Is Your Colorado Workers’ Comp Claim Closed? How to Reopen It

Picture this. It’s Tuesday. Nothing special about it. You did everything right. You got hurt at work, but you reported it and you went to the authorized treating doctor and they sent you to physical therapy. You went to all the physical therapy notes. You showed up for every appointment. You lost wages. You had to take time off of work. You let the insurance company know. You got your lost wages. You did all the physical therapy, all the injections. You took all the medications that they prescribed. And then one day, let’s say that Tuesday, you reach into your mailbox, you pull out an envelope from the workers compensation insurance company. Now, it’s not the first time that they’ve sent you an envelope. They’ve been sending you lots of envelopes. And let’s say this uh thing, and it says lots of things. It says admission, maybe a page or two somewhere in there. It says final admission of liability, but there are a lot of pages and there’s a bunch of medical reports in it. and you know it goes with the rest of the mail cuz you’re a busy kind of person and you’ve got life to live, maybe you’re back at work, etc. What you don’t realize is this document is about to close your workers’s compensation claim and it will within 30 days. Not 30 days from when you open it, not 30 days from when you read it, but 30 days from the date they say they mailed it. What does it mean to have a closed claim?

Hi everybody. My name is Britton Morrell and I’m an attorney who helps injured workers in Colorado. I’ve been doing that since 1995. Thank you for spending part of your day with me. So, a lot of people think, “How can I have a closed claim?” There was no phone call. There was no settlement. There was no conversation. I didn’t sign a check. I didn’t sign anything. There is just an envelope in the mailbox and sad to say that’s enough to close your claim.

The burning question in all of our clients minds are the sometimes or most of the time they’re not even clients because there are people who call us see can we help and we find out they have a closed claim and it’s not is they go how is this possible? I never agreed to this. I still have pain. I still can’t do my old job. I still am going to the medical doctor.

What does closed even mean? I’m here to tell you as an attorney who represents injured workers, people exactly like you, and what I can tell you is having a closed claim is the most misunderstood, most consequential, and most dangerous word in the whole workers’s compensation system.

So, today we’re going to take that word apart and we’re going to explain every way a claim can close, including the way it can close without you ever knowing it was happening. and we’re going to tell you what rights you have even if you still have a closed claim and which ones you may have already lost. Now, a lot of injured workers hear the phrase maximum medical improvement (MMI) and believe because their doctor said it or the adjuster said it that their case is closed, that it’s done, it’s over. Maybe the doctor says, “Hey, we’re closing your file here. We’re closing your care.” Let me tell you from a legal point of view, your case isn’t closed. It is not. Not yet. And understanding why is the first step to protecting yourself.

MMI, maximum medical improvement, is a medical determination. Your doctor is saying that in their medical opinion. There are no further treatments, no injections, no physical therapies, no surgeries, nothing more that they can offer you that you’re willing to take that can reasonably expected to improve your condition, to make you better, to help you learn to lift more, move more, move faster. Okay? Not that you’re cured, not that you’re fine, just that you’ve plateaued and you ain’t getting any better.

But MMI is a major milestone in the legal process, not the end of it. Okay? It triggers a clock and it starts a sequence of legal events that can close your claim if you are not careful.

So that leads us to the three main ways your claim can actually close. In Colorado, a worker’s compensation claim can close in three fundamentally different ways. And I need you to understand the differences between them. Okay? Because your rights after closure depend entirely on which path brought you to having a closed claim.

Path one, administrative closure. Your claim closes by operation of law, usually silently because a deadline passed. And that’s the one we were talking about with the MMI and the final mission.

Path two, settlement. you and the insurance company can reach a settlement and where you sign a document and you accept a lump sum and the claim closes by contract.

Path three, a judge’s order. Your case went to a hearing and an administrative law judge ruled that your case is closed. It’s done. You can’t get anything more and that order is now final. Those are three paths, very different destinations. And let’s take a look at them one at a time.

