Summary
A workers’ compensation injury can get worse weeks, months, or years after the original accident. In New York, a worsening condition may affect medical treatment, work restrictions, disability findings, wage-loss benefits, or the status of an older claim. The result depends on what changed, whether the change is medically connected to the accepted work injury, and how the original claim was resolved.
Cole, Sorrentino, Hurley, Hewner & Gambino, P.C. helps injured workers in Buffalo and nearby areas throughout Western New York understand what a change in symptoms may mean for an existing workers’ compensation claim. Prompt medical documentation can help show when the change occurred, how it affects your ability to work, and whether the issue may be addressed in the existing claim or may require other Workers’ Compensation Board action.
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Richard H. Cole
Partner
Thomas F. Hewner
Partner
Donna L. Haslinger
Partner
Keith R. Rosso
Attorney
Marc A. Cangé
Attorney
Teresa M. Cappiello
Attorney
Why a Work Injury May Get Worse Instead of Better
Recovery does not always follow a straight line. A back injury that improved with treatment may become more painful after a return to lifting. A shoulder injury may later require surgery. A knee injury may become less stable after months of standing, climbing, or other job duties. You may also develop increased numbness, weakness, swelling, reduced range of motion, or other symptoms that were not as severe earlier in the claim.
New York Workers’ Compensation Board guidance distinguishes between different types of changes in a medical condition. An exacerbation is described as a temporary worsening that eventually returns to the prior baseline. Board disability guidance also describes an aggravation as a permanent worsening of a prior condition. Those medical definitions can help describe the change, but the legal treatment of a claim still depends on the evidence and the facts of the case.
A temporary flare-up does not automatically mean that your disability level or benefits will change. A longer-lasting decline may raise questions about your current diagnosis, work capacity, treatment needs, and the relationship between the worsening condition and the original work injury.
What Should You Do When Your Symptoms Get Worse?
Start with medical documentation. Tell your treating provider what changed, when the change began, which activities make your symptoms worse, and whether your ability to work has changed. Your medical record should describe the condition accurately rather than relying only on your memory later.
Your updated records may need to address:
- New or increased pain, weakness, numbness, swelling, or loss of motion
• New diagnostic findings
• New treatment recommendations
• Changes in your ability to perform job duties
• Updated work restrictions
• Missed work, reduced hours, or lower earnings
• Whether a specific new accident or event caused the change
Medical care for an established workers’ compensation injury can continue as a lifetime benefit under New York Workers’ Compensation Board guidance. That rule can change if medical benefits were closed through a final Section 32 waiver agreement.
Key Point: Returning to work does not automatically end medical care for an established work injury. Your treatment rights depend on the accepted condition and whether medical benefits remain open.
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Can a Worsening Injury Change Your Workers’ Comp Benefits?
A change in your medical condition can affect treatment, work restrictions, disability findings, and wage-loss benefits.
For example, assume a Buffalo warehouse employee returned to light duty after a lower-back injury. The employee worked shorter shifts with lifting restrictions for several weeks. The pain then increased, and the treating provider determined that the employee could no longer perform the modified job. Updated medical evidence may support Board review of the employee’s current disability and wage-loss benefits.
If you return to work but your work-related disability causes you to earn less than you earned before the injury, you may qualify for reduced-earnings benefits. New York Workers’ Compensation Board guidance states that reduced-earnings benefits can pay up to two-thirds of the difference between pre-injury and post-injury wages, subject to the rules and limits that apply to the claim.
If you return to work but occasionally miss time because of the accepted work injury, you may qualify for intermittent lost-time benefits. Medical evidence must support that the absences are related to the work injury.
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What If the Insurance Carrier Disputes the Worsening?
An insurance carrier may dispute whether new symptoms are related to the original injury, whether requested treatment is medically necessary, or whether your level of disability has changed.
Your treating provider may need to address:
- Your current diagnosis
• The relationship between the present condition and the accepted work injury
• Objective medical findings
• Recommended treatment
• Current work restrictions
• Your ability to perform your regular or modified job
The carrier may also request an independent medical examination. If the parties cannot resolve a dispute involving treatment, disability, causation, or benefits, the Workers’ Compensation Board may need to address the issue.
