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Table of contents
- What Does It Mean to “Reopen” a Workers’ Comp Case?
- Legal Grounds to Modify a Workers’ Compensation Award in NJ
- How Long Do You Have to File?
- Reopening vs. Section 20 Settlements
- Serving Injured Workers Throughout New Jersey
- Workers’ Compensation Attorney Spotlight: Gary E. Adams
- Frequently Asked Questions
- Talk to a New Jersey Workers’ Compensation Attorney
The consequences of a work injury can have unpredictable results and increase in severity over time. If your work injury has gotten worse since your workers’ comp case closed, it may not be too late to do anything about it. In New Jersey, workers’ compensation claims can be reopened to attempt to collect additional benefits for an injury that has worsened over time.
At Pellettieri Rabstein & Altman, our NJ workers compensation lawyers have handled countless workers’ compensation cases. We are well-versed in evaluating workers’ compensation awards and settlements and helping clients determine when it may be appropriate to seek additional benefits as to a closed workers compensation claim in NJ.
What Does It Mean to “Reopen” a Workers’ Comp Case?
Many workers believe that once their workers’ compensation case is closed they are done – for better or for worse. However, the system was designed to deal with the unpredictable nature of injury and the unforeseen change in a worker’s condition years after injury. Moreover, the initial settlement of a Section 20 agreement may not account for the complications that develop later down the line. In order to address these situations, the workers’ compensation system in New Jersey has enabled injured workers to reopen their claims for re-evaluation.
When a workers’ compensation claim is closed it generally will have been resolved in one of two ways:
1) a formal workers’ compensation award for permanent partial or permanent total disability
2) a Section 20 settlement (informal agreement of workers’ compensation payments)
If a workers’ compensation claim has been resolved by way of a formal workers’ compensation award, then for a period of 3 years after the date of the award, you or your workers’ compensation attorney are able to file an Application for Review or Modification of Formal Award (referred to as a reopener claim) with the workers’ compensation judge if there is a subsequent change in your condition and you believe that you are entitled to increased workers’ compensation benefits as a result.
This type of claim is often referred to as a reopener claim and is officially referred to as an Application for Review or Modification of Formal Award. The application does and does not include the following:
- It does not start your case over from scratch. The reopener relies on your original claim petition and formal award as its legal foundation. You’re not re-litigating whether your injury was work-related; that was already decided.
- It asks the court to reconsider your disability rating. The core question is narrower and more specific: has your condition changed enough, since the award was entered, to justify adjusting the compensation you already received?
- It can go in either direction. While most reopener applications are filed by injured workers seeking additional benefits after a worsening condition, an employer or insurance carrier can theoretically also request a modification if a worker’s condition improves. In practice, the overwhelming majority of these applications are filed by workers whose conditions have deteriorated.
- It’s a separate filing with its own procedural requirements. You must file a formal application with the Division of Workers’ Compensation, and the carrier is entitled to respond, request an independent medical examination, and contest the claim just as it could in the original case.
Legal Grounds to Modify a Workers’ Compensation Award in NJ
Not every closed case can be reopened. To succeed, you generally need to show that:
- Your work-related injury has objectively and significantly worsened since the date of your award, and
- The worsening is causally related to the original work accident or occupational exposure, not a new or unrelated injury.
A worker who settled a low back injury for say 12% disability could later develop radiating pain down his or her legs, require additional surgery or have some loss of function that was not considered in the initial disability rating. The court needs to see some documented change in the worker’s condition and not just that things seem worse. Updated medical records, diagnostic imaging and opinion from treating physicians relating the worker’s current complaints to the original accident are typical items needed to process a reopened claim.
How Long Do You Have to File?
Timing is one of the most important and commonly misunderstood issues affecting the rights of injured workers to pursue additional benefits for work-related injuries under the New Jersey workers’ compensation law. The timing issue generally applies to an injured worker’s right to file an application to reopen a formal award issued under the New Jersey workers’ compensation law. The application to reopen must be filed by an injured worker within two years after the date of the last payment of compensation. Thus, the definition of “compensation” is very critical in this regard and, under the statute, includes the last payment of a disability award as well as the last authorized medical treatment paid for under an employee’s work-related injury claim.
If you miss the end of the 2 year time period you will be denied benefits for the injury even if your condition has further deteriorated. The timing of when your case was closed is a critical component in calculating the end of the 2 year time period. It is therefore strongly advised that you have an experienced workers’ compensation attorney review your settlement documents and advise you as to the date of the last payment and whether you have any possible claims for additional benefits for your work related injury.
Reopening vs. Section 20 Settlements
A reopener right applies generally to formal awards, not Section 20 settlements. A Section 20 settlement is a final and complete settlement of a claim against a workers’ compensation carrier that has been disputed by the parties and resolved through negotiation and approval of a workers’ compensation judge. Once a Section 20 settlement has been approved by the workers’ compensation judge, the matter is closed forever, and there is no right to seek a reopener of the claim later to claim worsening of symptoms, additional medical treatment, etc.
Most injured workers find this to be a surprising aspect to resolve a disputed claim by way of a Section 20 settlement as there is no right to reopen, due to worsening of symptoms or need for additional medical treatment for example. The amount of your disability is locked in as well in terms of degree of disability for life as compared to a formal award which has a 2 year window in which to file a formal application to increase the amount of your award as the effects of your work-related injury may worsen with time.
