The adjuster handling your workers’ compensation claim may tell you that they are “closing” your case. This statement is misleading, and often makes the injured worker believe they are no longer entitled to any workers’ compensation benefits when that is not the case.
If you have received a lifetime medical award from the Virginia Workers’ Compensation Commission, your claim only closes for good if you reach a full and final settlement. Otherwise, you are entitled to a lifetime medical award for your injuries. This means as long as your doctor says your medical care is the result of the original accident the workers’ compensation insurance carrier is responsible for paying for the medical treatment. So, what are your remedies if the insurance company says your case is “closed”?
The Virginia Workers’ Compensation Act includes provisions that enable an injured worker to ask for Commission review of a previous award based on a change in condition. Specific statutory requirements and Commission rules apply. If you think you may have reason to ask for reopening a closed Virginia workers’ compensation case, you should talk with an experienced workers’ comp lawyer before you take any action to ask for review of your case. Legal counsel is always beneficial in a Virginia workers’ compensation case and is especially important when asking the Commission to reopen a closed case.
Statutory Provisions and Commission Rules
Section 65.2-708 of the Virginia Code governs requests to ask for Commission review of a previous award. The provisions impose complicated limitations on Commission reviews. One restriction is that a review cannot occur more than 24 months from the last day compensation was paid, with limited exceptions.
Rule 1.2 of the Commission’s rules requires a change-in-condition claim to be in writing and to state the change in condition claimed by the injured worker. If the worker relies on medical reports, the Act requires that the medical reports be submitted to the Commission. The rule also requires the worker to send the employer a copy of the request to reopen the case.
Rule 1.4 provides that additional compensation may not be awarded for more than 90 days before the request to reopen is filed. Cost-of-living supplements are not subject to the 90-day limitation.
When to Reopen a Case
If your condition gets worse or your work status changes after the Commission approves your workers’ compensation claim, you may be able to request a review of your benefits. A change in condition may occur if your physician changes the assessment of your ability to work, which alters your work status and increases the extent of your disability. A change in condition also may be due to additional or different medical treatment that is necessary to treat your work injury.
Whatever the reason for the change of condition, the burden is on the injured worker to show the change through documentation. The worker also must demonstrate to the Commission that the change is due to the initial work injury.
On account of the time limitations on filing for a change-of-condition review and the restriction on how far back compensation changes can apply, you must act promptly to pursue reopening your case if your condition worsens or your work status changes because of your work injury or medical treatment.
Changes in an injured worker’s condition sometimes leads to multiple requests for change-of-condition review. There is no limitation on the number of requests, but each one must be documented and proven as required by the statute and Commission rules.
Process for Reopening a Workers’ Compensation Claim
If you file an application for review due to a change in condition, you have only 90 days to provide the evidence to document your claim. If you fail to file the necessary evidence within that time, the insurance company may file a motion to dismiss your claim.
In some cases, the Commission may refer your claim to the Alternative Dispute Resolution program. Mediation through the ADR program is voluntary. If the parties advise the ADR department that they do not want mediation, or if the insurance company files a response to your claim form, your case will be referred to the hearing docket.
At the hearing, you must present evidence to prove your change of condition and show that the change is due to the original accident. Representation by legal counsel is beneficial throughout the process and is especially important at the hearing. Your lawyer makes certain that presentation of your case complies with all the applicable procedural rules, in addition to providing the Commission with the necessary evidence to support your change of condition request.
Schedule a Free Consultation with an Experienced Richmond, Virginia Workers’ Compensation Lawyer
Legal representation is beneficial in any workers’ comp claim. Assistance from a knowledgeable lawyer is very important if you think you may have a case for reopening your case based on a change of condition. At the Richmond law firm of Renfro & Renfro, our dedicated workers’ compensation lawyers help clients with all types of Virginia workers’ comp claims, including claims to reopen a closed workers’ compensation case. Our lawyers are dedicated to getting injured workers the full compensation they deserve. We welcome you to contact us for a free consultation.