If you’ve settled a workers’ compensation case for an old injury that is now starting to bother you again, you probably have a lot of questions. You may be wondering if you can resume treatment, what happens if you need to leave work again, and if you can reopen your previous case. If you need to reopen your workers’ compensation case in the future, how do you go about doing that? Can you even do that? What if you run out of money or need another surgery? It’s important to understand when and how a workers’ compensation claim is closed and if it can be reopened.
Can You Reopen a Workers’ Compensation Case After Settlement?
Say your old injury flares up. You take out your paperwork and call the insurance carrier, who tells you your case is considered “closed.” But is it really? Many insurance companies use the word “closed” to describe a dormant file. In other situations, they may simply tell you they no longer handle the case or you may fail to reach them entirely because they are no longer operational.
No matter the circumstances, an insurance company cannot unilaterally “close” a workers’ compensation case. Once your case is established, you have lifetime medical coverage for that injury. You cannot “accidentally” close your treatment in a workers’ compensation case. Actually “closing” a case is an intentional and complex process. When the insurance company tells you the case is “closed,” what they are saying is that a long time ago they thought you were done with treatment.
Insurance companies are financial entities. Sometimes they go bankrupt or are bought out or sell some cases to another company. This does not prevent you from obtaining treatment. You can contact your attorney or the Workers’ Compensation Board to find out who is responsible for your claim.
If you have not been treated for your injury in some time, the insurance company may challenge the fact that your treatments remain related to the case. The company may question if your injury is really bothering you because of something that happened at work or if it’s simply due to age. You will need a doctor to clarify your condition and explain whether you exacerbated an old injury or if a new injury occurred. These situations can result in a hearing in front of the Workers’ Compensation Board.
Considerations for Reopening Workers’ Compensation Cases
Returning to work is the goal of almost every injured worker. However, not everyone’s return to work is perfect. If you need to come back out of work and reopen your workers’ compensation benefits, there are many factors that determine if and how much you will be paid for your missed work.
If you were classified with a permanent partial disability—usually related to an injury to the head, neck, or back—you will need to show you have not already received the maximum number of payments to which you were entitled at the time you were classified. For a schedule loss of use, the insurance carrier will say the lump sum of money you received was a “prepayment” of your future lost time. In these situations, you will need to show you missed as many weeks of work as you received payment for in the lump sum before you can receive any more money. You may also need to show a change in your medical condition.
In any case, you will need to show the medical reason for your missed time. As soon as your old injury forces you out of work, get to your doctor. Until you have a medical report connecting your lost time to your injury, the insurance company will not pay you anything. It’s also important to remember that inflation isn’t a contributing factor to the Workers’ Compensation Board. If you miss time from work months, years, or decades after your original injury, any payments you obtain will be based on what you were earning at the time of your injury.
If it has been more than 18 years since you were injured and you have not received any payments in over eight years, the insurance company will try to use a provision in the law to say you are no longer entitled to any payments. This will be brought in front of a judge at a hearing.
How Section 32 Settlements Impact Workers’ Compensation Cases
When the insurance company negotiates a settlement with you, the amount of money you’re entitled to is likely the first thought on your mind. Injured workers also have to consider that a case settled under Section 32 of the Workers’ Compensation Law will not be reopened for any reason. These settlements permanently end your entitlement to reopen your case, including the closure of payments and paid medical treatment if not both.
While the law technically allows a settlement to be reopened, it requires the consent of the insurance company. Insurance companies will never consent to reopen a settlement for the claimant to get more money or treatment. What’s more, if you reinjure the same part of your body in the future, the insurance company will have the right to claim and try to prove in front of a judge that your new injury is actually due to the case you already settled. When you consider a settlement for your case, you should take these things into account.
When to Ask a Lawyer for Help to Reopen a Workers’ Compensation Claim
If the insurance company tries to say your case is “closed” or that your condition is no longer their responsibility, or if the Workers’ Compensation Board issues a “Proposed Decision” or schedules a hearing, you should seek the advice of an attorney. These things signal that someone is challenging your ability to reopen your case. If you are being offered a settlement by the insurance company, or if a doctor says they have found you have a permanent injury, you will need to carefully consider the future of your case. That, too, should be discussed with an attorney who practices workers’ compensation law.
The attorneys at Lewis & Lewis, P.C. have negotiated millions of dollars in workers’ compensation settlements, handled tens of thousands of hearings in front of the Workers’ Compensation Board, and have expertise in reopening cases labeled “closed” by insurance carriers. There is never a fee for an initial consultation, and our only fees come from winning you money in your case.
