Claim Closures, Omitted Conditions, Disabling Injuries and Awards

After you claim has been accepted, at some point your employer’s insurance carrier will decide that your condition has reached maximum improvement and has become medically stationary. When this happens, your claim will be closed. When your claim has been closed, contact me at 503 620-3171 or at slgabin@pacifier.com to find out whether

You have an omitted condition

You have a disabling condition that has been classified as non-disabling;

You have received an appropriate award, and whether

Your claim has been closed prematurely

When your claim is closed, you will receive a letter at the time of closure reciting the conditions that have been accepted. Often, the carrier omits a condition. For example, if you have injured your back, the carrier may have accepted only a strain injury when, as it happens, you also have a disc injury. If the carrier fails to include all injuries you have sustained, you have an omitted condition. Please contact me right away to make a proper claim for an omitted condition. You must make claim in writing and must give the carrier 60-days to accept or deny. An acceptance or denial must also be in writing

If the carrier thinks your injury is non-disabling, you will receive only a letter stating that your injury is non-disabling. If you believe your injury is disabling, you may request a reclassification to disabling. You have one year from the date of the letter to request a reclassification to disabling. This time limit is strict. Please contact me right away to discuss appealing an improper non-disabling classification.

If the carrier thinks your condition is disabling, you will receive a document called “Notice of Closure” and this document, typically, will state an “award” for permanent partial disability. An “award” is a benefit and you give up nothing to receive it. An award is not a “settlement” where you cash out your benefits, including your award. You may appeal the closure AND “cash” the award while you appeal.

When you appeal a Notice of Closure, you may challenge the amount of the award. This likely will involve your being sent to a medical arbiters’ examination. A medical arbiter is a doctor who is allowed to give an opinion only on the extent of your permanent partial disability. Only your treating doctor can give an opinion on your ability to perform your job at time of injury. Both factors influence the value of your award.

When you appeal a Notice of Closure, you may also challenge whether your condition has properly been found medically stationary. This likely will also involve your being sent to a medical arbiter.

If you have received a letter stating that your claim is is non-disabling, you have one year to challenge this classification by seeking a reclassification to disabling.

If you have received a “Notice of Closure” giving an award or no award, you have 60 days from the date of closure to appeal the closure by requesting a reconsideration.

If you have made a claim for a new or omitted condition (and there is no time limit to make such a claim), know that if the claim is denied, you have 60-days from the date of the denial letter to appeal the denial.

Do not lose your right to claim valuable benefits by missing a critical time limit.

If you successfully win a denied claim for a new or omitted condition, the employer pays my fee. The same is true if you successfully obtain a reclassification of your condition from non-disabling to disabling.

If you are successful obtaining an increased award for permanent partial disability, my fee is 10 percent of the increase.

Please contact me at 503 620-3171 or at slgabin@pacifier.com for a free consultation. I return all calls and reply to all emails within 24 hours.