Get documents about "Table 2 COMPARISON OF STATE'S CLAIM CLOSURE, REOPEN AND
Document Sample
LMAC 12/14/09
Claim Closure
Table 2: COMPARISON OF STATE'S CLAIM CLOSURE, REOPEN AND SETTLEMENT PROVISIONS - 2009
CLAIM CLOSURE SETTLEMENTS MUST
OREGON
STATUTE OF WITH CLOSED INCLUDE
STATE REOPENING PROVISIONS APPROVAL CRITERIA APPROVER RANKING
LIMITATIONS ON MEDICAL MEDICARE'S
2008
BENEFITS AVAILABLE? INTEREST
A claim may not be re-opened because of a worsened condition
if settlement has been approved by a judge; Settlements may
be set aside for fraud, undue influence, or coercion, provided
2 yrs from date of last
application is made therefor within six months of the settlement;
compensation paid, doa or Circuit Court or Benefit
ALABAMA OD (they do not use date
if the employee has settled his claim based on a physical Yes Best interest of Employee
Review Conference
Yes 9
impairment, and then loses his job (except for certain specified
of last payment of medical)
reasons) he or she can then petition the court within two years
thereof for reconsideration of his or her permanent partial
disability rating (within 300 weeks from the injury).
4 yrs doa or 2 yrs last Before one year after date of last payment may reopen due to Change of condition, or because of a mistake in a
ALASKA payment of comp change of condition or mistake of fact
Yes but not favored
determination of fact
Work Comp Board Yes 1
Medical evidence which establishes to a reasonable medical
ARIZONA None for reopenings probability that the industrial injury caused or contributed to a Yes Genuine Dispute ALJ Yes 45
new, additional or previously undiscovered condition
2 yrs doi or 1yr from last
A change of physical condition or proof of an assignment of an
ARKANSAS payment of comp,
erroneous wage rate.
Yes Best interest of Employee Commission Yes 47
whichever is greater
Ordinary Benefits = 1 yr
from doi, date of last
indemnity payment, or date
of last furnishing of any
medical benefit; New & Must establish good cause for reopening within 5 years from Adequacy of all compromise and release Work Comp Appeals
CALIFORNIA Further Disability Benefits date of injury
Yes
agreements Borad
Yes 14
= 5 yrs from doi; Award = 5
years from date of injury to
file petition to rescind, alter,
or amend prior award.
A claim may be re-opened at any time within six years of the
injury on the grounds of fraud, overpayment, error, mistake, or
change in condition, unless the employee has entered into a
settlement in which he or she has waived the right to re-open;
Insurer gives notice of final however, a
payment of comp and if not settlement may be reopened at any time on the ground of fraud
COLORADO contested case is or mutual mistake of material fact. At any time within two years
Yes Pro Se settlements are strictly scrutinized Division of Work Comp Yes 43
automatically closed after the payment ofthe last temporary or permanent disability
benefit, the Division may re-open the claim for fraud,
overpayment, error, mistake, or change of condition, unless the
employee has entered into a settlement in which he or she has
waived the right to re-open.
Page 1
LMAC 12/14/09
Claim Closure
CLAIM CLOSURE SETTLEMENTS MUST
OREGON
STATUTE OF WITH CLOSED INCLUDE
STATE REOPENING PROVISIONS APPROVAL CRITERIA APPROVER RANKING
LIMITATIONS ON MEDICAL MEDICARE'S
2008
BENEFITS AVAILABLE? INTEREST
The commissioners may modify both awards and voluntary
There is a one-year
agreements whenever it appears "that the incapacity of an The incapacity of an injured employee has
limitations period for
injured employee has increased, decreased or ceased, or that increased, decreased or ceased, or that the
traumatic, single event; For
the measure of the dependency on account of which the measure of the dependency on account of which
death cases, it is two years
compensation is paid has changed, or that changed conditions the compensation is paid has changed, or that Hearing by a
CONNECTICUT from the date of accident or
of fact have arisen which necessitate a change of such
Yes
changed conditions of fact have arisen which Commissioner
Yes 20
onset of symptoms of the
agreement or award in order to properly carry out the spirit. No necessitate a change of such agreement or
occupational disease, or
modification is allowed if the employee has agreed to, and the award in order to properly carry out the spirit of
one year from date of
commissioner has approved, a "final" settlement known as a the Act.
death, whichever is later.
