The One-Year Rule: Can You Reopen a Workers' Compensation Case for Permanent Damage?

The “one-year rule” and reopening a workers’ compensation case are often discussed together, but they serve different purposes. In New York, the one-year rule generally refers to when certain extremity injuries should be evaluated for permanency, while reopening a claim is governed by a separate set of legal requirements.

At Sawers & Sackel, we focus exclusively on representing injured workers in Buffalo, New York. Since these questions come up frequently, we’ve put together this guide to explain how the one-year rule works and when a workers’ compensation claim may be reopened.

What Is the One-Year Rule?

If you’ve had surgery for a serious extremity injury, like a shoulder dislocation, you may have heard that you have to wait about a year before your permanency can be evaluated. That’s what’s commonly referred to as the “one-year rule.”

Before a Schedule Loss of Use (SLU) award can be made, an injured worker must first reach Maximum Medical Improvement (MMI). In New York workers’ compensation cases, MMI means your condition has recovered as much as expected and further treatment is not likely to result in additional improvement.

For certain extremity injuries, the New York Workers’ Compensation Board’s Impairment Guidelines recommend waiting at least one year after corrective surgery before the permanency evaluation takes place. The purpose is to give your condition enough time to stabilize so the evaluation reflects your lasting level of function rather than your early recovery.

The one-year rule applies only to certain SLU evaluations involving extremities. It doesn’t apply to every New York workers’ compensation claim.

When Can a Workers’ Compensation Case Be Reopened?

You may be able to reopen a workers’ compensation case if objective medical evidence shows that your permanent anatomical or functional loss has increased since your original SLU award. Your doctor must document the change by comparing your current condition to the original permanency evaluation. That may include decreased range of motion, reduced grip strength, or other measurable findings showing a greater permanent loss of function.

The New York Workers’ Compensation Board reviews the updated medical evidence to determine whether it supports an increased SLU award. Whether a case qualifies for reopening depends on the medical findings, the applicable law, and the facts of the individual claim.

If you settled your workers’ compensation claim through a Section 32 Waiver Agreement, different rules apply. A Section 32 is a settlement that closes some or all parts of a claim. Once the Board approves the agreement, the issues covered by the settlement are generally final and usually can’t be reopened.

The exception is if a case was finalized under Section 32 for indemnity rights only, but your medical rights remain open and in place. If so, you are entitled to reopen your case with medical evidence on issues of causally related medical treatment, but no further awards for lost time or permanency are due.

Discuss Your Case With Sawers & Sackel

Determining whether a workers’ compensation case qualifies for reopening starts with reviewing the original SLU award and comparing your current medical findings to the original permanency evaluation. An attorney can determine whether the medical evidence supports an increased award and help gather the documentation needed to present your claim.

Sawers & Sackel focuses exclusively on representing injured workers in Buffalo and throughout New York. If you believe your permanent condition has worsened since your original SLU award, fill out our contact form or call 716-202-2367 to discuss your case.