Whether a worker’s worsened condition is a result of a new incident or constitutes an aggravation of the original injury depends upon whether the new incident is a supervening cause, independent of the original injury. The question is one of proximate cause, i.e., whether “but for” the original injury the worker would not have sustained the subsequent condition.
In order to be entitled to benefits where a new traumatic event was wholly and independently responsible for the worker’s worsened condition, a new claim must be filed.
Criteria for Reopening a Claim
The criteria for reopening a claim after closure has become final require objective findings from a doctor that the worker’s condition has been aggravated or worsened since the claim closure. The same is true if there had been a previous reopening denial.
To qualify for reopening your claim by claiming aggravation you have to show that the condition or aggravation is at least causally related to the original industrial injury or illness. It takes more than simply you stating that things have become worse even if you know it. You have to have objective medical diagnostics or medical findings that show that the condition has worsened. If the worsening is related to a new injury, is a natural progression, or related to an unrelated condition, then the worsening would not qualify for cause to reopen the previous claim.
You, the injured worker, must prove that you have the right to receive the benefits. Have your condition documented by your doctor. However, you are not expected to pay for everything out of your own pocket. The Department of Labor and Industries or your employer if they are self-insured will pay for consultations with doctors, diagnostics, cat scans, MRIs, or x-rays to help determine whether or not to allow the claim to be reopened.
If a worker files an application to reopen his/her claim for medical coverage only, a request can be made at any time. However, if the worker is seeking time-loss compensation or permanent partial disability benefits, the worker must file an application to reopen claim for worsening condition within seven years of the date the claim was first closed. If the initial claim was for an eye injury, the time to file is extended to 10 years. The department will issue an order either granting or denying the request for reopening typically within 90 days. If the request is granted, the order will indicate an effective date for the reopening of the claim. This date may be up to 60 days prior to the date the reopening application is received by Labor and Industries or the self-insurer. The State Fund or self-insurer will pay for treatment administered beginning with the reopening effective date stated on the order.
If the request is denied, the injured worker is responsible for treatment costs not authorized by the department and has 60 days file a written to protest or appeal of the Department or self-insured’s decision and order.
If you have been re-injured in an accident at work or if you have an occupational illness, you deserve protection. Call our office today to talk to a Worker Compensation Attorney.
Call 253-631-6484. We don’t get paid unless you get paid.
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