Can a Claim Be Reopened Due to a Change in Condition?
Re-opening Workers' Compensation Claims
YES (with an exception). The claim may be reopened for a change of condition for up to one year from date of the last payment. The exception comes in when the claim was settled on a Clincher Agreement. R.67-801(E) The Clincher Agreement or final release relieves the employer and its representative from any further responsibility for payment of compensation or medical expenses even if the claimant's medical condition worsens. When there has been no clincher agreement, if there has been a change of condition, the Commission may end, diminish, or increase the previous compensation award. The review cannot be made after twelve months from the date of the last payment of compensation made pursuant to the previous award. S.C. Code Ann. §42-17-90.
Under S.C. Code Ann. §42-17-90, the review of an award based on a change of condition is sharply restricted to the question of the extent of improvement or worsening of the injury on which the original award was based; consequently, the statute is not applicable to a claim which was not previously compensated. Owenby v. Owens Corning Fiberglass, 313 S.C. 181, 437 S.E.2d 130 (S.C. App. 1993). A change in condition means a change in the physical condition of the claimant as a result of the original injury, occurring after the first award. Causby v. Rock Hill Printing & Finishing Co., 249 S.C. 225, 153 S.E.2d 697 (1967). If a claimant seeks review, the claimant must prove a change of condition and a causal connection between the change and the original compensable accident. The issue of change and causation are issues of fact to be determined by the Commission. Allen v. Benson Outdoor Advertising Co., 112 S.E.2d 722 (S.C. 1960). If claimant's mental condition is causally connected to the original, compensable physical injury, and is a newly manifested symptom of original injury which has caused worsening of the condition it can be considered in the change of condition proceeding. Estridge v. Joslyn Clark Controls, Inc., 325 S.C. 532, 482 S.E.2d 577, rehearing denied (S.C. App. 1997).
The claimant may request an informal conference by letter to have the employer pay for a medical evaluation to determine if there has been a change of condition. R.67-602(C).