Can You Reopen a Closed Workers’ Compensation Case in Virginia?

Workers’ compensation is designed to help employees who are injured on the job. In Virginia, as in other states, it provides medical benefits, wage replacement, and other support to workers who suffer job-related injuries or illnesses. However, what happens when an injured worker’s case is closed, but they believe there are grounds to revisit it? Can you reopen a closed workers’ compensation case in Virginia? This blog will explore the possibilities and procedures for reopening a closed workers’ compensation case in Virginia, including the relevant legal considerations and practical steps involved.

Understanding Workers’ Compensation Cases

Before diving into the specifics of reopening a case, it's important to understand how workers’ compensation cases generally function in Virginia. Workers’ compensation is a no-fault insurance system designed to offer financial and medical support to employees injured during work. When a claim is filed, the injured worker must provide evidence of the injury and its connection to their employment. If approved, the claim can lead to benefits such as medical expenses coverage, temporary or permanent disability payments, and vocational rehabilitation.

The Closure of Workers’ Compensation Cases

A workers’ compensation case is typically closed once the claimant has received all the benefits they are entitled to or has reached a settlement agreement. In Virginia, cases might close for several reasons.

1. Completion of Medical Treatment: The injured worker has finished the necessary medical treatment, and the insurance company has determined that no further benefits are needed.

2. Settlement Agreement: The parties involved (the injured worker and the employer’s insurance carrier) reach a settlement. This might involve a lump sum payment in exchange for a waiver of future claims.

3. Claim Denial: If a claim is denied and the decision is upheld through the appeals process, the case might be considered closed.

4. Statutory Time Limits: If the worker fails to pursue their claim within certain statutory time limits, the case can be closed.

Reopening a Closed Workers’ Compensation Case

Reopening a closed workers’ compensation case in Virginia is possible, but it’s subject to specific conditions and procedures. Below are the main avenues through which a closed case might be reopened:

1. New Evidence of Continuing Disability

One of the primary reasons to reopen a closed workers’ compensation case is the emergence of new evidence that suggests the claimant’s disability has continued or worsened since the case was closed. If an injured worker experiences a change in their condition or new medical evidence surfaces, they might have grounds to reopen the case.

Steps to Take:

• Gather New Medical Records: Obtain updated medical records or a new medical opinion indicating that the condition has persisted or deteriorated.

• File a Request with the Virginia Workers’ Compensation Commission: Submit a formal request to the Commission explaining the new evidence and why the case should be reopened.

• Provide Supporting Documentation: Include any necessary documentation, such as medical reports and treatment records, to support your claim for reopening the case.

2. Fraud or Misrepresentation

If it’s discovered that fraud or misrepresentation occurred during the original claim process, this could be a basis for reopening the case. For example, if it turns out that false information was provided to the Commission, or if crucial facts were hidden, the case may be revisited.

Steps to Take:

• Report Fraud or Misrepresentation: Contact the Virginia Workers’ Compensation Commission to report any suspected fraud or misrepresentation.

• Provide Evidence: Supply any evidence you have that indicates fraudulent activities or misrepresentation during the initial claim.

3. Settlement Disputes

If the claim was settled but there’s a dispute over the terms or if it’s believed that the settlement was unfairly determined, the injured worker might seek to reopen the case. This might occur if there was a mistake in calculating benefits or if new information affects the settlement’s fairness.

Steps to Take:

• Review the Settlement Agreement: Examine the terms of the settlement to identify any discrepancies or issues.

• Request a Review: File a petition with the Virginia Workers’ Compensation Commission to review the settlement and provide reasons why it should be adjusted or reopened.

4. Mistake or Clerical Error

Sometimes, cases are closed due to administrative errors or mistakes. If a clerical error impacted the closure of the case or led to an incorrect decision, there might be grounds to reopen it.

Steps to Take:

• Identify the Error: Determine what mistake or clerical error occurred that led to the case’s closure.

• Contact the Commission: Notify the Virginia Workers’ Compensation Commission of the error and provide evidence that supports your claim for reopening the case.

Legal Considerations for Reopening a Workers’ Compensation Case

Reopening a closed workers’ compensation case in Virginia involves navigating various legal considerations. Understanding these can help you prepare for the process and improve your chances of success.

Statutory Time Limits

Virginia law imposes specific time limits on reopening a workers’ compensation case. Generally, you must request to reopen a case within 30 days of discovering new evidence or the occurrence of fraud, as stated by the U.S. Department of Labor. This timeframe can be strict, so it’s crucial to act promptly.

Burden of Proof

When seeking to reopen a case, the burden of proof lies with the claimant. You’ll need to provide convincing evidence that supports your claim for reopening. This might include medical records, documentation of fraud, or proof of clerical errors.

Legal Representation

Given the difficulty of reopening a workers’ compensation case, it’s often advisable to seek legal representation. An experienced workers’ compensation attorney can help navigate the process, gather evidence, and present your case effectively to the Virginia Workers’ Compensation Commission.

The Process for Reopening a Case

Here’s a general overview of the process for reopening a closed workers’ compensation case in Virginia:

1. Gather Evidence: Collect all relevant documents, medical records, and other evidence that supports your reason for reopening the case.

2. File a Petition: Submit a formal petition or request to the Virginia Workers’ Compensation Commission. Include all necessary documentation and a clear explanation of why the case should be reopened.

3. Review and Hearing: The Commission will review your petition and may schedule a hearing to discuss the case. Be prepared to present your evidence and argue why reopening the case is justified.

4. Commission’s Decision: The Commission will make a decision based on the evidence presented. If they approve the request, the case will be reopened, and further proceedings will follow.

Enlist the Legal Support of a Reliable Attorney

Reopening a closed workers’ compensation case in Virginia is feasible under certain conditions, such as new evidence of continuing disability, fraud, settlement disputes, or clerical errors. It involves a process that requires careful preparation and adherence to legal procedures. If you believe you have valid reasons to reopen your case, it's important to act quickly, gather supporting evidence, and seek legal advice to navigate the intricacies involved.

Whether you're dealing with new medical findings, suspecting fraud, or addressing administrative mistakes, understanding the process and requirements can help you take the necessary steps to potentially reopen your closed workers’ compensation case in Virginia. Here at the Forbes Law Firm, we service clients throughout Virginia including Hampton, Newport News, Williamsburg, and Poquoson and York Counties. Give us a call today to schedule a consultation and get started working with experts in the field. We look forward to helping you with your case.