"stipulation."
Rarely, medicals
5 yrs from the last payment
must stay open as a
of comp. Payment of a Industrial Accident
DELAWARE medical bill may extend the
condition of approval Not applicable
Board
Yes 8
of any commutation
statute of limitations.
of benefits.
Claims for modification of orders must be made within 2 years
2 yrs from doi; Payment of after the date of the last payment of compensation pursuant to
Pro Se - best interest of claimant; Represented -
any med or indemnity tolls any order or within 2 years after the date copies of an order Judge of Compensation
FLORIDA the limitations period for 1 rejecting a claim are mailed. A claim for modification can only be
Yes claimant may waive all rights to any and all
Claims
Yes 28
benefits
yr from date of payment made if there is a change in the employee’s condition or when
there is a mistake in the judge’s determination of the facts
1 yr of last remedial The time for the filing of a claim for a change in condition is
treatment or 2 yrs after the generally two years from the last payment of income benefits,
GEORGIA date of last payment of though this period may be tolled if there are any
Yes Disputed benefits only The Board Yes 25
weekly benefits benefits outstanding which have not been paid.
With a showing of substantial evidence, on The Director periodically sets an informal
the ground of a change in or mistake in a determination of fact minimum amount required to obtain No - settlement
related to the physical complete waivers of an employee’s re-opening amounts may be
HAWAII 5 yrs from the doa
condition of the injured employee, a case may be reopened
Yes
rights. The amounts are presently $9,000 for
Director
recovered by
36
within eight years after the date waiver of future medicals and $6,000 for waiver of Medicare Liens
of the last payment of compensation. future indemnity benefits.
Standard
1 yr from date of last No - settlement
claims may be re-opened and modified within five (5) years of
payment of income Commission and its amounts may be
IDAHO benefits; Does not affect
the injury, or first manifestation of exposure if there is a change Yes Change in condition or disablement
staff recovered by
34
in condition or disablement, but not more often than once in six
right to medical benefits Medicare Liens
(6) months.
Page 2
LMAC 12/14/09
Claim Closure
CLAIM CLOSURE SETTLEMENTS MUST
OREGON
STATUTE OF WITH CLOSED INCLUDE
STATE REOPENING PROVISIONS APPROVAL CRITERIA APPROVER RANKING
LIMITATIONS ON MEDICAL MEDICARE'S
2008
BENEFITS AVAILABLE? INTEREST
If no comp paid, 3 yrs from Any claim that is settled by a lump sum settlement contract
Settlement by a lump sum settlement contract
doa or 2 yrs after date of cannot be re-opened except Arbitrator or
ILLINOIS last payment of comp for fraud; Within 18 months of award if disability recurred,
Yes closes out medical treatment unless otherwise
Commissioner
Yes 11
provided
whichever is later increased diminished or ended
After TTD ends and a PPI
has been adjudicated, An application by either party, or a modification by the board on
additional medical benefits its own motion, must be done within two (2) years from the last
INDIANA may be paid or awarded by day compensation was paid under the original award, except Yes Must be accordance with rights of parties Member of the Board Yes 50
the Board as is necessary that for PPI within one (1) year from the last day compensation
to limit or reduce the was paid.
t d t t f th
If no weekly benefits paid,
2 yrs from doi If weekly A review re-opening proceeding may be initiated Work Comp
IOWA benefits paid, 3 yrs from within three years of the last payment.
Yes Conform to provisions of law
Commissioner
Yes 41
last payment
Later of 3 yrs from doa or 2 An award may be modified at any time before disability ends, or
Generally, settlements close future medicals -
KANSAS yrs from last payment of before final payment, by means of an application for review and Yes
hearing before ALJ
Director of Work Comp Yes 42
comp modification by the Director
2 yrs from doi or from last Administrative Law Judge's will review these
TTD payment whichever is settlements closely and often request additional
later; Requires notice to Within 4 yrs of original award or change of disability, mistake, documentation or testimony verifying that the
KENTUCKY employee of statute of fraud or new evidence
Yes
Plaintiff understands what he/she is doing and
ALJ Yes 8
limitations in cases where has another source of income to pay for any
payments have been made future medical expenses should they arise.
