Can You Reopen a Workers’ Comp Claim in Pennsylvania?
The claims process for Workers’ Compensation is often far from a straight line. When you file your initial claim, you might be denied, but you might not have the time and physical health to find a lawyer and get help right away. If you do eventually get benefits, you may need additional help after your condition gets worse. In these cases, can you reopen your claim?
Usually, Workers’ Comp claims can be reopened after an initial denial or after benefits are paid and you “recover” from your injury, only to find yourself with a flare-up or otherwise worsened condition. As long as you did not sit on your rights too long or have an outside injury cause your condition to reemerge, reopening a claim is often allowed. However, once a claim has been settled and you’ve signed away your right to continue the case, it usually cannot be reopened.
For a free case evaluation, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers today at (267) 651-7945.
Common Situations Where You Can Reopen a Workers’ Comp Claim in Pennsylvania
When you file a Workers’ Comp claim, it usually has a few major steps. First, you report your accident and either have it accepted, settle the claim, or face a denial. From there, you can take your case to court, where there will be a determination one way or the other, or a settlement. If you were denied at that stage, you can appeal, potentially getting the determination overturned. If you were granted benefits, you can continue receiving them until you are improved – but you might get worse again later with some health conditions/injuries.
There are four major steps along this path where you can often “reopen” your Workers’ Comp claim:
Reopening a Claim in Court After an Initial Denial
If you report your injury to your employer’s Workers’ Compensation carrier and they deny your claim, you might take that as the final answer until you learn more about your rights. Many injured workers do not know that they can call Philadelphia Workers’ Compensation lawyers like ours to take their case to court. This leads to them potentially waiting until their condition is improved and dealing with the negative effects of the injury on their own until then.
However, you should know that you have 3 years from the denial to reopen your case by taking it to court. Our attorneys can file your petition and seek to get your ongoing and back benefits paid even if you were denied by the insurance carrier. In fact, a high percentage of Workers’ Comp cases are ultimately handled through court rather than being granted in this initial stage, putting this kind of court petition well within the range of what is “normal” in a Workers’ Comp claim.
Appealing Your Case
Once the case goes to court, the judge makes the decision as to whether you get benefits or not. If they deny your claim, we can have the Workers’ Compensation Appeal Board reopen your case and review that decision. This appeal has to be filed within 20 days of the denial.
From there, you can keep appealing and having higher levels of court review your claim. If the Appeal Board denies your case, you have 30 days to appeal it to the Commonwealth Court, and if they deny your claim, you have 30 days to appeal it to the Pennsylvania Supreme Court.
Going from Partial Benefits Back to Total Benefits
If you are totally disabled, you will continue receiving benefits at a rate of 2/3 of your average weekly wages (in most cases) until you can return to work. Alternatively, if you have been on “total disability” benefits for over 2 years and an independent medical examination (IME) says you are under 35% impairment, you will be shifted from total to partial benefits.
Once you are on partial benefits, it is possible your condition could worsen again. It is also possible that there was an error made at your IME and that they got it wrong when they put you on partial benefits. This would allow you to go back to court and try to get the “partial disability” determination overturned as long as you file within 500 weeks.
Condition Returns, Flares Up, or Worsens
In the same way that you can appeal a partial disability determination within 500 weeks of the decision to reduce your benefits to partial, you can also reopen a claim to get you back to total disability benefits within 500 weeks.
This arises in plenty of situations where the worker has an injury that comes and goes, eventually putting them back out of work because the condition came back, got worse again, or simply flared up. For example, back injuries are one of the most common injuries that come and go over time. If you had a herniated disc repair or spinal fusion surgery, it is possible that within the next few years, the injury could get worse again. If you had a work-related illness like cancer or silicosis, the injury could get worse again, putting you back out of work. In these cases, reopening the claim is often possible with a petition filed in court.
These petitions can also be filed after you seemingly recover or reach “maximum medical improvement” so long as the effects you face are still from the initial injury. If you get reinjured or face a new injury, you often have to file a new claim.
You may also be able to get new benefits for your “specific loss” if you had partial hearing/vision loss or lost partial function that eventually develops into total loss of hearing/vision, total loss of function, or an amputation.
Can I Reopen a Workers’ Comp Claim After a Settlement in Pennsylvania?
Usually, a settlement for a lump sum is the end of your case. These are called “compromise and release” agreements in that you are coming to a compromise and releasing the employer from any further benefits or lawsuits. As such, you usually cannot reopen these claims unless there was some kind of fraud or coercion that would make the initial agreement illegal and invalid.
Call Our Workers’ Comp Lawyers in Pennsylvania Today
Call our Northeast Philadelphia Workers’ Compensation lawyers for a free case review from Cardamone Law by dialing (267) 651-7945.
