Workers’ compensation benefits are meant to support an injured employee until they have reached “maximum medical improvement,” or MMI, and can return to work. Many times, these cases are resolved in the form of a settlement. Depending on the way the case was settled, the employee may be able to reopen the case for additional benefits.
If Younce, Vtipil, Baznik & Banks, P.A., is your workers’ compensation attorney, we can fight for these additional benefits and seek to reopen your case if a change in your condition entitles you to medical care and/or time away from work. Contact us in Raleigh, NC, if you need help reopening a North Carolina workers’ compensation claim.
What Is a Change in Condition?
At some point after suffering a workplace injury, the patient will either fully recover or get as well as they can. The medical provider overseeing the case must then make a series of decisions to:
- Declare the patient has reached maximum medical improvement (MMI)
- Assign the patient a Permanent Partial Disability (PPD) rating
- Order work restrictions as necessary
- Release the patient from treatment, typically with instructions to seek follow-up care as needed.
At this point, the insurer may propose a settlement in the form of an N.C. Industrial Commission Form 26A or a clincher agreement.
- Form 26A settlement. This is a signed agreement using the N.C. Industrial Commission’s Form 26A, which states the employee’s status and the PPD payments they are to receive and for how long. A Form 26A settlement preserves the right to reopen a claim within two years of the payment of the Form 26A settlement if there is a change of condition.
- Clincher agreement. This is a final resolution and settlement of every issue in a workers’ compensation case. In return for a lump sum payment, the worker waives the right to further benefits under the Workers’ Compensation Act and releases their employer from any future liability arising from the case. You cannot petition to reopen the case for a change of condition if you settle with a clincher agreement.
Your claim cannot be settled without your written permission, and the Industrial Commission must approve all settlements.
After the Form 26A settlement, if the employee’s injury worsens and affects their ability to earn wages or their wage earning is affected without a change in their physical condition or there is a change in the degree of their disability, the employee has the right to petition to reopen their claim due to a change of condition. If they are successful, they will have a right to the payment of medical care costs and wage benefits based on two-thirds (66 2/3%) of their pre-injury wages.
North Carolina workers’ compensation law states that, upon a change in condition, the worker has two years to seek review of the claim and reinstate benefits. In other words, the injured worker may seek additional benefits if they suffer a change in condition within two years of their Form 26A settlement. However, the employer and their insurer may challenge the employee’s claim for change of condition.
