Legal Question in Workers Comp in New York

Re: closed case

The term "lump sum" has special meaning in the compensation law. It used to mean that you agreed to completely abandon your claim in exchange for a "lump sum of benefits", typically consisting of a few years worth of future benefits. These agreements are now called "section 32 agreements." These agreements are virtually irrevocable and if you entered into one, you probably would not be eligible to reopen the case.

But that does not sound like what happened in your case. It sounds like there may have been a short period of lost time that was in dispute and the insurance company agreed to a retroactive award for the amount you received. If that is the case then, yes, you can reopen it.

The big issue would be whether the current need for treatment and lost wages is still related to a case that is over six years old. There is no automatic presumption that your ongoing problems are still "causally related" to the original injury even if they are of the same quality and location as they were on the date of the accident.

The passage of time is going to cause the insurance carrier to scrutinize what has transpired over that time period and it is common for them to controvert "on-going" or "further causally" related disability on an older claim.

This is unfortunately why some doctors will not take old comp cases. Another issue which is perhaps a little less problematic is the possibility that your case is turned over to the Special Disability Fund which is a fund created for claims that are over seven years old. This would not affect your right to further treatment or benefits but it would affect who pays. There can be some delay in getting medical care or benefits paid while the Insurance Carrier and the Special Fund work this issue out but ultimately, you would still be covered.

As for the issue with your lawyer, it is difficult to say whether you got a raw deal without knowing more facts. However given the facts as you described then, it sounds like you may need a lawyer to help navigate through and proving the issue of whether your current problems are related to the old injury. I would recommend contacting an experienced compensation attorney like myself to come up with a game plan to avoid some of the possible pitfalls that may lie ahead.