Your recovery from a work-related injury is not always a straight line. If your injury gets worse, can you reopen your case?
If you have not settled your case, then your lawyer can always file for modification of your benefits based on a worsened condition. Medical benefits automatically reflect the severity of your injury because they continue to pay whether you have ups or downs. If your condition changes your post-injury wages, then manual adjustments may be needed. Additionally, your disability status can be changed back to total disability status, or a closed case can be reopened if your original work injury/illness worsens.
Call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945 for a free case evaluation.
What to Do if Your Injury/Illness Gets Worse?
If you suspect that your injuries are worsening again, it can affect your Workers’ Comp case, so take the following steps.
See a Doctor
Your doctor can diagnose your changes, link them to the initial injury, and change the treatment plan to reflect the worsened condition. If you wait to receive treatment, it may be harder to connect the changes back to the initial work injury.
If your changes in health are unrelated to your initial work injury, then Workers’ Comp won’t cover them.
Document Any Changes
Insurance carriers are not usually happy if your condition declines and they need to pay more. Make sure to save records and document the changes in your health so we can prove they were related to your work injuries.
Talk to Your Lawyer
Your Pennsylvania Workers’ Comp lawyer can guide you through the process of how to respond to these changes and tell you what changes, if any, might be made to your benefits.
File for Modification
Medical benefits are paid for treatments as they arise. However, wage-loss benefits can be affected by worsened conditions.
Changing Benefit Rates for Worsened Conditions
As mentioned, medical benefits continue to cover the care you need, but wage-loss benefits may change in two ways:
Status
If you were previously switched to partial disability status after an impairment rating evaluation (IRE) determined your whole-body impairment rating was under 35%, you may need to go back to total disability status if your condition worsens.
Partial disability status can only last for 500 weeks total, but total disability status lasts as long as you are unable to work. If your injury gets worse, you may get back on total disability status, preventing your weeks from counting against the 500 weeks for partial status.
Rate
If you were working while injured, then your wage-loss benefits might have been 2/3 of the difference in pre- and post-injury wages. If you now work even less, this difference will increase, and the wage-loss benefits will go up.
If you are now completely unable to work, your wage-loss benefit should change to 2/3 of your pre-injury wage.
Reopening Closed Cases
If your case was closed because you got better and returned to work, you can still reopen if it if you get worse again. This is common if cancer comes back, for example.
As long as you did not settle the case, you still have the right to claim worsened conditions on your original case. However, if the injury is a new injury, then you have to file a new claim.
Can I Change My Benefits After I Settle?
If you settle your Workers’ Comp claim, then you typically cannot go back and change your benefits or reopen the case. That is why it is so important to discuss settlements with your lawyer and understand what you are signing away by settling.
However, the type of settlement does matter.
Global Settlements
If you signed a compromise and release agreement for a “global settlement,” that settles your entire case. This means that both wage-loss benefits and expected medical benefits have already been set in stone.
With some injuries and conditions that are expected to get worse, these kinds of settlements can be risky.
Wage-Loss Only Settlements
In other cases, you might settle only the wage-loss portion of your case. This is common in cases where your disability is expected to last for only a limited time or when we know you will never return to work again.
In those cases, we can calculate wage-loss benefits easily, but expected medical needs might not be as easy to determine.
Settling just the wage-loss benefits allows you to get that money in your pocket, then keep getting medical treatments covered as needed. If your injury gets worse again, no changes are needed because the medical benefits are still paid as they arise.
FAQs for Changed or Worsened Injuries in Workers’ Comp
What if My Loved One Died on Workers’ Comp?
If your loved one’s original work injury or illness is what killed them, then the case can switch to a death benefits case. This can provide ongoing wage-loss benefits plus burial costs.
If they died from another cause, you can get the rest of what their Workers’ Comp case would have originally paid before their death.
Do I Have to Convince the Insurance Company My Condition is Worse?
If you need increased wage-loss benefits, you may need to go to court. However, medical benefits continue to pay for treatments as they are needed.
You typically do not need pre-approval for medical treatments, so there is no need to convince the insurance carrier your injury is worse to get additional care.
Can You Reopen a Case After it is Over?
If your initial Workers’ Comp case is over and you were done with medical treatment and returned to work, you can still potentially reopen it.
For example, you might have gone into remission from work-related cancer, gotten back to work, and then the cancer might have come back years later. As long as the condition/injury is still related to your original work injury, you can reopen the case.
Can I Get Benefits for Worsened Hearing or Vision?
If your work conditions cause hearing or vision loss, you can get benefits for that. If it continues to worsen over time as you keep working at your job, you can file for additional benefits without needing to open a new case.
If this crosses into total disability, you can start getting wage-loss benefits now that you are unable to work.
Call Our Workers’ Comp Lawyers in Pennsylvania Today
Contact Cardamone Law at (267) 651-7945 for a free case review with our East Stroudsburg, PA Workers’ Compensation lawyers.
