge that the change in your condition was caused by the original work injury, as opposed to the normal effects of aging or other activities in your life. An experienced workers’ comp lawyer can improve your odds significantly by explaining the rules in your state (and how courts interpret those rules), helping you gather the right kind of evidence, and presenting that evidence persuasively at the hearing. An attorney can also explain when you may file a new workers' comp claim, if the medical condition from your original injury worsened because of more recent work activities.