Okay, this is the one that catches people off guard. The one that I see leg destroy legitimate claims, destroy legitimate disputes. It’s the claims where the person genuinely got hurt, generally needed help, they lost everything because of a piece of mail that they didn’t understand, or they set aside, or they meant to deal with it later. After your doctor places you at MMI, the insurance company’s going to file a document with the Colorado Division of Workers Compensation called a final admission of liability. You’ll see it referred to sometimes as an FAL. This document tells you exactly what the insurance company paid and what they’re willing to admit to paying in the future. What your impairment rating is, what permanent benefits they’re acknowledging, whether or not they’re going to admit for maintenance care or not going forward.

And it comes with a clock. You have 30 days, 30 days, calendar days from the date that they mailed it, okay, to file a written objection if you disagree with anything in it. 30 days. If you do nothing, if you set the letter on the kitchen table, meaning to call someone, meaning to call me to see if we can help you, and 30 days go by, the law treats your silence as acceptance and your claim closes automatically as to every issue addressed in that document. No signature needed, no check needs to be cashed, no agreement. The statute, the law simply operates and Colorado courts have been explicit. This is automatic closure and it’s designed to promote the prompt payment of compensation. Okay? So therefore, you’ve got a closed claim and you call us, we’re going to be so sad, we’re going to be sorry. We’re going to look and see if there’s some way out of it. But unfortunately, you’ve got a closed claim.

Now, here’s where it gets worse. The issues closed by a final mission that you didn’t object to are not subject to further investigation. The door has locked. What should you have done? You should have filed a written objection immediately within 30 days. If you disagreed with the impairment rating, if you disagreed with the fact that you’re at MMI, you needed to file what’s uh called a division independent medical examination to challenge the doctor’s rating or you needed to request a hearing. Those are your tools. But if only if you use them in time and so your benefits now, you can have a closed claim and still have right. Okay? And we’re going to talk about that later. There’s a second way your claim can close without your signature, and it’s even more avoidable. If no activity occurs in your case for at least 6 months, you don’t go to a medical appointment, you don’t request a hearing, nothing, the insurance company can file a motion to close your claim for what’s called failure to prosecute. And the division will then issue an order to show cause.

Now, that order says in plain language, hey, you need to tell us why you’re still pursuing this claim. If you are disputing something, you need to file for hearing. If you’re still getting treatment, let us know. But you’ve got 30 days to respond. And if you don’t respond, then your claim is going to close automatically. I’ve seen this happen to real people.

A woman, a housekeeper, filed a claim for a spine injury. And the respondents, the insurance company, and her employer challenged it. They denied it. And she didn’t do anything. She didn’t fight for a hearing. She didn’t apply for a hearing. She just let it stay. And after 6 months, they filed a motion to close. And their she didn’t respond to that. And the judge closed it.

I’ve seen other cases where someone missed two scheduled appointments with their authorized treating physician and the insurance company filed a motion to close. The show cause order went on answer. Done. Case closed. Here’s the lesson.

Workers compensation runs on deadlines. Open every letter. Respond to every order. Do not let the calendar do the insurance company’s work for them. Better yet, get an attorney so that we can make sure that you’re protected. We make sure that you are responding and your case stays open.

Now, I want to talk about another scenario that is in some ways the most painful of all because it involves a work injury, a claim for work injury that was never truly opened or rather a claim that was extinguished before it was even properly filed. In Colorado in general, you’ve got 2 years from the date of your injury or from the date that you knew or should have known that you had an injury that was work related and it was serious to file what’s called a formal workers’s compensation claim. Now, that’s not filling out papers with your employer. That’s not filling out the insurance company’s questionnaire. This is a form you have to send out to the state of Colorado. If you don’t do it within 2 years, there’s something called the statute of limitations.

Now, here’s what makes this particularly cool. There can be a record of your injury everywhere. Your employer reported it. The insurance company was notified. Insurance company even notified the state. Hey, this person says they got injured. And still, if you don’t file a formal claim yourself within those two years, you are barred permanently.

Notice to your employer isn’t enough. Notice to the insurance company isn’t enough. Not even the insurance company’s first report of injury filed with the Division of Workers Compensation in Colorado is enough. You, the worker, you have to file a claim. And if two years pass before you do that, the claim is not just closed, it never existed legally. You can’t reopen something that was never properly open.

