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Insurance carrier knows it (almost) got away with something

On Behalf of | Jan 2, 2012 | Workers' Compensation |

Interested in reopening his worker’s compensation case, a man came to see me who injured his neck several years ago.  His case had been closed on a final admission of liability when the doctor said he was at maximum medical improvement and gave him a 0% impairment.  This seemed strange since the man was still seeing the same doctor for injections and narcotic painkiller.  I thought he should have received a disability rating.  I visited the doctor who told me he made a mistake and that my client should have got a rating. The doctor wrote a report admitting the mistake and gave an 8% rating.

I send the rating to the insurance company and asked them to reopen the case and pay benefits pursuant to the 8% rating.  They refused to reopen the case. They didn’t give a reason.  They just didn’t want to pay what they should have paid several years before.

I had no choice but to file a petition to reopen and to go to hearing. The two reasons for reopening a closed workers compensation case are mistake and change of condition.  In this case, a mistake had clearly been made by the doctor.  My client testified that he had no reason not to believe the doctor, who told him that his pain would go away over time.  Reopening is at the discretion of the judge and the carrier thought it might as well take its chances rather than do the right thing.

While waiting for the hearing to begin, I asked opposing counsel if the carrier thought it got away with one on this case.  The attorney said, “yes, they probably do.”  Fortunately, they didn’t quite “get away with one.”   The judge ruled in my client’s favor and ordered the case to be reopened.

But the lesson is, don’t expect the worker’s compensation insurance carrier to do the right thing.  You can read more about reopening a case at


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