In California, once a workers’ compensation claim is settled and closed, it may seem like the case is finalized and cannot be revisited. However, under certain circumstances, an injured worker may have the right to reopen a closed workers’ compensation case. This is particularly important if your medical condition worsens, new evidence comes to light, or there was a mistake in the original claim resolution.
Reopening a workers’ compensation case can be a complex process, and it’s essential to understand when and how it can be done. This article will explain the circumstances under which a closed workers’ compensation case can be reopened in California, the steps to take if you believe your case should be reconsidered, and what workers should know about protecting their rights after a settlement.
1. When Can a Workers’ Compensation Case Be Reopened in California?
Reopening a workers’ compensation case is not automatic. To reopen a case, specific conditions must be met, and there are legal time limits that must be adhered to. The most common reasons for reopening a closed workers’ compensation case include:
1. Worsening of Your Condition
One of the most common reasons to reopen a workers’ compensation case is when your medical condition worsens after the case has been closed. If your injury or illness deteriorates, or new complications arise after your case has been settled, you may be eligible to reopen your claim to seek additional medical treatment or benefits.
For example:
- If you suffered a back injury and your condition worsened after the initial settlement, resulting in the need for surgery or further medical care, you may be able to reopen your case.
- If a previously treated injury develops long-term complications, such as chronic pain or reduced mobility, you may be eligible for additional disability benefits.
2. Discovery of New Medical Evidence
If new medical evidence comes to light after your workers’ compensation case has been closed, you may have grounds to reopen the case. This could involve new diagnostic tests, evaluations, or expert opinions that reveal additional aspects of your injury or condition that were not previously addressed.
For instance, if you were initially diagnosed with a minor injury but later discovered that you suffered a more severe underlying injury, such as nerve damage or a fracture, you may need to reopen your claim to cover the costs of additional treatment and any related disability benefits.
3. Mistakes or Errors in the Original Settlement
In some cases, a workers’ compensation case may be reopened if there was an error or mistake in the original settlement. This can include mistakes in calculating your disability benefits, missing medical records, or miscommunications between your doctor and the insurance company. If you believe your case was mishandled or that you did not receive all the benefits you were entitled to, you may be able to request a review and reopen your case.
4. Fraud or Misrepresentation
If there was fraud, misrepresentation, or concealment of important information in your original workers’ compensation case, this could be grounds for reopening the case. For example, if the insurance company concealed evidence that would have resulted in a higher disability rating or settlement, you may be able to have the case reopened to correct the issue.
2. The Legal Time Limits for Reopening a Workers’ Compensation Case
California workers’ compensation law imposes specific time limits for reopening a closed case. These time limits are known as statutes of limitations, and they determine how long after a case has been closed you are allowed to file a petition to reopen.
Five-Year Limit From the Date of Injury
In most cases, you can reopen a workers’ compensation case within five years from the date of your injury. This means that if you need additional medical treatment or your condition worsens within this five-year period, you can petition to reopen your case.
It’s important to note that the five-year clock starts on the date of your injury, not the date of your settlement. This means that even if your case was settled years after your injury, the five-year limit still applies based on the date of the original injury.
Exceptions to the Five-Year Rule
There are a few exceptions to the five-year limit:
- If your workers’ compensation case involved fraud or misrepresentation, you may be able to reopen the case even after the five-year limit has passed.
- If there are ongoing medical benefits specified in your settlement agreement, you may still be able to receive medical treatment after the five-year limit, but reopening the case for additional benefits may not be possible.
If you are unsure whether your case qualifies for reopening, it’s essential to consult with a workers’ compensation attorney who can evaluate your situation and determine the best course of action.
3. How to Reopen a Workers’ Compensation Case in California
If you believe you have grounds to reopen your workers’ compensation case, there are specific steps you need to follow to file a petition to reopen. Here’s how the process works:
1. Gather Supporting Documentation
Before filing a petition to reopen, you’ll need to gather documentation that supports your request. This can include:
- Medical records showing the worsening of your condition or new medical evidence.
- Doctor’s reports that explain why additional treatment is necessary.
- Documentation of errors in the original settlement, such as incorrect calculations of disability benefits.
If your condition has worsened, it’s important to have your treating physician provide a detailed report outlining how your injury has changed since the case was closed and why reopening the case is necessary.
