Recovery from a serious injury does not always move in a straight line. Many people suffer setbacks along the way that have a negative impact on their daily lives, including their ability to work for a living.
For an individual who has suffered a workplace injury and who is receiving workers’ compensation benefits, a negative change in condition means their benefits should continue. In some cases, this occurs after a claim has been settled and closed because the worker was considered fully recovered from their injury. Because of the change in condition, that worker may receive workers’ comp benefits again.
It can be difficult to re-open a settled workers’ compensation claim in North Carolina without qualified legal help. Many employers and insurers are reluctant to add more expenses to a case they thought was closed. But a recovering worker with a true need for continued medical treatment or time away from work has a right to assistance that is promised by law.
If you need to re-visit a workers’ compensation claim in North Carolina because of a change in condition, the workers’ compensation attorneys at Hardison & Cochran are here to guide you through the process and help you pursue all the benefits you deserve.
What Does Change in Condition Mean to NC Workers’ Comp?
Workers’ compensation is meant to pay all of an injured worker’s medical bills and a portion of his or her weekly wages while the worker cannot perform their job. The objective is to support the worker until he or she is well enough to return to work.
Eventually, the doctor treating the injured worker will determine that the patient has reached maximum medical improvement or MMI. This means the patient has fully recovered and can return to work, or that the worker’s health condition will not improve any further.
At this point, most workers’ comp insurers will move to settle and close the worker’s claim and stop paying benefits. This is not an issue for most workers’ comp claimants, who return to their jobs and the lives they had before being injured.
But closing a claim can be a problem if the employee returns to work and their medical condition changes for the worse. For example, a recent study found that 35% of patients hospitalized with traumatic brain injury (TBI) were readmitted to the hospital at least once after discharge. Forty percent of readmissions occurred within the first 30 days after discharge from the original hospitalization.
A worker who requires medical care or time out of work for a change in condition directly related to their original workers’ comp-eligible injury deserves continued benefits. But that requires some legal work if their original claim has been settled and closed.
How Can a Claim Be Reopened Due to a Change in Condition?
Workers’ compensation claims in North Carolina can be settled in one of two ways:
- Settlement agreement. This is a signed agreement using the N.C. Industrial Commission’s Form 26, which notes the employee’s status and agreed-upon wages or benefit payments they are to receive.
- Clincher agreement. This is a final resolution and settlement of all the issues and benefits in a workers’ compensation case. In return for a lump sum payment to the worker of all benefits, the worker releases their employer from any future liability arising from the case.
The relevant difference between the two ways to close a workers’ comp case is that a settlement agreement allows the worker to re-open the claim if necessary and the clincher agreement does not.
When a workers’ compensation beneficiary signs Form 26 to approve a settlement agreement, he or she acknowledges that they have two years from the date they receive their last compensation check to claim additional benefits.
In other words, if you have a change in condition within two years of receiving benefits from a properly settled workers’ compensation claim, you can seek to re-open the claim and resume receiving benefits related to your original injury. This requires asking for a hearing before a representative of the N.C. Industrial Commission, which administers workers’ compensation in our state.
To have your claim re-opened, you would have to document a substantial change in your condition and the need for medical care and/or wage replacement benefits. This could lead to a change in your disability rating assigned by the treating physician.
You would be obligated to be treated and diagnosed by the doctor previously assigned to your claim. However, if the presiding doctor denied the extent of your relapse and change in medical condition, you would have the right to seek a second opinion and present it at your claim hearing.
Help with Your NC Workers’ Compensation Benefits
The Raleigh workers’ compensation attorneys at Hardison & Cochran can help you pursue all of the benefits that you are due for a workplace injury in North Carolina, including additional benefits necessitated by a change in condition. We can help you document your current medical condition, including referring you to medical providers for additional exams, if necessary.
If Hardison & Cochran attorneys represent you as you approach maximum medical improvement (MMI), we can calculate the full extent of benefits you are owed and help negotiate a settlement for maximum compensation to you. There are few cases in which accepting a clincher agreement is the best result for an injured worker. If we are handling your case, we can fully explain and help you weigh the pros and cons of settling your claim.
We are here to assist you through the entire process and get you all of the compensation you deserve for a workplace injury. We serve injured workers across North Carolina, including those located in Raleigh, Cary, Research Triangle Park, Durham, City of Greenville, Wake County, Fayetteville, Dunn, Greensboro, Wilmington, Person County, and Southern Pines.
Call the experienced North Carolina workers’ compensation lawyers at Hardison & Cochran toll-free at (800) 434-8399 or fill out our online contact form. You’ll get a response within 24 hours.