This is why if you were hurt at work, even a year ago, and you haven’t formally filed, you need to talk to an attorney today because it doesn’t matter that the insurance company knows. Doesn’t matter that the employer knows. Talk to an attorney today. Not next month. Today.

Now, let’s say your claim did close because a final mission was filed and you didn’t object to it or you failed to prosecute for closure. You didn’t settle. Okay? It’s not through a judge’s order. It’s just administrative closure because the deadline passed. Are you finished? No, not necessarily.

For example, you could have what I call a closed but with rights claim. Understanding that may be the most important thing that you can take from this video.

Number one is if you were placed at max medical improvement with or without an impairment rating and your treating doctor said, “Hey, this person needs maintenance care.” The final admission of liability should include an admission for maintenance care. And the law says that if your doctor recommends it and there’s no contrary medical opinion in the record, the employer has to admit for it. And so you have a right to ongoing future maintenance medical care even though your claim is closed. Okay, that maintenance care obligation survive.

Now maintenance care, what’s the difference maintenance care versus other kind of care? Before MMI, the care was meant to get you better. After MMI, maintenance care is to help you manage the condition. Okay? It could involve regular visits to your treating physician. It could include medications, injections, physical therapy. I’ve even seen it include surgery. Okay? So, even if you have a closed claim, you may still have rights to maintenance care.

Now, there’s one important thing that you need to understand. Just because the insurance company admits that you have a right to maintenance care doesn’t mean that the insurance company has to give you whatever you want. Doesn’t even mean that the insurance company has to give you everything that the doctor says that you need for maintenance care. So, they can always challenge a particular recommendation, but at least you have the right to it without trying to reopen the case.

Second right that you have with a closed claim is you have a right to reopen. And this is another powerful tool. If you’ve got a final admission that you didn’t object to, etc. Under 843 303 of the Colorado Revised Statutes at any time within 6 years of the date of injury, an administrative law judge can reopen your claim on the grounds of fraud, overpayment, error, mistake, or most commonly a change of condition.

tNow the error can’t be oops I forgot to object to the final mission. That was the error. No, sorry. Error means something that wasn’t really apparent or should would not have been apparent at the time of the final mission or MMI. But at any point if you show that your condition naturally worsened, okay, then you can ask to reopen your claim. Now reopening is difficult, okay? Because to prove a change of condition, you typically have to show that your physical or mental condition as it related to the work injury genuinely worsened since the claim closed. If your knee was bad at MMI and you’re saying my knee is still bad, that’s not a change of condition. Okay? But if your knee was bad at MMI but didn’t need surgery and now you do need surgery, that’s a change of condition that you can try to reopen your case.

I had a client with a knee injury. Case closed after MMI when the maintenance injections seemed to be holding things together. But years later, the injection stopped providing relief and his surgeons recommended a total knee replacement. So, we filed a petition to reopen and the judge granted it and the surgery was authorized and the client then is entitled to more additional lost wages because of the surgery.

But I’ve also seen petitions denied where judges conclude the worsening was not the natural progression. It was due to a new condition, new work, not the industrial injury. Sometimes they’ll say it’s it’s it’s really due to age, right? You’re just a lot older now. So, you’re going to need medical evidence from a doctor showing the deterioration is causally connected to the original work injury, not just due to time, not just due to age. Two things to remember about opening. It’s not automatic. you’ve got to go to a judge. Okay? Sometimes insurance companies will voluntarily reopen the claim. Often they don’t.

Number two, the clock is running. You’ve got 6 years from the date of injury or 2 years from the date that last monetary benefits came to you or due. But just know your rights, but more importantly, talk with an attorney. Now, we’re going to draw a sharp line. Everything I just described, maintenance, care, right to reopen, the possibility of a second chance only applies to cases that were closed administratively through a final mission, failure to prosecute. Okay, some deadline passed. But there is a different category entirely when claims are closed forever and the difference is in settlement.

If you sign a settlement, that is a permanent trade. When you sign a full and final settlement in Colorado, you are entering into a binding contract where the insurance company’s going to pay you money and you are not going to bother them again. Is it possible to reopen settlements? It is. But it’s very challenging. You’ve got to show a lot of interesting and different stuff which I won’t get into in this video. But even if you get worse, even if you discover, oops, I need more medical care than I want. sorry, you’re not going to be able to reopen the case or get additional benefits. You’re waving, giving up your right forever to claim anything further.

