Years after a work injury, you thought you had put it all behind you. Your workers’ compensation claim was closed, you completed your medical treatment, and you returned to your life. But now, the pain is back. That old knee injury is flaring up, your back is worse than ever, or you are experiencing new symptoms related to your original injury. You need to see a doctor, and you may even need surgery. The medical bills are piling up, and you are once again facing the stress and uncertainty you thought was in the past.
A common question we hear at Arizona’s Work Injury Firm is: “Can I reopen my old workers’ comp claim?” It’s a question filled with anxiety, as people worry that they have lost their right to any further benefits. We want you to know that there is hope. In Arizona, the law allows injured workers to petition to reopen a closed claim under certain circumstances. It is a complex process, but it provides a vital safety net for those with worsening conditions.
Understanding the Basics of Reopening a Claim
When your workers’ compensation claim is closed, it means that the insurance company is no longer actively paying for medical care or lost wages. However, the law recognizes that the condition of an injured worker can change over time. An injury that seemed stable can deteriorate, or a new issue can arise that is a direct result of the original injury.
To reopen a claim in Arizona, you must file a “Petition to Reopen” with the Industrial Commission of Arizona (ICA). To be successful, you must prove two key things:
- You have a “New, Additional, or Previously Undiscovered” Condition: This is the medical component of the petition. You must have objective medical evidence from a doctor showing that your condition has changed since your claim was closed. This can’t just be an increase in pain; it must be a demonstrable change in your physical condition. For example, a new tear shown on an MRI, a disc that has herniated further, or a knee that now requires a replacement.
- The New Condition is Causally Related to the Original Injury: You must also prove that this new or worsened condition is a direct result of your original work injury, and not from some new, intervening event or the natural progression of aging.
The Strict Time Limit for Reopening a Claim
This is one of the most critical aspects of reopening a claim: you must file the Petition to Reopen within the legal time limits. The clock starts ticking from the date your claim was officially closed by a Notice of Claim Status. If you do not file your petition in time, you will be barred from receiving any further benefits, no matter how severe your condition becomes.
Filing the petition is a formal legal process. It must be in writing and submitted to the ICA. The insurance company will then have the opportunity to accept or deny the petition. If they deny it, the case will proceed to a hearing before an Administrative Law Judge, much like an initial claim denial.
What Happens if My Petition is Accepted?
If your Petition to Reopen is accepted, you are entitled to two main types of benefits:
- Active Medical Care: The insurance company must once again pay for all reasonable and necessary medical treatment for your condition. This can include doctor’s visits, physical therapy, prescription medications, and even surgery.
- Temporary Disability Benefits: If the new condition requires you to be out of work, you may be entitled to temporary disability benefits to replace a portion of your lost wages while you recover.
Reopening a claim does not typically change any permanent disability award you may have received in the past, but it does provide the medical and temporary wage loss support you need to deal with the new or worsened condition.
Frequently Asked Questions (FAQ)
Q: My doctor says my arthritis has gotten worse, and it’s in the same knee I injured at work. Can I reopen my claim?
A: This is a common but difficult scenario. You would need a doctor to state, to a reasonable degree of medical probability, that the worsening of your arthritis is a direct result of the physical changes caused by the work injury, and not just the natural progression of the degenerative disease. This requires a strong and specific medical opinion.
Q: I settled my original case with a lump sum payment. Can I still reopen it?
A: It depends on the terms of your settlement. If you signed a “full and final” settlement that closed out your right to all future benefits, including medical care, you may not be able to reopen your claim. This is why it is so critical to have an attorney review any settlement agreement before you sign it.
Q: How do I get the medical evidence I need to file a Petition to Reopen?
A: You will need a supportive doctor who is willing to review your old medical records and provide a detailed report explaining the change in your condition and how it relates to your original work injury. An experienced workers’ compensation attorney can help you find a qualified physician and ensure the medical report contains the specific language needed to support your petition.
Don’t Wait to Protect Your Rights
If you have a closed workers’ compensation claim and your condition is getting worse, do not delay. The clock is ticking on your right to reopen your claim. The process is legally and medically complex, and the insurance company will almost certainly fight it. Having a skilled advocate on your side is essential. The team at Arizona’s Work Injury Firm has extensive experience with Petitions to Reopen. We can evaluate your case, guide you through the process, and fight to get you the medical care you need. Contact us today for a free consultation before it’s too late.