District of Columbia Administrative Code

126 MEDICAL BILLS 126.1 (a) Medical services, appliances, or supplies shall be billed and reimbursed at a rate that does not exceed the rate set forth on the medical fee schedule adopted by the Program. (b) For medical services, appliances, or supplies included on a Medicare fee …

127 UTILIZATION REVIEW 127.1 Any medical care or service furnished or scheduled to be furnished under the Act shall be subject to utilization review, regardless of whether prior authorization was required for the medical care or service. The utilization review may be performed be…

128 BENEFITS DEDUCTION 128.1 An employee who receives the following benefits on the date that he or she is injured shall continue to receive the following benefits if his or her claim for indemnity compensation is accepted, and the premiums, if any, shall be deducted from the cla…

129 COMPUTATION OF WAGE INDEMNITY; TOTAL DISABILITY 129.1 If the disability is total, subject to the limitations in Section 2306a, the employee’s monthly monetary compensation shall be sixty-six and two-thirds percent (66 2/3%) of the employee’s monthly pay. 129.2 The employee’s …

130 COMPUTATION OF WAGE INDEMNITY; PARTIAL DISABILITY 130.1 A disability is partial, when a qualified health professional determines that a claimant can perform work with restrictions, provided that: The restrictions arise out of a work-related injury; A claim has been filed for …

131 AUGMENTED PAY 131.1 Pursuant to Section 2310 of the Act, amended September 24, 2010, only employees hired before January 1, 1980 are entitled to an augmented benefits rate for dependents. SOURCE: Final Rulemaking published at 28 DCR 2307 (May 22, 1981); as amended by Emergenc…

132 COMPUTATION OF WAGE INDEMNITY; STATUTORY MAXIMUM AND MINIMUM 132.1 The statutory maximum and minimum for wage indemnity shall be calculated in accordance to Section 2312 of the Act. The calculation shall be determined by following the federal general pay scale when using Sect…

133 OVERPAYMENT 133.1 If the Program makes an overpayment to a claimant as a result of an error of fact or law, the Program shall recoup the overpayment from the claimant or, if a claimant is receiving compensation from the Program, adjust the claimant’s compensation payments to …

134 ELECTION OF COMPENSATION 134.1 A claimant receiving indemnity compensation under this chapter shall not: (a) Receive other salary, pay, or remuneration of any type from the District of Columbia, including retirement pay for employees hired by the District of Columbia on or af…

135 ELIGIBILITY 135.1 [REPEALED] 135.2 The Program shall continue to investigate the claim throughout the life of the claim to confirm that a claimant or employee is still entitled to benefits under the Act. 135.3 Claimants and employees are required to cooperate with all aspects…

136 ADDITIONAL MEDICAL EXAMINATIONS 136.1 The Program may require a claimant to participate in an Additional Medical Examination (AME) with a physician selected by the Program. 136.2 The Program shall maintain a list of AME physicians. AME physicians shall have expertise and boar…

137 REPORT OF MEDICAL EVIDENCE 137.1 The claimant is responsible for providing sufficient medical evidence to justify the continuation of payment of any compensation sought. 137.2 To support payment of continuing compensation where an employee has been found entitled to temporary…

138 REPORT OF EARNINGS 138.1 If a claimant is subject to forfeiture of his or her right to workers’ compensation pursuant to Section 2306b(b) of the Act (D.C. Official Code §1-623.06b(b)), such forfeiture shall commence on the earlier of: (a) The thirty-first (31st) day after the…

139 COST OF LIVING ADJUSTMENTS 139.1 Cost of living adjustments shall be applied to compensation calculated pursuant to Section 2305 or 2306 of the Act. 139.2 The following cost-of-living adjustments apply in the calculation of compensation for disability or death: Cost-of-living…

140 PERMANENT DISABILITY 140.1 A claimant may be eligible for permanent disability compensation pursuant to Section 2307 of the Act (D.C. Official Code § 1-623.07) upon reaching maximum medical improvement (MMI). A claimant may apply for such compensation after: (a) Reaching MMI …

141 VOCATIONAL REHABILITATION 141.1 A claimant with a permanent or temporary disability that is compensable under the Act shall undergo vocational rehabilitation at the direction of the Program for a period not to exceed ninety (90) days. 141.2 After the ninety (90) day period ha…

142 MODIFIED DUTY AND RETURN TO WORK 142.1 An employee with partial disabilities shall participate in modified work programs at the direction of the Program. 142.2 An employee who is medically released to work in full or modified duty shall notify the Program immediately within o…

