Can I Reopen an Old Workers' Comp Claim?

As a general rule, workers’ comp settlements are not finalized until a claimant’s medical condition has fully stabilized. Only when the injured worker knows the severity of their work-related injury or illness and the extent of required treatment can they get the full and fair financial compensation that they deserve.

If your employer denies your original claim, you can file an appeal. If your claim is closed, you can petition to reopen your old claim. For legal advice about reopening an old workplace injury claim, talk to a local workers’ compensation lawyer.

Workers’ Compensation Benefits

The workers’ compensation system provides no-fault medical benefits and wage replacement benefits to injured employees. Many workers’ compensation claims are quickly resolved without dispute. But there are situations where a worker may need to reopen a previously resolved claim.

Typically, we are talking about scenarios where a worker’s injury gets worse after initially showing signs of improvement.

For instance, let’s say you sustain a back injury while lifting a heavy item at work. Your employer agrees to pay you a certain amount of workers’ compensation benefits. Initially, you think your injury is getting better, and you will be able to return to work. But then you suffer a relapse; your back pain is now significantly worse, and your doctor has advised you not to go back to work.

You should not assume that just because your condition has worsened that automatically entitles you to reopen your workers’ comp claim. In fact, depending on how your original injury claim was resolved, you may not be legally permitted to reopen your case at all.

Of course, medical care and physical recovery are not always predictable. You may have good cause to reopen a workers’ compensation claim if you find 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.”

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Closing Workers’ Comp Claims

Workers’ compensation cases usually end in one of three ways:

• Your employer or the insurance company can deny or dispute coverage, and you bring the matter before a state workers’ compensation board.
• You sign a settlement that allows you to continue receiving medical treatment for your injury and gives you the right to file a change of condition for the worse claim.
• You can sign a “full and final” release of all workers’ compensation claims.

If you attend a hearing and the commissioner awards compensation for scheduled member disability, the award may be limited to the degree of impairment, and specific provisions must be made to keep future medical coverage open. In other states, future medical care remains available by default unless you specifically agree to close it out.

Before agreeing to a lump-sum settlement, make sure you understand what you’re giving up. Get legal advice about your rights and what additional benefits you may lose. “If you settle your case on a clincher, then there’s nothing you can do to reopen that. That case is over,” says Harrell.

Reopening a Workers’ Comp Claim

Workers’ compensation laws vary by state. Each state has requirements for reopening a workers’ compensation case, including timeframes and statutes of limitations. Talk to a workers’ compensation attorney about the process in your state.

For example, under California state law, injured workers have the right to reopen a workers’ compensation claim. State regulations require that you file a Petition to Reopen 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 [in which] 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 claim, an injured worker must be able to prove that:

• They need new medical treatment, or
• The injury or disability has grown more severe.

Injured workers cannot 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. Rather, an injured employee must prove that something has changed—either because they require new treatment, or the injury is getting worse. Additionally, that change must be something that could not have been reasonably foreseen at the time of entering the initial decision.

“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

To reopen a workers’ compensation claim, you must file a Petition to Reopen. A Petition to Reopen should include a clear and comprehensive explanation from the claimant (the injured worker) as to why the work injury claim should be reopened.

“I think the vast majority of the time, what is going to carry the day on these claims is whether you have a doctor who is opining that, ‘Yes, the condition has worsened,'” says Ken W. Harrell, a workers’ comp attorney at Joye Law Firm in North Charleston. “If you can get that opinion from the authorized, treating doctor, it’s pretty hard for the insurance carrier to fight that claim.”

Among other things, you should include supplemental medical records with your Petition to Reopen. As noted above, workers’ compensation cases are reopened on medical grounds. To successfully reopen an older workers’ comp case, you need strong supporting healthcare records and new evidence.

Find Legal Help

“We’ve always told our clients,” says Harrell, “don’t wait until the midnight hour to call us because we may not be able to get the documentation that we need to successfully prosecute a claim for you.”

And as any workers’ compensation lawyer will tell you, simply claiming your condition is worsening is not enough. You will have to go in front of a Commissioner or judge and present medical evidence to support your claim. You must show there is a causal connection between your present condition and your original workplace injury. Additionally, you must demonstrate that the change in your condition occurred after deciding your original workers’ compensation case.

If you are considering reopening a claim, you should consult with a workers’ compensation attorney. Your workers’ compensation lawyer can review your situation and help you build a strong claim.