Reopen Your Workers’ Compensation Claim

Episode 24: Louisville workers’ compensation attorney Scott Scheynost discusses reopening your workers’ compensation claim.  Kentucky law allows for this valuable right for the injured worker.  However, there are specific time limits you need to know about, or you’ll forfeit this right.

What Does Reopening the Claim Mean?

In Kentucky, you can reopen your workers’ compensation claim, even if your claim was settled or ruled on by a judge.  There are criteria you have to meet, but it’s still possible.  An injured worker has the right to reopen if your condition gets significantly worse or if there are specific economic changes.  You must reopen the claim within 4 years of the date of the settlement/award.  Basically, it’s a chance to put extra money in your pocket.

Now, assuming you are still within that 4-year window, you need to be sure you retained the right to reopen your case, when you originally settled your claim.  Some settlement negotiations give up the right to reopen.  Assuming you didn’t, there must be a significant change in the impairment or a significant change (often a worsening) of your personal, financial situation. 

What Type of Medical Change Would Qualify?

Scott describes a change due to a surgery due to the work-related injury.

What Type of Financial Change Would Qualify?

For instance, if you went back to work but were unable to continue to perform the job.  Maybe the company you worked for went out of business.  Maybe you lost your job.  These factors can be taken into consideration. 

Don’t Wait to Talk to an Attorney

While you can reopen within 4 years, Scott strongly advises you not to wait too long.  Your attorney will need time to gather the documents from your original claim, determine the proof that you actual do qualify and to complete the paperwork needed to petition for a reopening.  It takes time to do this.  If you’ve waited until the last minute, it may be too late.  You should contact an attorney several months before your 4-year period expires.

Three Common Situations that Could Qualify

In Scott’s experience, there are 3 common reasons a Kentucky workers’ compensation claim is reopened.  These aren’t the only 3 situations, but they happen fairly often.

The first situation involves a knee injury.  Maybe you tore your meniscus or ACL while working.  You had surgery to fix it and your impairment rating was fairly small (i.e. 1-3%).  Down the road, you now need a knee replacement surgery.  That could significantly increase your impairment rating to 15-30%.  Assuming you can still reopen your claim, you could be eligible for an increase in the workers’ compensation benefits you receive.  The higher impairment rating now qualifies you for more money.  This could be especially beneficial if you’re 50-55 or older and can’t continue to do the job, after the knee replacement surgery.

The second situation involves a work-related back injury.  Assume you had surgery on your spine, such as a fusion.  Over time, arthritis or scar tissue can develop.  This may require an additional surgery or possibly an additional spinal fusion.  The result could be an increased impairment rating.  Again, if you’re still within the 4-year window you may be able to reopen your claim and get more money.

The third situation involves shoulder injuries at work.  Once again, you may now be experiencing arthritis due to the initial surgery to repair the torn labrum or the torn rotator cuff.  You may even need a shoulder replacement.  It’s possible you were given a relatively low impairment rating after the original surgery, but after the shoulder replacement is considerably higher.  The increase in your money could be as significant as 30-40 times higher and it could go even higher if you lost your job because of it.

This Is a Complex Part of Workers’ Compensation

Scott strongly suggests you speak with an attorney about reopening your case.  The terms of your settlement agreement need to be carefully reviewed.  The medical records will have to be reviewed to make sure it’s the same part of the body that was originally injured.  A determination must be made to ensure you’re within that 4-year window. 

The Insurance company may try to blame the arthritis on the aging process, rather than something related to or accelerated by the original surgery.  You’ll want to have an experienced Louisville workers’ compensation attorney handling this for you.

Arthritis May Qualify You for Increased Benefits

If your arthritis has gotten significantly worse, don’t let the insurance company deny your benefits.  You may need a joint replacement due to the original injury you sustained at work.  Maybe you need the replacement much sooner than you normally would have had.  These situations could qualify for workers’ comp to cover your medical expenses and monetary expenses. 

