Reopening Claim

A petition to reopen is different than an appeal of a workers compensation award or decision. A petition to reopen based on a new or different disability is based on a change of facts or circumstances related to the disability after the last decision was made. In contrast, an appeal of a prior decision is based on the same facts that gave rise to the decision, but instead typically argues the decision was legally wrong. In this article, we will be discussing issues our Sacramento Workers’ Compensation Attorneys are generally confronted with in relation to reopening a case for new or further disability. Specially we will cover what is considered new disability and what the time limits are in order to reopen a workers compensation case. Lastly, we will discuss what information you should include in your petition to reopen a workers’ compensation claim.

CA WC Case Reopening Claim
What is considered a new and further disability for the purposes of reopening a workers compensation claim?

The Labor Code is particularly vague on petitions to reopen, and simply states that proceeding may be brought "upon the ground that the original injury has caused new and further disability." There are many twists and turns within the courts about what meets this threshold. Generally speaking, when an employee's condition has gotten worse, that is considered new and further disability. The petition to reopen could be to continue temporary disability when appropriate, as well as an increase in the permanent disability award.  

To determine if there is a new or further disability, you will be required to utilize the same Qualified Medical Evaluator that performed your initial evaluation. Any evidence of additional medical treatment and diagnosis, hospitalization, or therapy from a practical standpoint would likely be required.

What are the time limits to reopen for a further disability?

To reopen a claim for a new or further disability, generally, a claim must be filed within five years of the original injury, or the court may lose jurisdiction. There are some situations in which jurisdiction has been preserved, but to be safe, you should ideally file the petition prior to the expiration of five years.  Note, it is five years from the date of the injury, not five years from the date of the prior stipulation and award or decision of the judge.

What information should go in a petition to reopen for a new and further disability?  

While the normal standards of proof for the disability apply, the actual petition to reopen is required to be liberally construed by the court.  In other words, the courts should liberally construe the pleadings for the benefit of the employee. However, the petition should set forth in detail the facts relied on to substantiate just cause to reopen. Ideally, it should describe the disability in detail and describe the new and further disability regarding substantiating medical reports, listing the periods of additional temporary disability claimed, and describing additional hospitalization, medical treatment, and/or therapy obtained.

In this article, we wanted to give you some guidelines on issues we are generally faced related to reopening a case for new and/or further disability. If your disability has gotten worse since you previously entered into a stipulation and award, or judgment entered in your case, and it has been less than five years, we encourage you to contact one of our Sacramento Workers Compensation attorneys for a free consultation.