Each year, hundreds of claim petitions are filed by employees for compensable work accidents alleging permanent disability to an injured part of the body. The process is always the same. An employee sustains a compensable accident at work. The employee receives authorized treatment. Both parties obtain permanency reports and negotiate a settlement.
Many employers hope to obtain a settlement pursuant to a Section 20 under N.J.S.A. 34:15-20, especially if the injury is not that serious. Moreover, a Section 20 closes a claim forever. However, some employers must settle their claims pursuant to an Order Approving Settlement (OAS). The OAS not only awards the petitioner for a permanent disability, but allows the petitioner the right to review his or her claim within two years from the date when the injured person last received a payment, hence the term "re-opener" claim.
When the two year mark approaches and just when employers think they are free and clear of the claim, an Application for Modification and/or Review of the Formal Award appears. The employer reluctantly re-opens the claim. The employer is back to where he or she initially started. However, what happens if the employee is no longer employed by the employer? Has the employee found new employment? Have there been any intervening accidents since the initial incident? There is always a chance the employee may have injured himself or herself in a new accident.
These are the questions that need to be addressed when handling a re-opener claim to confirm whether an employer is still liable for compensating the claim. There are several ways to obtain this information. The best source of obtaining it is to send the employee a demand for re-opener interrogatories, which are a series of questions to the employee and a demand for medical records. These questions will help obtain information including new treatment that the employee has undergone since the last award, new accidents sustained, new places of employment and whether the petitioner is receiving benefits such as social security or temporary disability. To further your investigation, a search should be conducted of any new claims that have been filed within the Worker's Compensation Division. An accident index bureau search report will also reveal workers' compensation claims and motor vehicle accidents. These searches will confirm whether the petitioner failed to include information in his/her answers to re-opener interrogatories. Furthermore, a request for the petitioner's primary care physician records can reveal whether the petitioner has been treated for any new injuries.
Taking the time to fully investigate a re-opener claim can make a difference to your client in possibly ending expensive, continued payment of benefits and may open the possibility of a Section 20 settlement.
By: Cheryl Binosa