Reopening a Workers’ Compensation Claim

What happens if you’ve settled your claim for workers’ compensation, but later find that your injury is getting worse? Do you have any recourse?

You do. However, a weighty burden of proof rests upon the injured party, as reopening a claim is relatively rare. 

First off, you need to establish that you pass the eligibility test to reopen your claim. 

  1. If you were not absent from work or received a Permanent Partial Disability (PPD) as a result of the accident, your case must be reopened within one year. 
  2. If your injury was of a minor nature and your medical expenses did not exceed $300, you will not be eligible to reopen your claim.
  3. To reopen a claim, you need a medical report or letter from a doctor that indicates:
  • Your original injury has worsened since the settlement of your claim. This does not simply mean that your injury still causes pain, or that you’re finding the pain harder to manage. This criterion usually means something more specific, such as the need for a surgical procedure.
  • The decline is not as a result of a pre-existing condition.
  • You require treatment for the worsened condition.
  • Any treatment of the worsened state of your workplace injury is attributable to the original injury.
  • A direct causative link can be drawn between the original work injury and the worsened condition.
Reopening a Workers' Comp Case

In most cases, the original workers’ compensation settlement will have taken into consideration the future of your injury. The medical reports relied upon in the settlement should assess how the injury is likely to develop or heal. It’s a speculative process to an extent, but medical doctors are skilled in providing a likely future prognosis, upon which a settlement figure can be agreed. Compensation payments are calculated with the future prospect of degeneration, or partial or complete recovery in mind. 

How about a scenario where a worker goes onto a new job, with a new employer, and has the misfortune to suffer another injury at the site of the old one. Is some or all of the new pain an exacerbation of the old injury, or does it give rise to an entirely new claim? Carefully considered medical evidence here is crucial. 

Grounds to reopen a claim are rare but it is possible. It is a tricky area to navigate and you should not attempt it on your own. 

If you want to talk about workers’ compensation, or if you think you have grounds to reopen your claim, Bighorn Law attorneys are here to give you clear, concise advice just when you need it. 

As recognized experts in workers’ compensation claims, Bighorn Law’s proven expertise and solid commitment to both our clients and to justice set us ahead of the rest. 

At Bighorn Law, we’ve always got your back.  

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