Petition to Reopen Form


An injured worker or authorized representative may petition to reopen a previously closed claim to secure additional benefits upon the basis of new, additional or previously undiscovered temporary or permanent condition by filing this form with the Commission.  

IMPORTANT:  This petition to reopen form must be completed in its entirety and must be accompanied by a statement from a physician setting forth the physical condition which serves the basis for reopening and its relationship to the industrial injury.

Adobe ESign Form