2. File a Petition to Reopen
To formally reopen your case, you must file a Petition to Reopen with the Workers’ Compensation Appeals Board (WCAB). The petition should include:
- A description of your original injury and settlement.
- An explanation of the reason for reopening the case (e.g., worsening of your condition, new evidence).
- Supporting documentation, such as medical records or evidence of errors in the original case.
Once the petition is filed, the WCAB will review the request and schedule a hearing if necessary.
3. Attend the Workers’ Compensation Hearing
If your petition to reopen is granted, the WCAB may schedule a hearing to review the new evidence and determine whether the case should be reopened. During the hearing, both you and the workers’ compensation insurance company will have the opportunity to present your arguments.
If the WCAB finds that there is sufficient evidence to support reopening the case, they may issue an order allowing the case to be reopened for further medical treatment, disability benefits, or adjustments to the original settlement.
4. Potential Outcomes of Reopening a Workers’ Compensation Case
If your workers’ compensation case is successfully reopened, several outcomes may occur depending on the reason for reopening the case and the new evidence presented:
1. Additional Medical Treatment
If your case is reopened due to the worsening of your condition, the insurance company may be required to cover additional medical treatment. This can include surgeries, medications, physical therapy, or other treatments necessary to address the new or worsening symptoms.
2. Adjustments to Disability Benefits
If your injury has resulted in a greater degree of disability than originally determined, reopening the case may lead to an adjustment of your permanent disability rating. This could result in an increase in your permanent disability benefits, providing you with additional financial compensation for your injury.
3. Correction of Errors
If your case is reopened due to mistakes or errors in the original settlement, the WCAB may issue an order to correct those errors. This could involve recalculating your disability benefits, correcting clerical mistakes, or revisiting aspects of your medical care that were overlooked.
5. Challenges and Limitations of Reopening a Workers’ Compensation Case
While it is possible to reopen a closed workers’ compensation case, there are several challenges and limitations to consider:
1. Proving the Need to Reopen
To successfully reopen a case, you must provide sufficient evidence that your condition has worsened, new medical evidence has emerged, or that there were errors or fraud in the original settlement. The insurance company may challenge your petition, particularly if they believe that your condition has not changed significantly or that the new evidence does not warrant reopening the case.
2. Time Limits
As mentioned earlier, the five-year limit for reopening a workers’ compensation case is strict in most cases. If you fail to petition within this time frame, you may lose the opportunity to reopen your case, even if your condition worsens. It’s important to act quickly if you believe your case needs to be reconsidered.
6. How Laguna Law Firm Can Help You Reopen Your Workers’ Compensation Case
Reopening a closed workers’ compensation case in California can be complex, and it’s essential to have experienced legal representation to guide you through the process. At Laguna Law Firm, our skilled workers’ compensation attorneys are dedicated to helping injured workers navigate the complexities of reopening cases and securing the benefits they deserve.
Legal Support for Reopening Workers’ Compensation Cases
At Laguna Law Firm, we provide comprehensive legal support, including:
- Evaluating your case: We review your original settlement, medical records, and new evidence to determine whether reopening your case is a viable option.
- Filing petitions to reopen: We handle all aspects of filing a Petition to Reopen with the WCAB, ensuring that your petition is complete and supported by strong evidence.
- Representing you in hearings: If a hearing is scheduled, we represent you before the WCAB, presenting your case and advocating for additional medical treatment, benefits, or corrections to the original settlement.
With offices in Mission Viejo, Los Angeles, West Covina, Corona, San Diego, Orange County, and Newport Beach, Laguna Law Firm is committed to helping injured workers across Southern California receive the benefits and medical care they are entitled to.
Conclusion
Reopening a closed workers’ compensation case in California is possible under certain circumstances, particularly if your condition worsens, new medical evidence arises, or there were errors in the original settlement. However, there are time limits and legal requirements that must be met to successfully reopen a case. If you believe your workers’ compensation case should be reconsidered, it’s important to take action quickly and consult with an experienced attorney.
At Laguna Law Firm, we are here to help you navigate the process of reopening your workers’ compensation case and ensure that your rights are protected. Contact us today for a free consultation, and let us help you get the benefits and care you deserve.
Spanish 
English 