If you are injured on the job in New Jersey, you could be entitled to workers’ compensation benefits for your medical treatments and lost wages. Once you recover, you may also receive a cash settlement. After the final payment is made, your case is considered closed. While you may feel relief that the ordeal of fighting with your employer’s insurance company is over, you may later discover that your medical problems got worse instead of better. Your settlement may not be enough to compensate you for the additional lost wages and expensive medical treatments you could need. Can you reopen your workers’ compensation case?
Your Type of Settlement Could Determine Whether You Can Reopen Your Case
There are two types of settlements of workers’ compensation cases in New Jersey: Section 20 lump sum settlements and Section 22 settlements. Which type your settlement is could determine whether you can reopen your workers’ comp case. The following rules apply:
- Section 20 settlements. In this type of settlement, a worker receives a lump sum payment as a full and final payment of his claim rather than payments over time. Once the agreement between the worker and the workers’ comp insurance company is approved by the judge, it is considered a final order and generally cannot be reopened.
- Section 22 settlements. This is the more common way workers’ compensation cases are resolved. The worker’s benefits are based on apportioning a percentage of disability of the injured body part. These settlements can be reopened if a worker’s medical condition deteriorates.
Even in a Section 20 settlement, there could be exceptions to the prohibition of reopening the case. Two exceptions that can apply include:
- If it appears you committed fraud
- If one of the parties made a mistake in submitting the facts in the case
If you entered into a Section 20 settlement and do not fit into these exceptions, do not assume that you cannot reopen your case. You need to consult with an experienced workers’ compensation attorney to be certain that there are not any additional reasons to reopen your case either due to court decisions or a new law giving you this right.
Reopening Your Workers’ Comp Case If Your Condition Worsened
Both you and your employer have the right to reopen a workers’ compensation case. An employer could consider this if he suspects you engaged in fraud or believes that you were over paid benefits.
The most common reason workers reopen their cases is when their injury worsens over time. To begin the process, a petition to re-open the case would need to be filed. Some injured employees assume that if they file a doctor’s report with their petition that their case will automatically be re-opened. Unfortunately, this is not the case. A person would need to prove the following:
- His worsening medical problem was caused by his original workplace injury.
- His worsening condition entitled him to additional workers’ comp benefits.
The worker must show that the continuing problem is a medical or mental one—not a purely economic problem. In addition, he will need to establish that the injury was related to his workplace accident and was not caused by a non-work related accident or intervening factors.
The administrative judge does not have to reopen a case and will only do so if there is compelling evidence. A detailed report from the worker’s doctor—even more effective if he has treated the person on a long-term basis for this injury—and the worker’s testimony at an administrative hearing could be crucial to granting a petition to re-open a case.
Know the Deadlines to Reopen Your Case
New Jersey law sets a time period or statute of limitations for reopening workers’ comp cases. You would need to meet these deadlines for workers comp claims or you would not be able to pursue your claim:
- To reopen a workers’ comp claim, you must file it within two years from the time of your injury or your last payment of compensation.
- To obtain addition medical benefits, the petition must be filed within two years of your original injury or of your last payment of medical benefits.
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