Skip to Main Content

Claim closed for more than seven years – are there still benefits available?

Has this happened to you or someone you know? Jack has an on-the-job injury. He files a claim for workers’ compensation benefits and the claim is allowed. His medical treatment was covered, he received time loss compensation, and because he could not return any of his former work, he received vocational retraining. All in all, Jack received the Labor and Industries benefits to which he was entitled. Once his injury became medically fixed and stable, his doctor, or doctors appointed by the Department, rated his disability and he was awarded a permanent partial disability award. The claim closed and Jack, in the best of all worlds, returned to work and that’s that.

Now suppose at some point after his claim was closed his injury gets worse and his
doctor tells him that he needs treatment again. He can apply to reopen his claim. If the
worsening, without a new injury, is something that can be identified objectively, meaning some studies or x-rays can measure the worsening of the allowed condition, the Department can reopen the claim for all benefits. If Jack’s doctor confirms the worsening (on a more-probable-than-not basis), his claim can be opened for treatment, time loss, vocational services, possibly additional permanent partial disability, or in some cases, total permanent disability which means he could get a lifetime pension.

Applying to reopen a claim is available to all Washington workers’ compensation cases
whether the claim is covered by the Department of Labor and Industries or by a self-insured employer like Boeing. worse. Although it may be harder in an “over seven” reopening for him to obtain additional benefits such as time loss compensation, vocational services, or pension, he should not give up.

At The Walthew Law Firm we have been successful in obtaining monetary benefits for
injured workers in over-seven cases while the claims were still at the Department level. We have also succeeded in having Director decisions overturned at the Board of Industrial Insurance Appeals. In cases where the Board has ruled against an injured worker on this issue, we have appealed to Superior Court and been successful at having both the Board’s and Director’s decisions overturned. In so doing, we have obtained benefits for our clients ranging from time loss compensation to total disability pensions. In over-seven cases, the path to success may not be easy, but it is always worth considering.

But what happens if the worsening of the condition occurs more than seven years after
the first closure of the claim? This is what is referred to as an “over-seven reopening.” The rules change a bit but there is still relief available.

In an over-seven case, Jack would still apply to reopen the claim. As with any reopening
application, if he can show that his allowed injury-related condition has objectively worsened, his claim can be reopened for medical treatment, but only medical treatment – not monetary benefits such as time loss compensation, permanent partial disability award, or lifetime pension.
Only the Director of the Department of Labor and Industries can grant those monetary benefits. But the Director has to follow rules to grant or deny those benefits.

Department policy requires that the Director consider issues such as the accepted or
denied conditions under the claim, whether Jack underwent vocational retraining, the
relationship of Jack’s need for treatment, whether he was working when his claim was reopened, his work history, and whether he “voluntarily retired.” If the Director denies benefits and fails to consider any of these factors, then her decision can be challenged in court. At hearing, Jack has to prove that the decision was an “abuse of discretion,” and that the decision was made with willful disregard for the facts and circumstances of his case. This is very difficult to prove. Under the law, the Director has the authority to review the evidence and decide which evidence to accept in making her decision. For example, when there are two medical opinions that disagree as to whether Jack can work, it is not abuse of discretion to choose one opinion over the other. The Director is the only one who is authorized by law to make that discretionary call.

However, the discretion of the Director can be challenged. For example, in Jack’s case,
the Director decides that he is not eligible for time loss compensation because he was not
working when his condition worsened. But the Director did not consider that his inability to
work was because of the industrial injury. The Director’s decision can be challenged because she failed to consider that fact.

The bottom line is, if Jack’s claim has been closed for more than seven years (10 years in
hearing loss cases), he can always reopen for medical treatment if his condition gets objectively.

Please contact us with any questions at: 206-623-5311 or 1-866-WALTHEW (925-8439)

Call us today.
Offices in Seattle and Everett.

Talk to an attorney to get free advice about your claim.


Mailing Address
PO Box 34645
Seattle, WA 98124-1645
*Packages and overnight deliveries should be shipped to the Seattle physical address.

Seattle Office
3000 1st Avenue
Seattle, WA 98121

Everett Office
2906 Colby Ave | Suite 101
Everett, WA 98201

Request an appointment

Schedule a free consultation >