In personal injury claims, once a settlement is finalized, that’s pretty much it. There is no going back to ask for more or alter the terms of the agreement. However, a workers’ compensation attorney can often help employees reopen claims after settlement.
This type of workers’ compensation assistance is imperative in cases where an employee has a disability that has recurred or increased. Whether a case can be reopened often hinges on whether it was settled by a “stipulation and award” or “compromise and release.” The latter usually resolves all worker’s claims – including into the future. Absent fraud, these settlements are usually final. However, cases that are resolved by stipulation and award can usually be reopened.
In the recent case of Poremba v. Southern Nevada Paving, the question was whether a worker was precluded from reopening his workers’ compensation claim after spending some of the settlement money on non-medical expenses.
Important to understanding this case, before the Nevada Supreme Court, is that in that state, as in North Carolina, the amount of workers’ compensation coverage received can be reduced by the amount of damages recovered by a third party. A workers’ compensation case can be reopened there if claimant can prove he or she has exhausted any third party settlement funds, which include coverage of medical expenses.
The state high court clarified in this case that while a claimant may spend his or her third-party settlement funds on medical benefits, he or she is not restricted solely to that. While it’s true that workers’ compensation funds can only be spent on certain specific expenses, state law doesn’t stop claimants from spending third-party settlement money on things like typical household expenses.
According to court records, claimant worked for a paving company as a construction driver. One day in 2005, plaintiff was driving his truck when another driver struck his vehicle with a backhoe. Plaintiff suffered injuries to his head, back, neck and knee and subsequently filed a workers’ compensation claim, which his employer accepted.
The claim was eventually closed, and there were instructions on how to reopen the claim if his condition worsened.
Plaintiff also sued the driver of the backhoe, ultimately settling four years after the accident for $63,500. More than half went to settle health care provider liens. Of the $34,600 he received personally, he spent $14,000 on remaining medical expenses and then spent the rest on living expenses, such as mortgage payments and food for him and his family.
He tried to return to work, but was unable to do so. Doctors instructed him not to work.
In 2013, he sought to reopen his workers’ compensation claim.
The commission ruled he could not do so because he’d spent a portion of his recovery on non-medical costs. The district court affirmed, but the state supreme court reversed.
The court ruled that while prior case law did require a claimant to exhaust all third-party settlement funds before trying to re-open a workers’ compensation claim, it was not necessary that those funds be entirely spent on medical expenses.
It was pointed out that while workers’ compensation benefits are intended to provide only limited recovery for medical expenses and lost wages, personal injury claims are intended to compensate people for pain and suffering as well. There is nothing that precludes them from reopening a workers’ compensation claim for a worsening or ongoing medical condition just because they spent their personal injury proceeds for personal costs.
If you have been injured at work, contact the Lee Law Offices at 800-887-1965.
Poremba v. Southern Nevada Paving, April 7, 2016, Nevada Supreme Court
More Blog Entries:
Report: Work Injury Risk Increased With Sleep Breathing Trouble, April 7, 2016, Asheville Workers’ Compensation Lawyer Blog