143 EMPLOYEE RETENTION 143.1 (a) An employee whose claim of disability is accepted by the Program shall have the right to resume the position he or she occupied before the date of the disability, or an equivalent position, if the employee overcomes the disability within two (2) y…

144 MODIFICATION OF AWARD OF COMPENSATION 144.1 The Program may modify an award of compensation if the Program has reason to believe that the claimant’s PSWCP file and records establish: (a) A change of condition has occurred pursuant to Section 2324(d)(1) of the Act (D.C. Offici…

145 ADJUSTMENTS TO BENEFITS 145.1 A claimant’s benefits shall be adjusted, where the claimant’s PSWCP file and records establish substantial evidence that: (a) The claimant’s benefits shall be forfeited for failure to: Complete a report of earnings pursuant to § 138 of this chapt…

146 WEIGHING MEDICAL EVIDENCE 146.1 When the Program receives medical evidence from more than one source, it should evaluate the relative value, or merit, of each piece of medical evidence. 146.2 In evaluating the merits of medical reports, no preference shall be given to treatin…

147 GOOD CAUSE DETERMINATION 147.1 A good cause determination shall be supported by evidence that establishes good cause as defined at § 199.1(q) and the proponent’s failure to act does not result in undue prejudice to the opposing party. SOURCE: Final Rulemaking published at 28 …

148 ROUNDING RULES 148.1 Except where otherwise noted under this chapter, all amounts, percentages, and other numbers are rounded down to the nearest hundredth, which is two decimal places. SOURCE: Final Rulemaking published at 28 DCR 2307 (May 22, 1981); as amended by Emergency …

149 COMPUTATION OF TIME 149.1 Any days required to be counted shall be counted commencing with the day after the date referenced in the rule, or, if a decision is issued, the date after the certificate of service attached to the decision issued by the Program or hearing forum. 14…

150 TRANSPORTATION AND MILEAGE 150.1 The Program may provide a claimant with transportation to and from a physical examination or medical treatment that is authorized by the Program pursuant to this chapter. 150.2 Unless § 150.3 applies, a claimant who needs transportation to and…

151 THIRD PARTY RECOVERY 151.1 If the Program determines that an injury or death for which indemnity compensation is payable under this chapter is caused under circumstances creating a legal liability on the part of a third party to pay the District or the employee damages, the e…

152 DEATH BENEFITS 152.1 In the case of the death of an employee, the Program shall determine the compensation owed to the employee’s beneficiary or beneficiaries by following the requirements of Section 2333 of the Act. 152.2 The maximum and minimum limits on compensation includ…

153 REQUESTS FOR AUDIT OF COMPENSATION BENEFITS 153.1 A claimant who believes that the Program has incorrectly calculated his or her medical compensation, wage-loss compensation, or death benefit may request an audit of the Program’s calculation by completing Form A-1 and submitt…

154 ASSIGNMENT OF CLAIM AND DELIVERY OF COMPENSATION 154.1 An assignment for a claim of compensation under this chapter is void. 154.2 Compensation received under this chapter is exempt from the claims of creditors. This subsection does not apply in the case of a valid court orde…

155 OFFICE OF ADMINISTRATIVE HEARINGS (OAH), JURISDICTION 155.1 Beginning December 1, 2016, the following decisions shall be appealed to the Office of Administrative Hearings (OAH): (a) Initial awards for or against compensation benefits pursuant to Section 2324(b) of the Act (D.…

156 OFFICE OF RISK MANAGEMENT, JURISDICTION 156.1 A claimant who is dissatisfied with a decision issued by the Program, other than a decision subject to review by OAH as set forth in § 155 of this chapter, may only appeal the decision to the Chief Risk Officer. 156.2 Appeals to t…

157 HEARING RULES 157.1 OAH Rules 2950 through 2969 (OAH Rules) shall apply to management of PSWCP cases filed pursuant to Section 2324 of the Act (D.C. Official Code § 1-623.24) with the Department of Employment Services, Office of Hearings and Adjudications (OHA) and Office of …

158 HEARINGS, STANDARD OF REVIEW 158.1 All appeals of Program decisions before the OAH and OHA shall be reviewed under a de novo standard of review. SOURCE: Final Rulemaking published at 28 DCR 2307 (May 22, 1981); as amended by Emergency and Proposed Rulemaking published at 57 D…

