They say my work injury claim is closed!

Sep 19, 2024 | Claims Process

They say my work injury claim is closed! – When people say your claim is closed oftentimes it’s misunderstood. People might say the claim is closed because they’re thinking from their point of view. For example, the doctor may say the claim is closed meaning they’re done treating you so their file is closed. However, that doesn’t mean your claim is closed.

What does having a claim closed mean?

Having a closed claim means that you can’t change what the insurance company has given you in the past. Or change what they have agreed that they will give you in the future.

You can have a closed claim and it doesn’t necessarily mean that you have no rights or benefits. For example, you can have a closed claim and have a right to what’s called maintenance care. Meaning you will still get medical care not to get better but to maintain your condition.

Also, even if you have a closed claim, you’re entitled to money being paid out for your impairment rating. But the amount of that money has been set and won’t change because your claim is closed.

What can close your claim?

1. Final admission of liability

The final admission of liability is a technical document. Once the final admission is filed you have 30 days to do some things, like request a division IME, object, file an application for a hearing, and if you don’t do those things your claim will be closed, and what on the final admission is what you’re going to get.

2. Motion to close

In cases where the injured worker is not going to medical care, they’re not filing an application for a hearing, they’re not doing anything to pursue their rights to get medical care, etc., the insurance company can file a motion to close, and if there’s no objection within a certain amount of time a judge will close the claim.

3. Order agreement

You can agree to close your claim. You can go to a hearing and say you want your claim closed, but you have to be there and a judge has to do it.

4. Legal sanctions

You can have a closed claim for sanctions. For example, if you’re fighting for rights and the insurance company asks you for medical releases but you don’t provide them, and the company goes to a judge and gets an order compelling you to give those medical releases and you still don’t provide them, at some point, a judge could close your claim as a sanction.

5. Settlements

A settlement closes everything, meaning you won’t get more maintenance, you won’t get anything more.

What are your options if you have a closed claim?

1. Petition to reopen

If you can show that your condition has worsened you can go to a judge and ask to reopen the claim. There are some limitations, for example, you can’t reopen a claim when it’s been more than 6 years after the date of injury.

2. Argue deficiency – Lack of notice

You can’t reopen a claim saying it was a mistake that you didn’t object to, in that case, you would have to show that there was an error that was beyond your power to address at the time that had you been diligent you wouldn’t have let your claim close.

For example, you were treating and you get into a car accident and you’re put in a coma for 6 months, and during that time they file a motion to close or a final admission of liability, you’re not in a position to object to it, then you come out of coma and you find out that your claim has been closed, you could reopen it.

You can also even reopen settlements but it’s really difficult, you have to show what’s called a mutual mistake of material fact or you have to show fraud on the other side.