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Can I Reopen an Old Workers' Comp Claim?

If you need new treatment or severity has increased, it’s allowed in California

As a general rule, workers’ comp settlements are not finalized until a claimant’s medical condition has fully stabilized—only when the severity of work-related injury or illness and the extent of treatment that will be required is known can a worker get access to the full and fair financial compensation that they deserve.

Of course, medical care and physical recovery is not always predictable. You may have good cause to reopen a California workers’ compensation claim if you found out that you need new treatment or if your condition is materially worsening. “If somebody’s condition deteriorates significantly, there’s a Petition to Reopen,” says Russell L. Glauber of Glauber Berenson Vego law firm in Glendale, California. “It probably happens 10 percent of the time.”

The Requirements for Reopening a Workers’ Comp Claim in California

Under California state law, injured workers have the right to reopen a workers’ compensation claim. That being said, state regulations require that a claim Petition to Reopen such a claim must be filed within five years of the date of the injury. After five years have passed a petition to reopen may be over the time limit as a matter of law. However, says Glauber: “There was a case that came down: A person was taking medications causing damage to his insides, and it was past the five years. I remember reading, and it said something to the effect of: If you have an insidious deterioration of your body because of the workers’ comp condition you didn’t know about, the statute doesn’t run.”

In order to successfully reopen an old in California, an injured worker must be able to prove that:

  1. New medical treatment is needed; or
  2. The injury or disability has grown more severe.

To be clear, California law does not let injured workers re-litigate workers’ comp decisions over and over again. You cannot reopen a workers’ comp case simply because you did not like the initial result. Further, reopening a workers’ comp claim is not the same thing as filing an appeal. With this type of case, an injured employee must prove that something has changed—either because new treatment is required or the injured is getting worse. Additionally, that change must be something that could not have been reasonably foreseen at the time the initial decision was entered.

“We’ve had cases where the guy hurt his back and his left knee. As a result of his back and the limping, he started favoring his right side. In addition to him having an injury to his left knee, he’s developed an injury to his right knee—and now he can barely walk,” says Glauber. “As a result, his back has gotten worse. So, the injury to the right knee arises out of the original; that is a primary reason to reopen a case for new and further disability.”

How to File a Petition to Reopen in California

To reopen a workers’ compensation claim, you must file a Petition to Reopen. As explained by the California Department of Industrial Relations (DIR), a Petition to Reopen should include a clear and comprehensive explanation from the claimant (the injured worker) as to why the injury claim should be reopened.

Among other things, you should include supplemental medical records with your Petition to Reopen. As was noted above, workers’ compensation cases are reopened on medical grounds. To successfully reopen an older workers’ comp case, you need strong supporting medical records and medical evidence. If you are considering reopening a claim, you should consult with an experienced California workers’ compensation attorney. Your workers’ compensation lawyer will be able to review your circumstances and help you build a strong claim.

If you’d like to know more about workers’ compensation benefits, read our workers’ compensation law overview and social security disability.

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