 |
D.C. Municipal Regulations (Last Updated: September 13, 2017) |
 |
Title 7. EMPLOYMENT BENEFITS |
|
Chapter 7-1. [DELETED] |
Section 7-199. DEFINITIONS
-
199.1The definitions set forth in section 2301 of Title 23 (Workers’ Compensation) of the District of Columbia Government Comprehensive Merit Personnel Act of 1978 (D.C. Law 2-139; D.C. Official Code §§ 1-623.01, et seq.) (2006 Repl. & 2012 Supp.) shall apply to this chapter. In addition, for purposes of this chapter, the following definitions shall apply and have the meanings ascribed:
Act – the District of Columbia Comprehensive Merit Personnel Act of 1978 (D.C. Law 2-139; D.C. Official Code §§ 1-623.01, et seq. (2006 Repl. & 2012 Supp.)), as amended and as it may be hereafter amended.
Administrative Law Judge or ALJ – a hearing officer of the Office of Hearings and Adjudication in the Administrative Hearings Division of the Department of Employment Services.
Alive and well check – an inquiry by the Program to confirm that a claimant who is receiving benefits still meets the eligibility requirements of the Program.
Beneficiary – an individual who is entitled to receive death benefits under the Act.
Best practices – practices that reflect well-established methods of adjustment for weighing evidence, consulting industry reference materials, seeking advice from medical consultants, and engaging in the other steps of adjustment commonly known in the Public Sector Workers’ Compensation field.
Claim – an assertion properly filed and otherwise made in accordance with the provisions of this chapter that an individual is entitled to benefits under the Act.
Claim File – all program documents, materials, and information, written and electronic, pertaining to a claim, excluding that which is privileged or confidential by law or custom within the Public Sector Workers' Compensation industry, and under District of Columbia law.
Claimant – an individual who files a claim for benefits under the Act or who is receiving those benefits.
Compensation – the money allowance payable to a claimant or his or her dependents and any other benefits paid under the Act, including medical benefits.
Controversion – holding a claim in abeyance due to insufficient information to either accept or deny the claim.
Earnings – for the purposes of § 104, any cash, wages, or salary received from self-employment or from any other employment aside from the employment in which the worker was injured. It also includes commissions, bonuses, and cash value of all payments and benefits received in any form other than cash. Commissions and bonuses earned before disability but received during the time the employee is receiving workers’ compensation benefits do not constitute earnings that must be reported.
Eligibility Determination (ED) – a decision concerning, or that results in, the termination, suspension, modification, or reduction of a claimant's existing Public Sector Workers’ Compensation benefits, excluding de minimus modifications and corrections of technical errors that affect five percent (5%) or less of the claimant's monetary benefits.
Employee – (a) A civil officer or employee in any branch of the District of Columbia government, including an officer or employee of an instrumentality wholly owned by the District of Columbia government, or of a subordinate or independent agency of the District of Columbia government, as defined by D.C. Official Code § 1-603.01(7)(2012 Supp.);
(b) An individual rendering personal service to the District of Columbia government similar to the service of a civil officer or employee of the District of Columbia, without pay or for nominal pay, when a statute authorizes the acceptance or use of the service or authorizes payment of travel or other expenses of the individual, but does not include a member of the Metropolitan Police Department or the Fire and Emergency Medical Services Department who has retired or is eligible for retirement pursuant to D.C. Official Code §§ 5-707 through 5-730 (2008 Repl. & 2012 Supp.); and
(c) An individual selected pursuant to federal law and serving as a petit or grand juror and who is otherwise an employee for purposes of this chapter as defined by paragraphs (a) and (b) above.
The phrase “personal service to the District of Columbia government” as used for the definition of employee means working directly for a District government agency or instrumentality, having been hired directly by the agency or instrumentality; it does not mean working for a private organization or company that is providing service to the District government or a District agency or instrumentality.
Employment Agency – the agency or instrumentality of the District of Columbia government which employs or employed an individual who is defined as an employee by the Act.
Good Cause – Substantial or legally sufficient ground or reason, one that affords a legal excuse, depending on the circumstances of an individual case. The finding of its existence lies largely in the discretion of the official or court to which the decision is committed.
Indemnity payment or compensation – the money allowance paid to a claimant by the Program to compensate for the wage loss experienced by the claimant as a result of an injury sustained while in the performance of his or her duty, calculated pursuant to §§ 114 and 141 of this chapter.
Initial Determination (ID) – a decision regarding initial eligibility for benefits under the Act, including decisions to accept, deny, or controvert new claims, pursuant to this chapter.
Loss of wage earning capacity (LWEC) payment – indemnity compensation payable to a claimant pursuant to § 141 of this chapter that is the difference between the employee’s pre-injury salary and the claimant’s current wage earning capacity.
Mayor – the Mayor of the District of Columbia or a person designated to perform his or her functions under the Act.
Medical opinion – a statement from a physician, psychiatrist, psychologist, or other acceptable medical source that reflects judgments about the nature and severity of an impairment, including symptoms, diagnosis and prognosis, physical or mental restrictions, and what the employee or claimant is capable of doing despite his or her impairments.
Office of Hearings and Adjudication – the office in the Administrative Hearings Division of the Department of Employment Services where Administrative Law Judges adjudicate workers’ compensation claims, including public sector workers’ compensation claims under D.C. Official Code §§ 1-623.01, et seq. (2006 Repl. & 2012 Supp.).
Office of Risk Management (ORM) – the agency within the Government of the District of Columbia that is responsible for the District of Columbia's Public Sector Workers’ Compensation Program or its designee.
Official Superior – the immediate supervisor of the employee. In the event the immediate supervisor is not available, official superior shall mean the person acting as the employee’s immediate supervisor or the officer having responsibility for the supervision, direction, or control of the employee.
Permanent Partial Disability (PPD) payment – a schedule award calculated and paid to a claimant who has suffered a permanently disabling injury to a member, body part or organ pursuant to § 121 of this chapter.
Permanent Total Disability (PTD) – indemnity compensation payable to a claimant pursuant to § 114 when a qualified physician has determined that a claimant has reached maximum medical improvement and is unable to work on a permanent basis. The indemnity compensation is calculated by the Program pursuant to § 114 of this chapter. Nothing shall prohibit the Program from obtaining or accepting a later opinion from a qualified physician that states that the claimant has recovered from his or her injury.
Program – the Public Sector Workers’ Compensation Program of the Office of Risk Management or its designee, including the third party administrator.
Qualified health professional or qualified physician – includes a surgeon, podiatrist, dentist, clinical psychologist, optometrist, orthopedist, neurologist, psychiatrist, chiropractor, or osteopath practicing within the scope of his or her practice as defined by state law. The term includes a chiropractor only to the extent that reimbursable services are limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist and subject to regulation by the Mayor.
Temporary partial disability payment (TPD) – indemnity compensation payable to a partially disabled claimant pursuant to § 114 that is sixty-six and two thirds percent (66 2/3%) or seventy-five percent (75%) of the difference between the claimant’s pre-injury salary and the claimant’s current salary. The indemnity compensation is calculated by the Program pursuant to § 114 of this chapter.
Temporary total disability payment (TTD) – indemnity compensation payable to a completely disabled claimant pursuant to § 114 that is sixty-six and two thirds percent (66 2/3%) or seventy-five percent (75%) of the claimant’s pre-injury salary. The indemnity compensation is calculated by the Program pursuant to § 114 of this chapter.
Treating physician -- the physician, psychiatrist, psychologist, or other medical source who provided the greatest amount of treatment and who had the most quantitative and qualitative interaction with the employee or claimant.