There’s another way that a claim can close where you’re not going to get anything. And that’s after you’ve gone to a hearing and a judge says, “Hey, you’re not entitled to anything more. You’re not entitled to any further medical care.” Sometimes a judge can even say, “I’m allowing the insurance company to withdraw their admission that there was never an injury.” and you lose an appeal and the order is final, then that claim is dead and you’re never going to get anything from it.

Here’s what I want you to walk away with. Closed does not always mean the same thing. A claim closed because you didn’t respond to a final mission in time, that’s painful. That’s annoying, but it’s potentially fixable. You still have tools. You still have a right to maintenance care perhaps if it’s admitted in the final mission. You have the right to reopen. Get an attorney and find out where you stand.

A claim closed because you didn’t file a claim or an application for hearing within 2 years of date of injury. That is harder problem. You can talk to an attorney, don’t wait another week. Don’t let those two years and don’t think it’s necessarily two years from the injury. It could be two years from the date that you knew or should have known it was work injury.

If your claim is closed because you signed a settlement agreement, then you only get out of it if you can prove fraud or mutual mistake of material fact. Those are very difficult.

Do not settle a claim without talking to an attorney.

And then finally, a claim closed by a judge’s final order. That’s the end of the road. You may have other options, but that claim is finished. The through line in all of this is time.

The system runs on deadlines. The insurance company knows every single one of them. Their adjusters are trained on them. Their attorneys live by them. The question is whether you know them, too. You don’t. You should not be navigating this alone.

Not because you aren’t smart or intelligent. You clearly are. You’re here. You’re asking the right questions. You probably do your job better than most people doing it. But you haven’t trained on this because this system was not designed to be navigated by someone who also has to heal from an injury or worry about their family or figure out how to pay their rent.

That’s what we’re here for. If you’ve received a final admission, if you’ve been told you’re at max medical improvement, you aren’t sure what to do, call us. If someone told you your claim is closed and you don’t understand why, call us.

If you’re considering a settlement offer, call us before you sign. Stay safe, know your rights, and thank you for spending part of your day with me.

Here is the cleaned-up transcript with formatting fixes, standardized paragraph spacing, and grammatical flow cleanup:

One really confusing and concerning thing that happens to injured workers is when they are told by somebody—it’s always somebody—that their workers’ compensation claim is closed. Well, is it? And if so, what are your options?

Hello everyone, I’m Britton Morrell with Kaplan Morrell. We are a law firm that’s been helping injured and disabled workers get the benefits that they deserve since 1997. If this video has been helpful to you, would you please hit like and subscribe? If you’ve got questions or comments, do so below. We’d love to have you be part of our online community. With that, let me dive into it.

Today, I’m going to discuss three things:

1. When people say your claim is closed, but it isn’t
2. What having a closed claim really means
3. What can actually close your claim

So with that, let me talk about it. If you stick to the end, I’m going to talk to you about your options to reopen your claim if you do have a closed claim.

When people say your claim is closed, often times it’s misunderstood. Doctors are saying it’s closed, adjusters are saying it’s closed, employers are saying it’s closed, but that doesn’t mean your claim is actually closed. What having a closed claim means is that you can’t change what the insurance company has given you or what they have agreed that they will give you.

Now, why then do people say it’s closed? Well, because they’re thinking from their point of view. A really common thing is a doctor or physical therapist will say your claim is closed, meaning, “We’re not going to give you any more benefits, we’re done treating you, our file is closed.” But that doesn’t mean your claim is legally closed. Sometimes employers or adjusters will say your claim is closed, and it’s really not—either because they’re confused, or in the case of adjusters, they’re just trying to get you confused. They think it’s closed, but they haven’t done what’s necessary to close it.

