By the time you get a workers’ comp settlement or a court award for your work-related injury or illness, your medical condition has usually stabilized. That means you should have a good idea about the extent of any ongoing pain or limitations from your injury, as well as any need for further medical treatment. But what if your condition unexpectedly gets worse, or you discover new evidence that shows you’re more disabled than your doctors previously said? You might be able to get more benefits by reopening your case or asking for a modification, depending on the rules and deadlines in your state, as well as how you resolved your workers’ comp claim.
Just because you’ve had a final decision in your workers’ comp case (even after any appeals), that doesn’t necessarily means that you case is closed for good. For a certain period of time after a final award or order, workers’ compensation judges generally have the power to change a previous award for a good reason. The time periods and qualifying reasons vary from state to state.
Typically, you may reopen your case if you have medical evidence showing that your condition has gotten worse or that you’re more disabled than you were at the time of the award. For example:
Several states also allow you to reopen your workers’ comp case if there was a legal or factual mistake in the court’s order or award, or if the insurance company acted fraudulently.
If a judge ruled after a hearing that you weren’t entitled to any workers’ comp benefits, some states will allow you to reopen your case only for limited reasons. Typically, you’ll need to show that there is new and compelling evidence that wasn’t available at the time of your previous hearing.
Once a judge has approved your settlement agreement, it could be especially difficult to reopen your case or get the court to set the agreement aside. Just how difficult will depend on the type of settlement you signed and where you live. If you’ve agreed to a full and final settlement (also called a “compromise and release”), you received a lump sum of money in exchange for giving up or releasing your claims against your employer for the injury. In this situation, you typically can’t reopen your claim, even if your condition has worsened. In some states, however, you can’t legally give up your right to future medical care in any workers’ comp settlement. So if you live in one of those states, you may seek reimbursement for medical treatment that you need after you signed a lump-sum settlement. (For more information, see our page on navigating workers’ comp settlements by state.)
If you signed a settlement that provided payments over a period of time (often called a “structured settlement”), you might be able to reopen your case. But many states allow courts to set aside settlements only for limited reasons, such as when the agreement was based on fraud, deception, or certain kinds of mistakes.
States have different procedures for requesting that your workers’ comp case be reopened. Typically, you must file a form or letter with the state workers’ compensation agency and send a copy to your employer or its insurance company. You should attach documents that support your claim (such as medical records showing your worsened condition) to your request. A hearing may also be scheduled to determine your eligibility for benefits.
You must file your request within a certain period of time, as set by state law. The deadlines vary considerably from state to state. For instance:
Even when you can’t reopen your workers’ comp case, you may be able to file a new claim if your old injury was aggravated or “lit up” by a work activity, whether at the same job or for a different employer. For instance, say you settled a workers’ comp claim for a back injury related to a workplace accident; then, years later, the pain started up again or escalated after you lifted a heavy box at work. In this situation, the aggravation or worsening of your medical condition would be considered a new injury. In order to be eligible for benefits, you must follow the rules in your state for reporting the new injury and filing a workers’ comp claim.
The rules for reopening a workers’ comp claim can be complex, difficult to understand, and different from state to state. If your medical condition has unexpectedly deteriorated after a judge ruled on your claim, or even after you signed a settlement agreement, you should consider speaking to a local workers’ comp lawyer. An attorney who’s experienced in this field can explain how your state’s laws apply to your situation. If you had a lawyer’s help with your original case, that’s a good place to start. If you didn’t have an attorney the first time around, or you need a new one, see our lawyer directory.