How to Reopen Your Arizona Workers' Compensation Case

If you've suffered a work-related injury in Arizona and your workers' compensation claim was previously closed, you might find yourself needing further medical care or experiencing a worsening of your condition. Fortunately, the Arizona Workers' Compensation system allows for the reopening of claims under specific circumstances. Understanding this process is crucial to securing the benefits you may still be entitled to.

What Qualifies for Reopening?

To successfully reopen a closed workers' compensation claim in Arizona, you generally need to establish the existence of a new, additional, or previously undiscovered temporary or permanent condition. This condition must be causally related to your original industrial injury.

It's important to note what does not qualify:

• A claim cannot be reopened solely because of increased subjective pain if that pain is not accompanied by a change in objective physical findings.

• A claim cannot be reopened solely for additional diagnostic or investigative medical tests. However, expenses for reasonable and necessary diagnostic or investigative tests causally related to the injury must be paid by the employer or carrier without the need for reopening.

• A claim cannot be reopened if the initial claim for compensation was previously denied by a notice of claim status or determination by the Industrial Commission of Arizona (ICA) and that denial became final, unless an exception applies for excusing a late filing to request a hearing.

You have a lifetime right to file a petition to reopen a previously closed, compensable claim, unless you have entered into a "Full and Final Settlement" that waived this future right.

The Process for Requesting Reopening

1. Prepare Your Petition:

   • Your request must be in writing, and it's recommended to use the Petition to Reopen form available from the ICA (Form ICA 04-0528-83).

   • It must be signed by you or your authorized representative.

   • The petition should identify or describe the new, additional, or previously undiscovered disability or medical condition justifying the reopening.

   • It should also include your medical and employment history.

   • Do not file your request with the carrier; it must be filed with the ICA.

2. Attach a Medical Report:

   • The petition must be accompanied by a statement from a physician setting forth your physical condition that serves as the basis for reopening and its relationship to the industrial injury.

   • If the ICA receives your petition without the required medical report, they will notify all parties. The carrier is not required to act on your petition until the medical report is received.

   • If the medical report comes from an out-of-state physician and a party objects at least 20 days before a scheduled hearing, the report may not be considered unless the author is produced for cross-examination (with expenses paid by the party submitting the report).

3. Carrier's Action and Your Rights:

   • Once the ICA receives your complete petition with supporting medical documentation, they will send a "Notice of Petition to Reopen" to the payer (your employer's insurance carrier or self-insured employer).

   • The payer must notify the ICA and you in writing of its acceptance or denial of the petition within 21 days from the ICA's notification date.

   • If your petition to reopen is denied, the notice will include a 90-day protest period. If you disagree with the denial, you must file a Request for Hearing within this 90-day period; otherwise, the carrier's decision becomes final.

     
     

Important Considerations for Reopening

• Financial Benefits: If your claim is successfully reopened, payment for reasonable and necessary medical, hospital, and laboratory expenses incurred within 15 days of filing your petition to reopen will be paid. However, no monetary compensation is payable for any period prior to the date you filed the petition to reopen. Surgical benefits may be payable for up to seven days prior if a bona fide medical emergency prevented you from filing the petition before surgery.

• Comparative Analysis: The "reopening" process is fundamentally about change. The Administrative Law Judge (ALJ) will compare your physical condition at the time of your petition to your condition at the time of the last claim closure or previous denial of a reopening petition. This change can be an objective physical finding, a radiographic finding (e.g., further disc protrusion), or a change in recommended medical care (e.g., surgery now recommended where it wasn't before).

• Medical Evidence: For conditions not readily apparent to a lay person, their existence, cause, need for treatment, or permanent impairment must be established by expert medical evidence. The ALJ has the duty to resolve conflicts in medical evidence.

  
  

Where to Find More Help

The Arizona workers' compensation system can be complex.

• The Industrial Commission of Arizona (ICA) website (www.azica.gov) is a primary resource for information, forms, and updates.

• The ICA's Ombudsman can provide general information about the workers' compensation system and hearing process, but they cannot give legal advice.

• Given the complexities, especially with issues like causation, comparative analysis, and potential preclusion doctrines, it is highly recommended to consult with an attorney who specializes in Workers' Compensation.

  
  

Navigating a workers' compensation claim, especially a reopening, requires careful attention to detail and adherence to specific procedures. By understanding these steps and seeking appropriate guidance, you can better protect your rights and pursue the benefits you need.