What, in actuality, does having a closed claim mean? A closed claim means that you don’t have a right to change what the insurance company has paid you in the past, and you don’t have a right to change what they’re going to pay you in the future. So, 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 still have a right to what’s called maintenance care. How much maintenance care will you get? I don’t know, they don’t know, the doctors don’t know. But you’re entitled to maintenance care, which means that you can go back to the doctor and continue to get medical care—not for the purposes of getting better, but for maintaining your condition and not worsening it. You’re also entitled, even if you have a closed claim, to money being paid out for your impairment rating. However, the amount of that money that has been set isn’t going to change, because you have a closed claim.

So what can close your claim? There are really only four to five things that can close your claim:

First is what’s called a Final Admission of Liability. A Final Admission of Liability is a really technical document. It’s written in English, and it does have big bold notices like, “This is an important legal document which may affect your rights,” etc. But most people, when they see it, don’t understand what it is. The bottom line is that once that final admission is filed, you have 30 days to do a lot of things: request a division IME, object, file an application for hearing, etc. If you don’t do those things, then your claim is closed, and what’s on the final admission is what you’re going to get.

The second way claims can close is through a Motion to Close. This means the insurance company says, “Look, this person has fallen off the face of the Earth. They aren’t going to medical care, they aren’t doing anything, they’re not filing an application for hearing, they’re not doing anything to pursue their rights to get medical care.” In those cases, the insurance company can file a Motion to Close. If you don’t object to it within a certain amount of time, a judge will order the case closed. But again, there has to be something in writing sent to you—which is a really important reason why you have to keep your address up to date. More importantly, you should just hire a lawyer, because none of our clients get their claims closed from a Motion to Close; we know what to do with them.

Third, you can agree to close your claim. You can go to court, go to a hearing, and say, “Hey, I want my claim closed.” But again, you have to be there and a judge has to order it.

Fourth, you can have a claim closed as a sanction. For example, if you’re fighting for rights and the insurance company asks you for medical releases and you don’t provide them, the insurance company can go to a judge to get an order compelling you to give those releases. If you still refuse to give them, a judge could, as a sanction, close your claim. But again, you would have had plenty of notice.

Fifth, you can close your claim by a settlement. A settlement closes everything. It means you’re not going to get any more maintenance care, you’re not going to get anything more—a settlement fully closes a claim.

Those are the five ways a claim can close. Even if you have a closed claim, you may still have some rights, like maintenance care. You also have a right to try to reopen your claim. Closing a claim involves you getting a piece of paper, and sometimes it doesn’t require you to actually physically receive it—as long as they’ve mailed it to your address of record on file, your claim can close if you do nothing.

So if you’ve got a closed claim, what are your options? You’ve got pretty much only two:

Number one is you can file what’s called a Petition to Reopen your claim. If you can show that there was a mistake, or you can show that your condition has worsened, you can go to a judge and ask to reopen the claim. There are some limitations on that. For example, you can’t reopen a claim when it’s been more than 6 years after the date of injury. You can’t reopen a claim simply by saying, “Well, I forgot,” or “It was a mistake that I didn’t object to the final admission.” If you’re going to argue mistake, you’ve got to show that it was an error beyond your power to address or correct at the time, and that had you been diligent, you wouldn’t have let your claim close.

If it’s something way outside of your control—for instance, if you were receiving treatment, got into a car accident, and were put in a coma for 6 months, and during those 6 months they filed a Motion to Close or a Final Admission of Liability—you’re obviously not in a position to object to it. Once you come out of the coma and find out your case was closed, you could reopen it due to a definite lack of notice.

You can 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. Those are very difficult things to prove, though it has been done. It’s definitely complicated, and you would need a lawyer.

Hopefully this video helps you understand what having a closed claim means. A closed claim means that there is something at the Division of Workers’ Compensation which sets in stone what the insurance company paid for you in the past and what they may have to pay for you in the future, and it can’t change unless you reopen the claim. But even if you have a closed claim, there is a way to reopen it.

If you or a member of your family has been injured on the job with a work injury in Colorado, please get in touch with us. We help our clients on what’s called a contingent fee basis, which means we don’t get paid unless we’re successful in getting our clients what they deserve. Please call us, text us, or visit our website. Our initial consultations are free and confidential, and we will give you peace of mind when you know your rights. With that, thank you for spending part of your day with me. Bye.