Do you need to reopen a workers’ comp claim?
If your claim was denied/rejected, you must protest or appeal the denial within 60 days. You cannot submit a reopening application on a denied claim. If your claim was denied and 60 days have gone by, you may need to file a new claim (see our page on the statute of limitations for filing L&I claims).
If you’re experiencing worsening conditions after your claim was closed, you may be able to reopen your workers’ compensation claim. There are several factors that impact the ability to reopen a claim and whether you should submit an application to do so.
Common things that influence the reopening of your claim:
The situational urgency/severity of the claim
- Are you in severe pain or emergent distress? Call 911 or get to the doctor and figure this part out later – a reopening application can be filed after you receive emergent care. However, there is no guarantee that it will be granted, which means you or your private insurance may be charged, but sometimes treatment can’t wait.
How your claim was resolved prior
- Was your claim closed by order?
- If not, your claim may not actually be closed (even if it seems like it is because treatment or benefits are being denied).
- If yes, was it done in the last 60 days? If so, you need to protest or appeal the closure rather than submit a reopening application.
The amount of time that’s passed since your claim was closed
- If it was less than 60 days ago, see above. If it was more than seven years ago, you might be able to reopen, but likely for medical benefits only. (Monetary benefits such as time loss, Permanent Partial Disability or “settlements,” retraining benefits, etc., will not be available.)
- If your claim was closed as part of a Claim Resolution Structured Settlement Agreement (CRSSA), this also would likely prevent you from receiving any benefits other than medical treatment.
While this is a great place to start, it still doesn’t inform you how to reopen your claim. Don’t worry; we’ll get there!
The timeline of reopening a claim
Within seven years of the initial closing order, the Department of Labor and Industries may review injury or occupational disease claims for both medical and monetary benefits once the worker applies. After seven years, your claim can only be reopened for medical reasons.
If you’re dealing with a condition that has worsened and your claim has been closed for 60 days or more by the department, you and your doctor must fill out an application to reopen your claim. If you happen to be dealing with a new injury from work, you must complete another Report of Industrial Injury or Occupational Disease form.
Getting started: how to reopen your claim
What’s needed to reopen your workers’ compensation claim? First, discuss your legal options with a knowledgeable party to determine any benefits you may still qualify for based on the length of your claim’s closure.
Next, you’ll want to schedule an appointment with your doctor(s) to gather and submit all of the findings that convincingly, measurably, and repeatably demonstrate how your occupational sickness or industrial injury has worsened. This is known as objective medical evidence.
Lastly, you’ll just need to apply to reopen your claim (or protest if your claim was closed in the last 60 days). This form can be found online. Here’s a link to the form if you’re applying to reopen your claim in Washington State.
But what if my claim was rejected so I can’t reopen it?
It can be so frustrating to go through the workers’ compensation claim process only to find out your claim was denied. What went wrong? Though we can’t get into your case specifics, we can list the most common reasons a workers’ comp claim gets denied.
Top reasons for workers’ comp claim denial:
- You’ve missed any deadlines while filing your claim
- There was any doubt that the illness or injury was work-related
- The condition that you have doesn’t meet the state’s guidelines for claim allowance
- There is information missing from your application (date, employer, etc)
Carlisle + Byers: your workers’ compensation attorneys
To quite literally add insult to injury, the workers’ compensation process is anything but easy on the injured party. With decades of experience in workers’ compensation and personal injury cases, we’re here to help navigate you through all the twists, turns, and paperwork. To request a free consultation with us, click here. We’d love to hear from you!