To reopen a settled case, or "vacate the previous award," a
disgruntled employee or comp insurer must file a petition with the Workers'
Comp Court of Appeals (WCCA).
The Court has broad discretion in determining whether to vacate an award. It recognizes four "causes," or reasons to reopen a settled case:
I. A substantial change in medical condition II. Fraud III. Newly discovered facts IV. A mutual mistake of fact
If the Court reopens your case, they'll refer you to the Office of Administrative Hearings (OAH) where a workers' compensation judge will decide your new case unless you reach a new settlement with the comp insurer.
To reopen a case based on substantial change in medical condition, you'll need to show that:
(1) Your work comp injury has substantially deteriorated since your settlement was awarded; (2) The deterioration has diminished your ability to function; and (3) The deterioration was something clearly not anticipated, nor could it have been anticipated, at the time your settlement was awarded.
You'll need to submit medical evidence that contrasts what your medical condition was -- and what your ability to function was at the time of settlement, and what it is today.
However, you won't need to petition to reopen your case if you're seeking benefits for a "consequential" injury. A consequential injury can simply be a temporary aggravation of your existing work injury, or it can be a new injury that arose from your work injury.
For example, if you hurt your neck in a car accident while on your way to therapy for your lower back work injury, the neck injury is consequential because it arose from your work injury. Similarly, if you fractured your right hip on the job, your left hip may develop a problem and require treatment due to compensating for the fractured hip.
Settlement agreements cannot generally foreclose on consequential injuries so a petition to reopen them is unnecessary.
Fraud, or lying, is an allegation more commonly made by the comp insurer against you.
For example, If you've held out that you can't work because you're limited to lifting five pounds and can only bend far enough to reach your knees, the comp insurer might get a little upset when they see surveillance video of you laying down sod in your back yard.
Such video, however, is not likely to reopen the case if it was taken years after your settlement was awarded.
To reopen a case based on newly discovered evidence, you must show:
(1) A new fact has been discovered that, had it been known at the time of the settlement award, would have had a significant bearing on the case; and
(2) The fact existed but was not discovered at the time of the award even though a thorough investigation was made; or
(3) The fact developed after the settlement had already been awarded.
WCCA may consider reopening the case if both parties made a mistake over a fact that had significant bearing on the case.
For example, if one party mistakenly recorded the disability rating as 2% instead of 20%, and the opposing party failed to detect it before it went to the compensation judge for his or her signature, your settlement award would be significantly, and unfairly diminished.
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