No provision in the
1 yr from doa or 1 yr from Subject to Court's discretion; Generally recognized as 1 yr from
LOUISIANA last payment date of last payment; basis is a change in condition
Act, but they are Best interest of parties Hearing Officer Yes 12
allowed
In a lump sum settlement that releases the
Employer from liability for future medical
expenses, the Board can approve the
2 yrs after doi or 6 yrs after
Up to 6 yrs from date of last payment for recurring or worsened settlement only if it finds that the parties would Hearing before Work
MAINE most recent payment of
condition
Yes
have been unlikely to reach agreement on Comp Board
Yes 6
benefits
the amount of the lump sum settlement without
the release of those medical expenses.
Such approval is routinely given.
Commission has power to reopen within 5 yrs of last indemnity
No-Medicare
payment; The Commission retains power and jurisdiction to Work Comp
MARYLAND NO-ONLY FILING LIMITS
readjust compensation for aggravation,
Yes Only upon a hearing
Commission
would enforce 44
their lien
diminution or termination of disability.
Page 3
LMAC 12/14/09
Claim Closure
CLAIM CLOSURE SETTLEMENTS MUST
OREGON
STATUTE OF WITH CLOSED INCLUDE
STATE REOPENING PROVISIONS APPROVAL CRITERIA APPROVER RANKING
LIMITATIONS ON MEDICAL MEDICARE'S
2008
BENEFITS AVAILABLE? INTEREST
If employee has "suffered a substantial deterioration of his
medical condition which (i) could not reasonably have been
foreseen at the time said agreement was entered
Conciliator, Adm Judge
MASSACHUSETTS NO-ONLY FILING LIMITS into, and (ii) is the result of an injury for which the insurer would Yes Disputed Medical Only
or ALJ
Yes 49
have been liable"; Must be filed within one year of when the
employee first became aware of the causal relationship between
the deterioration and his employment.
Retroactive payment of
A redemption settlement usually terminates all
MICHIGAN benefits limited by the one Reopening if not barred by res judicata Yes
benefits
Magistrate Yes 32
and two year back rules
Can be re-opened by a Judge of Compensation Claims for: (1) a
mutual mistake of fact; (2) newly discovered evidence; (3) fraud;
Commissioner, Comp
or (4) a substantial change in Parties to settlement have burden of proving
Judge, Court of Appeals
MINNESOTA NO-ONLY FILING LIMITS medical condition since the time of the award that was clearly Yes settlement is reasonable, fair and in conformity
District Court exercise
Yes 24
not anticipated and could not reasonably have been anticipated with the Act
discretion
at the time of the award. There is no statute of limitations for re-
opening a claim.
2 yrs if no indemnity paid or Unrepresented claimants are required to be
MISSISSIPPI 1 yr after last payment of Within 1 yr after closure if a change in condition Yes personally interviewed by a Commissioner or ALJ Commission Yes 24
indemnity prior to approval
2 yrs from doa or date of "At any time" restricted by case law to mean before expiration
last payment (for medical & of the payment of the award. May be reactivated for life-
Requires the
TTD) If emplr failed to file threatening surgery or replacement of prosthetic device; a
employee to sign that he understands that he will
MISSOURI FROI, then 3 yrs from doa; medical claim can be reactivated if the claimant can show good Yes
not receive any more medical treatment for
ALJ Yes 28
OD starts to run when cause and the claim is for payment of medical procedures
this injury because of the settlement
disease is reasonably involving life-threatening surgery or replacement of a
apparent prosthetic device.
Settled claims may be reopened upon a
showing of mutual mistake of material fact in entering into the
Medical benefits close if settlement agreement. The statute of limitations for alleged
MONTANA not used within 60 mistake is 2 years from date of discovery of the mistake. A Yes Only disputed medicals ERD Yes 2
consecutive months worker or an insurer may petition the Workers’ Compensation
Court for a change in disability status if medical conditions
underlying the disability have changed.
