Types of closed work injury claims and if they can be reopened
A question that’s commonly asked by prospective clients is if it’s possible to reopen a closed workers’ compensation case.
There are many different types of “closed cases,” so the answer to that question varies. If you’re unsure which type of closed case you’re dealing with, schedule your free consultation with one of our Athens workers’ compensation lawyers to find out.
Here are the different types of closed workers’ comp cases, and whether or not they can be reopened.
When a case has been settled and submitted for approval
The first type of closed workers’ compensation case is one that has been settled and submitted to the Georgia State Board of Workers’ Compensation for approval. Consideration for settlement of both the medical portion and the indemnity portion of the workers’ compensation claim are included in the settlement documents.
If the State Board of Workers’ Compensation has formally approved the settlement, the case is considered closed and cannot be reopened. Just because funds have not yet been distributed, doesn’t mean the case is not formally closed by the State Board of Workers’ Compensation.
When the insurer or employer fails to pay the settlement
The insurance company or the employer has 20 days to make payment after the settlement or they are subject to a 20% penalty. There are some instances where the insurance carrier or the employer fails to pay the settlement and fails to pay the penalty as well.
In this scenario, there are ways to recover civil penalties against those parties, but it is still difficult to have the case reopened unless you can prove there was fraud.
When the statute of limitations has expired
The statute of limitations in a Georgia workers’ compensation case has many different components. If an injured worker has never received any indemnity benefits or medical treatment paid for by the insurance carrier or the employer, they have 1 year to file a notice of claim with the State Board of Workers’ Compensation. If they fail to file a claim, the statute has run and they are barred from filing a claim for that specific accident. Therefore, they cannot reopen the case without a new incident or injury.
A second statute of limitations in Georgia is that the injured worker has 1 year from the date of the last treatment to file a notice of claim with the State Board of Workers’ Compensation. Many people are mistaken in thinking that their case is closed because their medical treatment has stopped. This is not the case. If it is within 1 year from the last date of treatment, or a claim has been filed, the case is still open. Many individuals think that their case is closed, when in reality it is merely dormant.
A third statute of limitations is that the injured worker has 2 years to file a notice of a claim after they have received indemnity benefits. In other words, it can be up to 23 months after receipt of benefits before a claim has to be filed with the State Board of Workers Compensation.
To be clear, just because the statute has not expired and a case can be brought, does not mean that there is a viable case that has value.
When the insurance company closes your claim
Just because insurance company closes their claim doesn’t mean the case is closed. We have many people inform us that the insurance company has closed their claim. It’s important to realize that the statute of limitations is the controlling doctrine, not the arbitrary and capricious decisions of the insurance carrier. The insurance carrier may decide to controvert the claim going forward, meaning they deny the claim. But you still have the right to fight that decision in court.
Closing a workers’ compensation claim is a legal term that is often misused in the colloquial sense. If you have a question about your workers’ compensation injury and/or case, don’t hesitate to contact the experienced attorney’s at Gerber & Holder.