159 HEARINGS, BURDEN OF PROOF 159.1 Burden of Proof, Initial Determination. Claimant has the burden to prove, by a preponderance of the evidence (more likely than not) (a) That the injury was work related; and (b) The extent and nature of Claimant’s injuries and disability. 159.2…

160 HEARING DECISIONS, COMPLIANCE AND ENFORCEMENT 160.1 The ALJ shall issue an order to reverse, modify, affirm, or remand a determination rendered by the Program within thirty (30) days after the hearing ends or the record closes. 160.2 Unless the OHA or OAH decision is stayed b…

161 INTEREST ON COMPENSATION AWARDS 161.1 Interest may only be awarded where the Program fails to make payment toward the compensation award within twelve (12) months after the date of the compensation order. 161.2 Interest on compensation awards, when awarded, shall: (a) Be the …

162 ATTORNEY’S FEES 162.1 “Actual benefit secured” for the purposes of Section 2327 of the Act (D.C. Official Code § 1-623.27) means the total established amount of benefits secured by an attorney in connection with a hearing or court proceeding through the date of the compensati…

163 ADMINISTRATIVE AND JUDICIAL REVIEW 163.1 The provisions of 7 DCMR §§ 250 to 271 concerning administrative appeals to the Compensation Review Board (sometimes referred to in these regulations as the Board) established pursuant to the Directive of the Director of the Department…

199 DEFINITIONS 199.1 The definitions set forth in Section 2301 of Title 23 (Workers’ Compensation) of the District of Columbia Government Comprehensive Merit Personnel Act of 1978, effective March 3, 1979 (D.C. Law 2-139; D.C. Official Code §§ 1-623.01 et seq. (2016 Repl. & 2019…

1000 PURPOSE AND SCOPE 1000.1 The purpose of this chapter is to establish principles and guidance for the implementation of the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.1, et seq.) (Act). 1000.2 Unless otherwise required by law…

1001 LIVING WAGE PAYMENT REQUIREMENT 1001.1 All recipients of District of Columbia government contracts in the amount of one hundred thousand dollars ($100,000) or more, and all recipients of government assistance in the amount of one hundred thousand dollars ($100,000) or more, …

1002 AMOUNT OF LIVING WAGE 1002.1 The amount of the living wage shall be eleven dollars and seventy-five cents ($11.75) per hour, regardless of whether health benefits are provided. The amount of the living wage shall be adjusted pursuant to section 103(c) of the Act (D.C. Offici…

1003 NOTICES TO CONTRACTORS AND SUBCONTRACTORS 1003.1 All contracts and agreements for government assistance subject to the Act shall include provisions and language incorporating the requirements of the Act as to coverage (section 103, D.C. Official Code § 2-220.03), notices (se…

1004 NOTICES TO EMPLOYEES 1004.1 The Director shall provide a fact sheet and notice to each recipient of a District of Columbia government contract and government assistance subject to the Act. 1004.2 The fact sheet and notice shall contain the following: (a) Notice of the living…

1005 CREATION AND RETENTION OF RECORDS 1005.1 Each recipient of a District of Columbia government contract or government assistance subject to the Act, and their subcontractors subject to the Act, shall retain payroll records created and maintained in the ordinary course of busin…

1006 ENFORCEMENT 1006.1 A complaint concerning the payment of wages required by the Act shall be made in accordance with, and shall be subject to, the provisions of an Act To provide for the payment and collection of wages in the District of Columbia, approved August 3, 1956 (70 …

1007 EXEMPTIONS 1007.1 The following types of contracts, government assistance, and employment are exempt from the requirements of the Act: (a) Contracts or other agreements that are subject to higher wage level determinations required by federal law; (b) Existing and future coll…

1008 WAIVERS 1008.1 The Director may exempt a recipient from the requirements of the Act if the waiver is approved by the Council of the District of Columbia. 1008.2 A recipient requesting a waiver shall submit a signed written application to the Director and shall demonstrate th…

1099 DEFINITIONS 1099.1 When used in this chapter, the following terms shall have the meanings ascribed: Affiliated employee – an employee of a recipient who receives compensation either directly from the government contract or assistance or from the government funds paid to a su…

1100 PURPOSE AND SCOPE 1100.1 The purpose of these rules is to set forth labor standards, policies and procedures relative to the registration and deregistration of apprenticeship programs and to the registration of apprenticeship agreements and the resolution of disputes thereun…