What if My Workers' Compensation Injury Gets Worse?

The circumstances under which you can reopen your case in North Carolina

Workplace accidents remain a significant public safety issue in North Carolina. According to data published by the United States Bureau of Labor Statistics (BLS), 71,000 job-related injuries and illnesses were reported in the state in the most recent year for which comprehensive data is available.

For an injured employee, resolving a workers’ compensation claim often brings relief and a sense of stability. Unfortunately, medical needs are not perfectly predictable. Some workers find that their condition unexpectedly worsens over time. This raises an important question: Can you reopen a workers’ compensation claim in North Carolina? The short answer is “yes,” but only in certain circumstances.

North Carolina Law: Reopening a Workers’ Comp Claim

As a starting point, injured employees should know that it is possible to reopen a workers’ compensation claim. Our state’s policymakers have recognized that injuries and illnesses can change and that some injured workers may need additional financial compensation.

Under North Carolina law, workers’ comp awards and settlements can be adjusted when a claimant’s condition worsens. That being said, whether or not you will be permitted to reopen your workers’ comp case depends on how it was resolved:

  1. Claims Settled Under Using NCIC Form 26: Was your workers’ compensation claim settled using NCIC Form 26? If so, you will be eligible to reopen your case as long as you meet the time limitations. In most cases, workers have two years from the date that the last payment was made to reopen the case. However, if you brought a “medical only” case, you must reopen within one year. In reopening your claim, you will need to prove that your injury/illness has worsened in a manner that was not accounted for at the time of settlement.

“It’s a fairly short window,” says Bob Bollinger, a workers’ compensation attorney in Charlotte. “But the biggest problem is that the injured worker never really knows when the two-year period starts, because they’re never really told when the insurance company makes the last payment of medical compensation. There’s a form that the insurance companies send out that’s supposed to provide that information, but sometimes they don’t send it, sometimes that information isn’t accurate. You really can’t rely on it.”

  1. Claims Settled Using ‘Clincher’ Agreements: In North Carolina, some workers’ comp cases are resolved through Compromise Settlement Agreements. These are also frequently called ‘clincher agreements.’ With narrow exceptions for cases of fraud, clincher agreements cannot be reopened in North Carolina. To be clear, this means that you cannot reopen a workers’ comp claim settled through a clincher agreement on the grounds that your physical condition worsened. A clincher agreement is a full and final settlement agreement—in obtaining one, an injured worker is required to give up their right to reopen the case.

“The clincher agreement is pretty common,” says Bollinger, who adds that reopening comp claims is pretty uncommon. “We call them clinchers because they clinch up all the issues in a case—a full and final settlement.

“If there’s a substantial risk there’s future medical care, you probably want to arrange to leave your medical benefits open,” he continues. “Of course, the insurance companies always want to do a clincher, because they want to get rid of the case. When people are not represented by a lawyer, they’ll dangle a clincher in from of them—a settlement amount that looks good to the unrepresented. A certified specialist in workers’ compensation can help a person figure that out.”

Injured Workers Should Be Ready to Seek Professional Guidance

The workers’ compensation claims process is complicated—especially if you are attempting to reopen a case that has already been settled or resolved. If your injury has worsened and you are considering re-opening your claim, an experienced North Carolina workers’ compensation attorney can help. An attorney will be able to review the specific circumstances of your case, determine if you are eligible to reopen it, and help take action to protect your rights and interests.

If you'd like to know more about this area, read our workers' compensation law overview.

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