2 yrs from doa or if comp
paid, then 2 yrs of last
payment ; The statute of
limitations will not be a
NEBRASKA defense to claims for Within 2 yrs of knowledge of change of condition Yes Best interest of the parties Workers' Comp Court Yes 32
payment of medical bills
even though more than two
years passed without the
payment of benefits
Page 4
LMAC 12/14/09
Claim Closure
CLAIM CLOSURE SETTLEMENTS MUST
OREGON
STATUTE OF WITH CLOSED INCLUDE
STATE REOPENING PROVISIONS APPROVAL CRITERIA APPROVER RANKING
LIMITATIONS ON MEDICAL MEDICARE'S
2008
BENEFITS AVAILABLE? INTEREST
Application to reopen must be filed wihtin 1 year after the date
the claim was closed if: (a) the claimant was not off work as a
result of the injury; and (b) the claimant did not receive benefits
for a permanent partial disability. If an application to reopen is
filed more than 1 year after the date on which the claim was
No - statute of limitations
closed, the insurer shall reopen the claim if: (a) a change of Only allows lump sum settlements in lieu of voc
NEVADA only applies to initial filing
circumstances warrants an increase or rearrangement of
No
rehab, death, or ppd
No Yes 18
of the claim
compensation during the life of the claimant; (b) the primary
cause of the change is the injury for which the claim was
originally made; and (c) the application is accompanied by the
certificate of a physician or chiropractor showing a change of
circumstances
4 yrs from cessation of
If the Petition is filed more than four years from the last payment
indemnity benefits Causally
NEW HAMPSHIRE related medical bills are
of indemnity benefits, only medical bills can be re-opened. No Causally related meds may not be settled Labor Department No 5
Causally related medical bills are compensable for life.
lifetime
2 yrs doi, 2 yrs of failure to
receive payment in
accordance with an Basis that
Within 2 yrs of the date of last payment of compensation;
NEW JERSEY agreement, or 2 yrs after
Settlement agreements bar reopenings
Yes the settlement is fair and just under all the Division of Work Comp Yes 16
the last payment of comp circumstances.
or date of medical
treatment
The employee must show an increased disability, and the
NO-ONLY FILING LIMITS;
employee can move to re-open
There is no statute of New Mexico has taken the position that medicals
NEW MEXICO limitations on medical
only every six months. A case can be reopened even if there No
cannot be settled unless they are in dispute
Work Comp Adm Judge No 32
was a settlement if there has
claims
been a worsening of the condition.
A claim can be re-opened because of a worsening of a condition
that is not anticipated at the time of final determination by the
Workers' Compensation Board. The re-opening requires a
All Full & Final Settlements close medical. Board
statement (Form C-27) by a physician that the condition has Workers Compenation
NEW YORK NO-ONLY FILING LIMITS
worsened and was
Yes considers both need for further med care and
Board
Unknown 19
clmt's ability for self-support
not otherwise previously anticipated. The period within which a
claim can be re-opened is seven years from the date of accident
or death.
Page 5
LMAC 12/14/09
Claim Closure
CLAIM CLOSURE SETTLEMENTS MUST
OREGON
STATUTE OF WITH CLOSED INCLUDE
STATE REOPENING PROVISIONS APPROVAL CRITERIA APPROVER RANKING
LIMITATIONS ON MEDICAL MEDICARE'S
2008
BENEFITS AVAILABLE? INTEREST
2 yrs doa or 2 yrs after last
payment of med comp
when no other comp has
been paid Med treatment
terminates 2 yrs after last Within 2 yrs of last payment due to change in condition. In Change in conditions, which means a substantial
NORTH CAROLINA payment of med expenses cases where only medical benefits were paid, no reopening after Yes change of the employee's physical capacity to Industrial Commission No 22
or disability comp unless 12 months from date of last payment for medical treatment earn wages.
prior to expiration
Commission approves
additional medical
treatment
Workforce Safety &
There is no appeal from the State Fund's determination not to
NORTH DAKOTA NO-ONLY FILING LIMITS
reopen a claim
Yes Discretion of State Fund Insurance Organization Yes 51
(State Fund)
For injuries occurring before October 10, 2006, no
modifications, changes, findings, or awards shall be made with
respect to disability, compensation, dependency, or benefits
after six years from the date of injury in the absence of the May be disapproved if deemed clearly unfair or
OHIO NO-ONLY FILING LIMITS
payment of
Yes
gross mis-carriage of justice
Industrial Commission Yes 3
medical benefits. For injuries occurring on or after October 10,
2006, no such modifications shall be made after five years from
the date of injury.
