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Reopened Workers Compensation Claims – Watch Them Closely


Reopened Workers Compensation Claims Conundrum

I have not covered reopened workers compensation claims articles for many years.  This type of claim exists on almost all the loss runs that I have seen over the years.  You are reviewing your claims loss runs, right?

Let us look at what a reopened status could mean on a claims loss run.  The reopened workers compensation claims review covers approximately 5%  loss run review tasks. The 5% is still important.

Having a Reopened Status is not really a bad thing every time it appears on a loss run.  It is not a red flag situation – more of a yellow flag.

pic baby owls watching reopened workers compensation files
Public Use License – chdwckvnstrsslhm

How to Spot These Claims on a Loss Run

If you have access to your loss runs and claims online, you are definitely ahead of the game.  If you have to request your loss runs, you should be doing it quarterly, if not more often.  As I have said often, online claims access is golden.

Each insurance carrier or Third Party Administrator (TPA) has its own format.  No standardization exists – unfortunately.  Search for the column that says Claims Status.  The three statuses you will usually see are Open, Closed, and Reopened designated as O, C, or R.  Sometimes you will see RC which means Reopened Closed.

Why Are Claims Reopened?

A reopened workers compensation claims status usually means the claims adjuster has previously closed the claim – which is a good thing.  Now some type of occurrence resulted in further future benefit payments.   The reason could be anything.

A few examples are:

  • A medical bill is received after the file was closed
  • The injured employee is now seeking treatment and possible benefits again
  • An unexpected Permanent Partial Disability rating was given by the treating physician
  • Attorney involvement
  • To pursue Subrogation

Most carrier or TPA systems do not allow any type of work on the file without the file being reopened by the adjuster – other than inputting a note.  Very few allow payments without reopening the file.

How Reopened Workers Compensation Claims Can Wreck Insurance Programs

The Bad Part

See this article for more info.  I wrote it back in December 2020. The old reserves that were on the file sometimes peg back to the reopening reserves. A file that was closed with $12,500 in benefits paid was reopened with $75,000 in reserves to pay a $500 bill, then not closed before the UNITSTAT Date, so an extra $60,000+ was added into their Experience Mod – ouch!   The Rating Bureaus will not back out of the increased reserves.

The same goes for self-insureds and large deductible programs.  An actuary or predictive analytics may not reduce the claim back to $12,500. ouch!

The OK Part

Usually, a Reopened Workers Compensation claims status on a loss run results from an innocuous situation.  The file had to be reopened to pay a medical bill and the file was subsequently re-closed.  Unless the bill was huge, the result will have little effect on your WC program.

Working With Your Adjuster To Get The Claim Reclosed

If a file has the R status, then an email (not a call) to the adjuster may be all you need to do on the file.  If you have online claims access, then you could review the claim to see why it was reopened.

If the file needs to stay open, just make a note of it and review it monthly or whenever you receive or request new loss runs.

Bottom Line –  Not all R Statuses are bad, but they can be negative.  Workers Compensation reopened claims need to be part of your review.

Related: Third Party Administrator Adjusts Workers Comp Claims For Self Insureds



James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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