Should I Open a New Workers Compensation Claim for a Recurring Injury?

So, spring should arrive in Ohio sometime this year (we’ve been fooled by a few days of warm weather followed by more snow). With spring comes, for many, house cleaning, yard work, gardening and the sore backs that result. Any gardener knows that spring can bring sore backs, typically the morning after an evening’s work. These sprains and strains usually improve after a few days rest and maybe some aspirin or ibuprofen—and then the cycle often repeats every few weeks or so.

In the workplace, the same cycle can occur. I have clients who have suffered several low back strains and sprains over the years and have a separate workers compensation claim for a recurring injury. If you think about it, this makes sense as the injury happens, responds to treatment and resolves. However, employers (particularly self-insured employers, in my experience) often appear downright irrational when it comes to accepting or rejecting such claims.

If there’s only one incident (and hence only one claim), then an employer may argue that treatment and compensation for the injury should be completely unnecessary beyond the first 6-8 weeks as sprains and strains should be healed. So, let’s say you have another on-the-job low back strain 7 or 8 years after the first claim. Well, of course, in that case (the argument goes) the problems you have 8 years after the first claim are clearly the result of the injury that happened 8 years ago and for which you’ve had no treatment for more than 7 1/2 years! How does this even make sense?

The obvious answer is, of course, these conflicting arguments make no sense: how is it strains/sprains “resolve” in 6 -8 weeks but yet that old injury is now supposedly the genesis of my current strain/sprain 8 years later—and why my employer wanting to ignore that I was picking up heavy boxes at work last week and felt a pull in my back? Well, the answer is an old one: follow the money. Claims can cost money, whether the employer is state-funded (as most are) or self-insured. State-funded employers pay premiums to have workers’ compensation coverage, just as we do for auto or homeowners insurance. And, as with other insurance, if several claims are filed, the employer’s premiums may go up.

As a general rule, claims stop impacting an employer’s workers’ compensation premiums after roughly 5 years. Thus, an employer will argue that a new claim shouldn’t be filed for your recent back sprain but, rather, it should go under the old claim—and they argue this because the older claim costs them less money or sometimes no money at all. The BWC pays the claim costs but, depending upon the age of the claim, the employer may face no increase in premiums. So, employers may not contest new treatment or compensation requests in older claims but don’t want a new claim as these can impact what they pay out in workers’ compensation premiums.

With self-insured employers, the reasoning is similar in that such employers are required to set-aside a reserve to cover claim costs. The more claims, the more money required to be set-aside. Also, rates of payment increase each year. All other things being equal, this means that compensation paid in a 1990 claim is paid at a much lower rate (and hence costs the employer much less) than compensation in a 2014 claim—so a self-insured employer would much rather have an old claim reopened than have a new claim filed. Heck, they’ll often even help you with the paperwork in these situations!

As an injured worker suffering a lost-time injury claim, it is likely worthwhile to consult with someone if your employer insists on re-opening an old claim rather than certifying a new claim for a recurrent injury. The best interests they have in mind are theirs, not yours.

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