The jurisdiction of the court to re-open any case upon an
application based on a change of condition extends for that
period of time measured by the maximum number of weeks that
could be awarded for the particular member where the change
2 yrs doa or 2 yrs last
of condition occurred, or for 300 weeks in the case of injuries to
payment of comp or last
OKLAHOMA payment for authorized
the body, and are barred unless filed within said period of time Yes Identify issues in dispute and issues in agreement Workers' Comp Court Yes 10
after the date of the last order. The jurisdiction of the Court to
medical treatment
reopen any cause upon an application based upon a change in
condition for the worse shall extend for three years from the
date of the last order, and unless filed within said period of time,
shall be forever barred.
After the last award or arrangement of compensation, an injured
worker is entitled to additional compensation for worsened
conditions resulting from the original injury. A claim for additional
5 yrs doi or 5 yrs after first
compensation, also known as an “aggravation claim,” must be
OREGON determination or first notice
filed within five years after the first notice of closure of the claim
No May settle all matters, except medical The Board Yes 39
or order of closure
for a disabling claim, or after the date of injury provided the
claim has been classified as non-disabling for at least one year
after the date of acceptance.
Page 6
LMAC 12/14/09
Claim Closure
CLAIM CLOSURE SETTLEMENTS MUST
OREGON
STATUTE OF WITH CLOSED INCLUDE
STATE REOPENING PROVISIONS APPROVAL CRITERIA APPROVER RANKING
LIMITATIONS ON MEDICAL MEDICARE'S
2008
BENEFITS AVAILABLE? INTEREST
The Pennsylvania Workers' Compensation Act permits
resumption of benefits where benefits have been suspended or
terminated provided there is: (1) recurrence of disability after full
The Compromise and Release Agreement
recovery; (2) recurrence of disability after return to pre-injury job
requires a vocational rehabilitation evaluation of
with residual disability; (3) recurrence of disability after return to
the employee which may be waived by the parties
3 yrs doi or 3 yrs last modified work with residual disability; or (4) recurrence of Work Comp Judge after
PENNSYLVANIA payment of compensation disability after commutation.Petitions to Reinstate
Yes and particular emphasis must be given by the
an open hearing
Yes 15
workers' compensation judge to
Compensation Benefits following a termination of workers'
the complete understanding and acknowledgment
compensation benefits must be filed within three years of the
of the agreement by the employee.
last date of payment of compensation. A compromise and
release agreement can be set aside upon a clear showing of
fraud, deception, duress or mutual mistake.
10 yrs after date of final All settlements are final w/meds closed as of date
RHODE ISLAND payment
Within 10 yrs from award Yes
of approval
Work Comp Court Yes 26
Effective July 1, 2007, the change of condition statute was
amended to require that awards
for a change of condition be based on “proof by a
preponderance of the evidence that there Amount of comp and time and manner of
2 yrs doa or 1 yr from date has been a change of condition caused by the original injury, payments comply with Act. Full & final release of Work Comp
SOUTH CAROLINA of last payment of comp after the last payment of
Yes
all benefits requires in-person approval by Commission
Yes 13
compensation.”;No such review shall affect such award as Commission for unrepresented claimants.
regards any monies paid and no such review shall be made
after twelve months from the date of the last payment of
compensation pursuant to an award.
Review based on a change in condition; The Department of
Labor can then end, diminish, or increase amounts if it finds that
7 yrs for right of comp if no
a change in condition warrants such action. The "change of
med treatment has been Emplr can't be
condition" must be physical; an economic change is insufficient.
SOUTH DAKOTA obtained or 3 yrs from last
The change of condition must be causually connected to the
Yes Disputed only Dept of Labor relieved of any 36
payment of benefits for all obligation
original complaint of injury and must have been unforeseeable
benefits
at the time of settlement. There is no statute of limitations for re-
opening claims.