- A formal award typically reflects an agreed-upon (or judge-determined) percentage of permanent disability tied to a compensable injury. Because liability and the nature of the injury are established, the law allows room to revisit that percentage later if the underlying condition genuinely worsens.
- A Section 20 settlement is used specifically to resolve disputed claims where the employer or carrier is contesting whether the injury is even work-related, whether it happened as described, or whether it’s compensable at all. In exchange for a lump-sum payment, the injured worker gives up the right to pursue the claim further, including any future medical treatment or reopener rights tied to that injury.
Serving Injured Workers Throughout New Jersey
Our experienced Workers’ Compensation attorneys serve injured workers, union members and their families throughout New Jersey including Mercer and Burlington Counties, Essex County, and all points in between from our three offices: Lawrenceville (near Princeton) and Cherry Hill in South Jersey, and Nutley in North Jersey.
We have represented numerous categories of employees with similar job duties over the years including tradespeople, construction workers, state and county employees, correctional officers, health care workers, factory workers and warehouse workers. Often their injuries from many years ago have progressed.
Workers’ Compensation Attorney Spotlight: Gary E. Adams
Gary E. Adams is a Managing Partner of Pellettieri Rabstein & Altman and is the Chairman of the firm’s Workers’ Compensation Department. He is a Certified Workers’ Compensation Trial Attorney by the New Jersey Supreme Court. With a practice limited to representing injured workers and union members, he has extensive trial experience in a wide array of workers’ compensation cases including occupational pulmonary and cancer claims as well as cardiac claims and repetitive motion injury claims.
Gary has negotiated many reopener settlements increasing the workers’ compensation benefits of his clients as their condition worsened following an initial workers’ compensation settlement. For example, he recently settled a reopener for $85,964 increasing his client’s disability rating and workers’ compensation benefits. He also settled another reopener for $37,830 preserving his client’s right to reopen his workers’ compensation claim for treatment of any future work injuries.
Gary was selected as the 2021 “Lawyer of the Year” for his Workers’ Compensation practice by Best Lawyers. Gary has also received an AV Preeminent Rating from Martindale-Hubbell and has been repeatedly selected as a New Jersey Super Lawyer. He is the former Chairman of the NJ State Bar Association’s Workers’ Compensation Section and recently testified before the New Jersey Legislature on several proposed amendments to the New Jersey Workers’ Compensation Statute.
Frequently Asked Questions
How long do I have to reopen a workers’ comp case in New Jersey? In most cases, you have two years from the date of the last payment of compensation under your formal award. This deadline is strictly enforced, so it’s important to act quickly if you believe your condition has worsened.
What do I need to prove to modify a workers’ compensation award in NJ? You must show that your work-related condition has objectively worsened since your award and that the worsening is connected to your original accident or occupational injury. Medical documentation from a treating physician is typically the backbone of this showing.
Can I reopen a claim that was resolved with a Section 20 settlement? Generally, no. Section 20 settlements are considered full and final, which is why it’s important to fully understand the long-term consequences before agreeing to one.
Is there a difference between “reopening” a claim and “modifying” an award? The terms are often used interchangeably. Technically, you’re filing an Application for Review or Modification of Formal Award, asking the court to adjust your existing disability rating based on new evidence, not starting an entirely new case from scratch.
Do I need a lawyer to reopen a workers’ compensation claim? You’re not legally required to have an attorney, but insurance carriers routinely contest reopened claims, and the medical and procedural requirements can be difficult to navigate alone. An experienced workers’ compensation attorney can help gather the right evidence and file within the statutory deadline.
What if I’m not sure whether my award was formal or a Section 20 settlement? Many injured workers don’t remember the exact terms of a settlement reached months or years earlier. Our attorneys can review your case file and settlement documents to determine what type of resolution you had and whether reopening is an option.
Talk to a New Jersey Workers’ Compensation Attorney
Don’t assume that your work injury has gone too long without you getting the help you need. Many people mistakenly believe that once a worker’s compensation claim has been settled that the claim is closed for good. But under New Jersey law workers’ compensation claims are not necessarily closed forever. If your condition has worsened, if you have needed additional medical treatment, or if you can no longer work in a manner in which you were able to work before your injury then you may be able to reopen your claim for further benefits.
An injured worker generally has two years from the date of the last payment of workers compensation benefits to file an application for modification of a formal award. A modified award can provide increased benefits due to a worsening of the work related injury or as a result of a new injury that is related to the original work related injury.
Pellettieri Rabstein & Altman attorneys have decades of experience in handling reopened and modified workers’ compensation claims in New Jersey. We are knowledgeable as to the time-sensitive issues, necessary documentation and procedures involved in such cases. We will gather the necessary evidence and create a solid record that indicates how your condition has worsened since your last workers’ compensation award whether it be a degenerating back, complications from a prior surgery or a spreading or worsening of an existing condition. We will work tirelessly to assist you in obtaining additional benefits to which you are entitled.
Don’t wait to find out if you are entitled to additional benefits! Contact us today for a free consultation to go over your case.
