Reopening Your Worker’s Compensation Claim

So you just received an order closing your claim. The question you may now have is what rights do you have under your claim in the future?

Video: Reopening A Workers Comp Claim

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The General “7-year” Rule

The general rule for worker’s compensation cases is that you have seven years from the date of the first, final order closing your claim within which to file an application to reopen that claim for access to all benefits available under the Industrial Insurance Act. There is no limit to the number of times you can apply to reopen your claim within that seven year period, although the fewer times you attempt to reopen, the better your chance is of proving worsening.

Whether your claim is reopened depends on the medical evidence. If you try reopen your claim for the physical component of your injury, then you must have a medical provider describe the objective medical evidence that supports the reopening of your claim, as compared to your medical condition at the time of the first claim closure.

Objective Medical Evidence

What constitutes objective medical evidence can be the subject of litigation. At the Administrative level, the Department of Labor and Industries (Department), or the Self Insured Employer (SIE), will typically look for things like radiological studies such as an x-ray or MRI, they may look for something like an EMG or Nerve Conduction Velocity test, they may look at lab work, anything basically that shows worsening that does not require patient involvement in the assessment. Even then, if present, your application to reopen your claim may be denied if they conclude that the worsening is not related to your industrial injury. It is not unusual for the Department or the SIE to send you to their own doctors in what they refer to as an Independent Medical Examination (IME) and find they conclude that any objective worsening is due to mere aging.

Under the law, objective medical findings are those that can be “seen, felt, or measured” by a doctor. In fact, in the State of Washington, even tenderness can be considered an objective medical finding. However, it is common for defense attorneys to argue that any finding which requires patient input is not objective and therefore cannot be relied upon as a basis for reopening a claim for a physical injury.

Re-opening Claim for Psychological Health Reasons

If you wish to reopen your claim for psychological health reasons, the medical basis is somewhat different. Because mental health disorders are not amenable to the “pure” objective measurements such as x-ray, MRI, and the like, the test of objective worsening is different for mental health disorders. Instead, a psychologist or psychiatrist need to examine you to compared your mental health condition at the time of the first, final claim closure, to your condition at the time you wish to reopen your claim, then offer an opinion as to whether there is evidence you have worsened. For example, if your diagnosis is some form of depression, indicators of increased depression may include weight change, increased isolation, increased mood lability, hallucinations from severely depressed mood, or any number of other medical factors tied to that condition. A psychologist or psychiatrist will be instrumental in sorting this out.

If more than seven years have passed from the date of the first, final closing order and the date you wish to reopen, you may apply for what is termed a “discretionary” reopening of your claim. If the Director of the Department grants reopening of your claim after the seven-year period has passed, the benefits to which you might be entitled would also be granted only at the discretion of the Director of the Department. However, this is often helpful knowledge, particularly if you only seek medical treatment and do not want to be burdened with the co-pay of private health insurance.

Seek Help from an Attorney

In any event, when you apply to reopen, the Department will issue an order. If that order denies your application to reopen, you should seek the assistance of an attorney experienced in worker’s compensation law. That attorney will help you understand your rights and will advocate for you.