Suppose you develop a new condition on your claim. You have a serious back injury, your life is turned upside down, and you develop depression. If your treating doctor says that a cause of your depression was your industrial injury, then depression should be allowed under your claim. The Department frequently denies the new condition, saying that it pre-existed or is unrelated. No reason is given; the Department can just issue an order denying a condition.
Treatment for your accepted conditions under the claim will continue so long as you continue to improve. The Department calls this “curative” treatment. Once treatment is no longer curative, further treatment is denied. Other terms used are “fixed and stable” or “maximum medical improvement.” The Department or self-insured employer may move your claim toward closure when you are no longer getting better.
No treatment is covered after the date the claim is closed. If the closing order becomes “final and binding,” meaning there was no protest within 60 days, then you must submit a reopening application. You will need to prove worsening or aggravation of your condition. If you cannot prove by medical opinion that your condition has measurably worsened since claim closure, your claims manager will deny your reopening application by order.
If you have had treatment denied or your reopening application denied, please call us. We would be glad to review your claim file. Remember that you only have 60 days from the date of any unfavorable order to take a written protest or appeal. Take action before it is too late.