Application To Reopen Claim Due To Worsening Of Condition {F242-079-000}

F242-079-000 - APPLICATION TO REOPEN CLAIM DUE TO WORSENING OF CONDITION. This form is used by workers in Washington State to request the reopening of a previously closed workers’ compensation claim when their medical condition related to a workplace injury or occupational disease has objectively worsened. This form must be completed by both the injured worker and their treating medical provider. The worker is responsible for filling out personal information, details of the original injury, current symptoms, employment status, and any new injuries or treatments since the claim closure. They must then submit the form to their provider within 30 days of receiving any medical services necessitated by the worsening condition. The complete application must be received by the Washington State Department of Labor & Industries (L&I) or the self-insured employer within 60 days of those services. The medical provider is required to document the clinical basis for determining that the condition has worsened, based on objective medical evidence and comparison with prior findings. The provider must also detail any resulting work restrictions and treatment plans. If approved, the claim may be reopened for further medical benefits or time-loss compensation; however, if the application is denied after benefits were issued, the worker may need to repay those benefits. www.FormsWorkflow.com