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What is a Re-Opener in a Workers’ Compensation Claim?

Workers’ compensation attorney Scott Schulman explains the two types of workers’ compensation settlements, what a re-opener is and how to file a re-opener.

Video Transcript:

Petrillo: Final area I wanted to discuss with you. You’re all done, you’ve got your medical benefits, perhaps you filed a motion to get more medical benefits, the temporary disability benefits are paid, the partial total award is granted and approved by the judge, which I understand every award has to be approved in worker’s comp by the judge. Now, after all that occurs, the worker still has surviving rights., Doesn’t he?

Schulman: Yes.

Petrillo: Or she.

Schulman: Yes.

Petrillo: What are they? The term I’ve heard many times is the re-opener. What is that?

Schulman: That’s correct. There’s two different types of settlements in workers comp court. There’s one settlement that is generally used for disputed cases, called a section 20 settlement. And with that settlement, you get a lump sum of money. Both sides agree that there’s difficulties in pursuing your case and the insurance company doesn’t want to fight the case to a trial, because even though they may be successful in limiting the value of your case, they know that they’re still going to end up paying something. They will pay a lump sum of money. And when you get that type of settlement, that forecloses any further rights that you may have against the insurance company or the employer. Your case will be forever closed at that point.

The other type of settlement, which is called an order approving settlement, and we always strive to get that for the injured worker. And what that does with that settlement, you will get your permanent disability benefits, your money, and it will also keep open your case for your re-opener benefits.

Petrillo: How long?

Schulman: That is for two years from the time you get your last benefit.

Petrillo: Two years.

Schulman: Yes. Now, the time you get your last benefit, which means when you get your check you have additional two years. That brings up some other terms of art that we use.

Petrillo: From your last check. In other words, sometimes the settlements are such that the monies continue to get paid out after you go to court.

Schulman: Depending on the level of your disability, yes. You may be in court-

Petrillo: You have two years from the last date of payment to file a re-opener.

Schulman: Yes.

Petrillo: Can anybody file a re-opener? My checks stop and I want more money, can I just come in, call you, and say, “I want more money. I want to go back to court. Let’s go.” What do you tell them?

Schulman: It would be nice if it worked that way, but it doesn’t always work that way in theory. What you have to do, if you want to reopen your claim, you have to prove that your condition is substantially worsened. You can’t just say, “I’m still having knee pain. I had knee surgery for a torn meniscus, and I got my settlement award, and I’m still having knee pain and I want to go back to court and I want to get more money.”

Generally, that’s not going to happen, because the reason why you’re getting money for your permanent disability, your permanency award, is you’re going to have those knee problems forward for the permanent future.

Petrillo: Right.

Schulman: If for some reason I’ve had cases where someone may have a knee surgery and they have continued knee problems, and we’ll ask the insurance company and send him back to the initial authorized doctor who did the surgery. The doctor may examine him and say, “Yeah, there is a problem here.” They may get another MRI and determine that there’s another tear in the same area where I operated before, and it’s because of the damage already done to their knee.

Petrillo: Sure.

Schulman: And the doctor will re-institute treatment. And if we’re able to prove that there is an increase in their disability, or worsening of their condition, we’ll perform the same procedure again with the permanency exams. And then we may be able to get an increased percentage of disability and the person will get an increased amount of money based upon the prior award.

Petrillo: These cases that you handle, as a seasoned veteran worker’s comp attorney, they can go on for years and years.

Schulman: Yeah.

Petrillo: Depending on the injuries.

Schulman: Depending on the injuries, I’ve had people that have had two or three successful re-opener claims depending on the injury.

Petrillo: Wow.

Schulman: And if the insurance company is still responsible to… If their doctor says, “You still need ongoing medication or ongoing physical therapy, even though you’re back to work.” Then many times those benefits can last 5, 10, 15 years, or a lifetime.

Petrillo: Wow. Okay. Well, I want to thank you for coming. We’re here interviewing Scott Schulman, who is a seasoned 25 years solely practicing workers’ compensation work in New Jersey. Scott, is there anything you want to add to our viewers, anybody that might be watching this video, in terms of what you do or workers’ comp, or anything? This is your time.

Schulman: Yeah. Saying if you’re watching this and you believe that you have questions, or you believe that some of these circumstances may apply to you, feel free to give us a call at (856) 486-4343. We’ll be happy to speak with you, answer any of your questions. And if we believe that you have a work related injury and potential claim, we’ll be happy to pursue it.

And like I said in the outset, I enjoy doing this. I enjoy fighting for the injured worker.

Petrillo: Sure.

Schulman: I enjoy making sure that they get whatever benefits to which they are entitled, and I don’t let the insurance companies push them around or push me around, and I don’t back down to them until I get whatever the injured worker is supposed to get.

Petrillo: So I’ve heard. Well, thank you very much.

Schulman: You’re welcome. Thank you.

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