Arthritis is a common reason for reopening a workers’ compensation claim in Kentucky.

Did You Waive Your Right to Reopen?

At the end of your workers’ compensation claim, you will sign a settlement agreement.  If you’re able to reach a fair settlement with the insurance company, a settlement agreement documents the specifics of agreement.  It will include the monetary agreements and the payment frequency, among other elements.  The insurance company wants to limit its future costs, so it may offer incentives for you to waive the right to reopen your case.  They may offer to increase the money they’re willing to pay or even to pay you in a lump sum.  Many people take these offers, depending on the extent of their injury.

Scott is able to use his decades of experience to help his clients to determine whether the offers are fair and whether it’s in the clients’ best case to agree to them.  Unfortunately, many people may not realize what they are giving up if they agree to waive their right to reopen.

Now, if the decision regarding your claim was decided by a judge (not via a negotiation), that starts the clock on your 4-year window.  Scott explains that the decision can be appealed.  Once those appeals are finished, the clock begins. 

Do I Need to Keep My Attorney Updated after the Claim is Finished?

Scott says his clients can call anytime they want.  However, there are certain situations in which you should definitely contact your workers’ comp attorney. 

If your doctor places restrictions on what you can do at work (i.e. the amount you’re able to lift) or if your job changes, you should contact your attorney.  If your doctor is talk about doing another surgery, this should be a definite red flag for you to get in touch with your attorney, before the surgery.  Your case may need to be reopened.

If you lose your job or you have to take a lower-paying job because of your injury, contact your attorney. 

There are other situations that should prompt you to contact your worker’s compensation attorney, after the resolution of your claim, but the above are definite flags.

What If I Don’t Have My Case File and Settlement Agreement?

Scott’s office retains the files and documents for 5 years.  This means he should be able to easily access your records to determine whether you can reopen your claim.  You may not be able to contact your previous attorney, or you may not have a copy of your settlement agreement.

You can contact the Department of Workers Claims at (502) 564-5550.  They should be able to assist you.  The state retains the records for a significant period of time.  You’ll need to file an Open Records Act Request and a Medical Records Release.   It can take several weeks to get them.

Interestingly, there was a recent data breech at one of the providers.  This shut down access to medical records for a period of several weeks.  The court does not add additional time to the 4-year window, because of extenuating circumstances.  If that delay would have taken an individual beyond their 4-year window, there probably wouldn’t be anything his/her lawyer could do.

Understand that the Insurance Company Might Play Games

The insurance company in your workers’ comp claim isn’t on your side.  Don’t assume they are looking out for your best interest or that they want to pay for your injuries.  They don’t.  There are games that often get played, usually to the detriment of the injured worker.  If you’ve sustained a serious injury, talk to an experienced workers’ compensation attorney.  You deserve to have someone watching out for you and your rights to benefits.

No Up-Front Charge to Contact Scott

As he’s discussed in previous episodes, Scott handles workers’ compensation claims on a contingency fee basis.  There are no up-front fees to speak with him.  Scott only gets paid at the end of your case.  The fees are based on a percentage and they are capped by law.  Court costs and case expenses are the responsibility of the client, but again, those are reimbursed to Scott at the end of the case. 

Scott can handle workers’ compensation claims across the state of Kentucky.  In some cases, you may not reside in Kentucky, but maybe your job has a connection to Kentucky.  There are certain circumstances in which Scott may be able to represent you with your workers’ comp claim.

It’s important to work with an experienced Louisville workers’ comp attorney to protect your rights and the benefits you deserve, especially when you need to reopen your workers’ comp claim.

It Cost You Nothing to Speak with Scott

Contact Scott Scheynost at (502) 937-5287.  This podcast is meant to provide information and is not legal advice.  Scott’s principal office is located at 7619 Dixie Highway, Louisville, KY 40258.  Co-host Jim Ray is a non-attorney spokesperson.  This is an advertisement.