A workers' comp case is considered closed once you've received benefits for your work-related injury or illness by way of a settlement agreement or court award. Typically, by the time this happens, your medical condition has stabilized. But what happens if your condition gets worse after your workers' comp case is already closed? The answer depends in large part on where you live and how you resolved your case.
Most states allow injured workers to reopen their claims if there's medical evidence that their injuries have gotten significantly worse. In some states, however, it can be much harder to meet this requirement than in others. For example:
If your case was resolved by a workers' comp judge following a hearing, the main issue you'll face in seeking to reopen your claim will be whether you meet your state law requirements. If you signed a settlement agreement, however, you'll also need to consider the terms of the agreement.
You might be allowed to reopen your case if your settlement agreement provided for installment payments and left open the right to collect additional benefits.
But if you signed a full and final release of all claims, you probably won't be able to reopen your case. A full and final release typically means that, in exchange for a lump-sum payment, you give up the right to bring any future claims relating to your injury. Insurance companies often insist on this type of settlement.
The deadlines for reopening a workers' comp case vary widely from state to state. The time limits are generally measured from either the date of your original workers' comp injury or the date you received your last benefits payment, and range from a year after your last payment, to eighteen years after your injury, to no deadline at all in some states.
To reopen your workers' comp case, you generally need to file a form with the workers' compensation agency in your state. You'll also need to attach medical evidence supporting your request. States typically require that a doctor write a report, or fill out a designated form, explaining your condition (your state may have restrictions on which doctors can submit these reports). States may have differing requirements for the doctor's report, but it usually needs to include:
After you submit your application to reopen your case, the process is generally similar to any dispute over a workers' comp claim. Your case will be set for a hearing before a workers' comp judge. At the hearing, you'll 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.
Reopening a closed workers' comp case can be difficult. Insurance companies usually deny requests to reopen, and workers' comp judges are reluctant to reopen old claims. The more time that's passed since your original work injury, the harder it can be to prove that the change in your medical condition stems from that injury, rather than from an intervening cause such as the normal effects of aging or other activities in your life.
An experienced workers' comp lawyer can improve your odds of reopening your case and receiving additional benefits. Your lawyer can help you make sense of the applicable laws in your state, assist in gathering the right kind of evidence to support your case, and represent you at your hearing.