Keep records that show the change over time. Useful records may include medical reports, imaging, work-status notes, pay stubs, attendance records, and written communications about light duty or modified work. A clear timeline can help show whether your condition gradually worsened or whether a separate event occurred.
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What If Your Claim Was Inactive or Closed?
A worsening condition can involve extra procedural questions when the Workers’ Compensation Board is no longer actively handling the case.
Under 12 NYCRR 300.14, an application for rehearing or reopening may be based on:
- Material evidence that was not available at the time of the earlier hearing
• A change in your condition that is material to the issue involved
• Reopening in the interest of justice
The Workers’ Compensation Board states that an application for rehearing or reopening does not necessarily have to be made within 30 days of a decision, but it must be made within a reasonable time after the applicant learns the facts supporting the request.
That rule does not mean that every old claim can be reopened. Separate statutory limits can affect older claims, and the way the case was closed can matter. If your injury worsened after a long period with little or no treatment, gather the most recent Board decisions, prior medical records, payment history, and new medical evidence before deciding what procedure may apply.
What If You Signed a Section 32 Settlement?
A Section 32 waiver agreement can change which benefits remain available.
A Section 32 agreement may settle wage-loss benefits, medical benefits, or both. Once the Workers’ Compensation Board approves the agreement and the agreement becomes final, the benefits that were settled are closed.
If medical benefits were settled, the insurance carrier generally will not resume paying medical expenses because the injury later becomes worse. If wage-loss benefits were settled, the worker generally cannot return for additional indemnity payments on the settled portion.
Some Section 32 agreements settle wage-loss benefits while leaving medical benefits open. Read the actual agreement before assuming that all benefits ended.
Key Point: A worsening condition does not reopen benefits that were permanently closed by a final Section 32 waiver agreement. The specific settlement terms control which benefits remain open.
Is It a Worsening Injury or a New Work Accident?
The answer can affect which claim and procedure apply.
Suppose a construction worker injured a shoulder in an accepted claim, returned to work, and later experienced gradually increasing pain without another accident. That situation may be evaluated differently from a later fall, lifting incident, or other event that causes new shoulder trauma.
A new accident, new trauma, or injury to another body part may require a separate workers’ compensation claim. Gradual worsening related to the accepted condition may instead involve the existing claim. The medical history, timing, mechanism of injury, and Workers’ Compensation Board findings can affect that determination.
Tell your medical provider exactly what happened. If there was a new event, identify it. If there was no new accident and the symptoms increased over time, make that clear as well. Accurate reporting can help create a medical record that matches the actual history.
Steps to Take Before the Worsening Becomes a Dispute
If your work injury is getting worse:
- Schedule medical care promptly and describe the change accurately.
• Explain when the symptoms increased and whether a new accident occurred.
• Follow written work restrictions.
• Ask your provider to update restrictions when your abilities change.
• Keep medical reports, diagnostic testing, work notes, and wage records.
• Track missed workdays, reduced hours, and changes in pay.
• Save communications about light duty or modified work.
• Review prior Workers’ Compensation Board decisions.
• Review any Section 32 settlement papers.
• Seek legal guidance when treatment, causation, benefits, or claim status becomes disputed.
Why Legal Guidance Can Matter When a Condition Changes
A worsening injury can raise several issues at the same time. The medical issue may concern whether your condition has changed and whether the change is related to the original work injury. The benefit issue may concern your current work capacity or earnings. The procedural issue may concern whether the existing claim remains active, requires Board action, or was resolved by settlement.
A workers’ compensation attorney can review the medical history, Board decisions, payment records, settlement documents, and current work status together. That review can help identify which evidence and procedure fit the current problem.
Speak With a Buffalo Workers’ Compensation Attorney
If a work injury has become more painful, caused new restrictions, reduced your earnings, or kept you from working at the same level, Cole, Sorrentino, Hurley, Hewner & Gambino, P.C. can review the history of your New York workers’ compensation claim and explain the legal options that may apply.
The firm has provided legal advice and representation in Western New York for more than 45 years and serves injured workers in Buffalo and nearby communities.
Call 716-869-3011 to request a legal consultation.
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This article is for general informational purposes only. It is not legal advice or a legal opinion about any specific facts or circumstances. Every workers’ compensation case is different. You should speak with a qualified attorney about your specific situation.