Reopening an existing workers’ compensation claim

There are circumstances in which it is possible to reopen an existing work comp claim instead of starting a new one.

Some on-the-job injuries are straightforward and easily corrected. A simple broken ankle, for example, will usually heal in a relatively short time with no long-term effects. A repetitive motion-induced condition like carpal tunnel syndrome can often be addressed with activity modifications, a course of physical therapy or a relatively basic surgery.

Other injuries, however, aren't necessarily so simple. A complex fracture or soft tissue injury can have lasting impact well beyond required surgeries and rehabilitation. There may be nerve damage, weakness or chronic pain that can flare up years afterward. In those instances, the injured worker shouldn't have to foot the bill for new medical treatment, so it may make sense to either reopen the initial workers' compensation claim or file a new one in order to have those expenses covered. Claims could also be reopened to seek additional benefits or compensation if a disability worsens or results in new medical conditions. Conversely, a disability insurer could reopen a claim if they feel that too much compensation has been paid.

To reopen an old claim or start a new one - that is the question

Generally, a workers' compensation claim could be reopened if:

  • There has been a change in the claimant's condition
  • Some fraud comes to light (on the part of the claimant, the employer or the insurer that paid the benefits claim)
  • There was an overpayment of benefits
  • A clerical error was made that impacted the claim
  • There was a mistake/misinterpretation of a material fact in the case

It is important to note that, if a claim was resolved via a "full and final settlement" or a "compromise and release," it usually cannot be reopened absent compelling evidence of some fraud on the part of one party to the agreement.

With the recent closure of the New York Fund for Reopened Cases (sometimes referred to as the "25A fund,"), reopened claims are now paid directly by work comp insurers, and the process for reopening a claim has changed slightly. An application still needs to be made to the state's Workers' Compensation Board, though.

In circumstances when it isn't possible to reopen an existing claim, it may behoove a claimant to simply open a new one to seek compensation. There may be procedural or strategic differences in a new claim based upon an old injury, though, so it is advised that the claimant have the guidance of an experienced workers compensation attorney throughout the process. Of course, legal representation is always a good idea, but it may be particularly helpful in this instance. For help determining if you should reopen a New York work comp claim, contact the Staten Island law firm of Angiuli & Gentile.