If your workers’ compensation claim has been closed, you may think that is the end of that. That isn’t always the case, however.
The fact is that workers’ compensation laws in Pennsylvania are complicated, and consulting with an experienced workers’ compensation attorney regarding a reopening is usually in your best interest. Luschas, Naparsteck & Crane LLP explain.
Why Workers’ Compensation Claims Are Closed
There is a range of reasons for workers’ comp claims to be closed, including:
- The injured worker received the maximum disability amount allowed in the Pennsylvania Workers’ Compensation Act.
- The doctor determines that the injured worker has achieved maximum medical improvement.
- The injured worker dies – family members can only seek death benefits if the death was directly caused by the work injury.
- The injured worker accepted a one-time settlement payment – called a compromise and release agreement.
Generally, once a claim is closed, the injured worker is legally barred from seeking additional benefits via a reopening of the workers’ comp claim due to the fact that insurance settlements are designed to put an end to the matter at hand. However, there are instances in which reopening a workers’ comp claim is possible.
Reasons for a Potential Workers’ Compensation Case Reopening
There are specific situations in which an injured worker can reopen a workers’ comp claim in Pennsylvania – even after the worker has returned to work. In other words, just because a final decision has been handed down in the case does not mean that it is necessarily closed permanently.
A prime example of when a closed workers’ compensation claim may be reopened is when the employee recovers, returns to work to continue performing their pre-injury job duties and experiences a worsening of the original injury. In such instances, it’s necessary to prove that your original injury is the root cause of your worsening condition – as opposed to being brought on by the natural aging process or any other cause that is unrelated to that original workers’ compensation injury.
Additionally, as a worker in Pennsylvania, you are entitled to benefits for pre-existing injuries if you can prove that they were exacerbated by your work.
If You Received a Lump Sum Settlement
If your work-related injury left you off the job for more than four months and you ultimately settled the matter with a lump sum full and final settlement, it’s very unlikely that your claim will be reopened since such settlements amount to releases for any further payment. Only in rare situations like the following are exceptions made:
- A medical mistake or error in diagnosis was made.
- There was an error in the original calculation of benefits.
How to Reopen a Workers’ Compensation Claim
If you need to reopen a workers’ comp claim, you’ll need to demonstrate that there is a legitimate reason for doing so. In Pennsylvania, injured employees typically have up to 500 weeks after receiving their final payment through workers’ compensation to reopen a case.
For example, your knee suffered a severe injury on the job, and you spent five months recovering before you were given the go-ahead to return to work. If returning to work causes the knee injury to flare back up – and you can directly correlate returning to work with the flare-up – you may have a viable reason for reopening your original workers’ compensation claim.
The Elements of a Successful Workers’ Compensation Reopening
There are specific elements that must be present to reopen a workers’ compensation claim.
Your Injury Has Worsened
Let’s return to the theoretical knee injury. If your recovery involved surgery that really made a difference, and you returned to work as a result, your workers’ compensation likely ended. While the surgery on your knee may have helped you considerably, this does not mean that your knee was necessarily returned to pre-injury condition.
Returning to work might leave you needing a total knee replacement. That the original injury is directly related to your need to have a replacement surgery is a prime example of a worsening injury supporting the reopening of a workers’ comp claim.
You Did Not Accept a Full and Final Settlement
Finally, the only way to move forward with the reopening of your claim is if you did not sign off on a lump sum in the form of a full and final settlement, which can only be reopened when there are extenuating circumstances involved – as discussed above.
Seek the Professional Legal Guidance of an Experienced Pennsylvania Workers’ Compensation Attorney Today
If you suffered an injury on the job, recovered, closed your case, returned to work, and experienced a worsening of your condition as a result, you may need to reopen your workers’ compensation claim. The fact is, however, that workers’ comp claims are complicated, and reopening them tends to be more so.
The Pennsylvania workers’ compensation attorneys at Luschas, Naparsteck, & Crane, LLP, are well-prepared and well-positioned to seek your claim’s best possible resolution – in pursuit of the compensation that you need to reach your fullest recovery. For more information, please contact us on our website or call us at 570-799-8809 today.
Workers’ Compensation Case FAQs
How can a workers’ compensation attorney help?
Your workers’ comp attorney will carefully compile your strongest claim while skillfully advocating for its most favorable resolution. Because workers’ compensation claims tend to be exceptionally challenging, having a dedicated workers’ comp attorney in your corner is the surest path forward.
What should I do if I can’t afford a workers’ comp attorney?
You’ve suffered an injury on the job and attendant financial losses, which makes paying for legal assistance more challenging. Fortunately, most workers’ compensation attorneys charge a prearranged percentage of the claim’s total settlement or court award, which means you won’t owe anything until your claim has been successfully resolved in your favor.