1 yr from doa or 1 yr from May not close future meds until 3 yrs from date of
date of last comp payment May be reopened under certain conditions - no time frame settlement Then may petition to close future meds Adm Body, Work Comp
TENNESSEE or last authorized med provided
Yes
Scheduled injury of less than 200 weeks, may Specialist, or Court
Yes 21
treatment close future meds PTD cannot close meds
The Act allows
consideration of new evidence if the court finds that there has Carrier not
TEXAS NO-ONLY FILING LIMITS
been a substantial change of
No May only settle income benefits Division
relieved for meds
17
condition based on certain specified circumstances.
Page 7
LMAC 12/14/09
Claim Closure
CLAIM CLOSURE SETTLEMENTS MUST
OREGON
STATUTE OF WITH CLOSED INCLUDE
STATE REOPENING PROVISIONS APPROVAL CRITERIA APPROVER RANKING
LIMITATIONS ON MEDICAL MEDICARE'S
2008
BENEFITS AVAILABLE? INTEREST
For injury dates prior to April 30, 2007 that do not involve
permanent total disability or prosthetic devices, the employee’s
medical treatment benefit ceases if no medical expenses are
incurred and submitted for payment for a period of three Such settlements are only available when
6 yrs from doa or 3 yrs
consecutive years. For injuries that occur on or after April 30, compensability is disputed, or when the
UTAH from doa if no meds on non
2007, the employee is entitled to be compensated for a medical
Yes
settlement is a commutation of reasonable future
Labor Commission Yes 46
PTD
expense if the expense is submitted within one year from the benefit entitlements.
later of the day on which the expense was incurred, or the day
on which the employee knew or should have known that the
medical expense is related to the industrial accident.
Limited circumstances and best interest of
VERMONT NO-ONLY FILING LIMITS May reopen if brought within 6 yrs of award Yes
claimant
Commissioner Yes 4
An employee has the greater of twenty-four months from the
last day in which indemnity
benefits were paid or thirty-six months from the day in which
benefits were paid pursuant toa permanent partial disability, to
VIRGINIA NO-ONLY FILING LIMITS
seek re-opening a claim for worsening condition. After the lapse
Yes Best interest of the employee Commission Yes 48
of the applicable twenty-four or thirty-six month time period,
indemnity benefits shall be barred while lifetime medical benefits
will continue.
An employee can apply for reopening of the claim for additional
compensation within seven years (ten years for eye injuries)
from the date the first closing order based on medical advice,
recommendation or examination becomes final. In every case
WASHINGTON NO-ONLY FILING LIMITS
the employee must show, by a comparison of objective medical
No Department No 38
findings, that
his or her causally-related condition worsened between the time
of last closure and date the application is acted upon
Generally, within 5 yrs of closure - claimant must demonstrate
The parties are permitted to settle medical
that there has been an aggravation or progression of his or her Agreement by the
WEST VIRGINIA NO-ONLY FILING LIMITS
condition or the existence of a previously unconsidered material
Yes benefits in all claims, except for
parties
Yes 41
nonorthopedic occupational disease claims.
fact
Twelve years from the date of injury or last payment of
12 yrs doi or last payment
indemnity, whichever is later. All claims are open, unless
of indemnity whichever is Dept of Workforce
specifically closed by compromise, for the length of the
WISCONSIN later Some specific OD's
applicable limitation period. In those cases where a “final order”
Yes Valid dispute between the parties Development Work Yes 34
and injuries have no statute Comp Division
has been obtained after a hearing, only medical expense claims
of limitations
remain open.
A claim for increase or modification of benefits must be made
1yr doa or 4yrs from last within four years from thedate of the last payment of benefits an Considered best practice to have closed med Recommended but not
WYOMING payment of benefits dmust be based on the ground of increase or decrease
Yes
settlements approved by ALJ but not required required
Yes 37
ofincapacity due solely to the injury, or for mistake or fraud.
Sources: 2009 Edition of Workers' Compensation Law by ALFA International (Questions 7,27 and 48)
Oregon Workers' Compensation Premium Rates, 2008
Page 8
Related docs
