Section 7-219. INFORMAL PROCEDURES

 

219.1Informal procedures may be utilized by the Office to resolve in a manner acceptable to all interested parties any matter in dispute regarding a claim.

 

219.2Informal procedures may include informal conferences or informal conferences with mediation services; provided, that participation by interested parties in these conferences shall be voluntary.

 

219.3Prior to the informal conference, the parties shall file with the Office the following documents:

 

(a)The notice of injury and claim;

 

(b)The employer's report of injury;

 

(c)Evidence of insurance coverage, if any;

 

(d)The notice of controversion, if any.

 

(e)medical records.

 

219.4Failure to file the required documents, pursuant to §219.3, prior to convening the informal conference shall not prevent the interested parties from going forward with the conference.

 

219.5A matter may be resolved through written communication, copies of which shall be maintained in the official record.

 

219.6Informal proceedings may begin at anytime after notice of claim is served on the interested parties.

 

219.7The Office shall, in the context of open discussion, utilize maximum efforts through conference, persuasion, and conciliation to eliminate any disputes and to reach a resolution acceptable to all interested parties.

 

219.8Each controverted claim or medical benefits shall be investigated by the Office. The Office shall attempt to resolve disputes with respect to a claim in a manner designed to protect the rights of the interested parties at the earliest practicable date.

 

219.9Informal conferences may be conducted by telephone.

 

219.10To the extent practicable, informal conferences shall be held with all interested parties present or represented.

 

219.11The Office, when investigating claims by telephone or with only one (1) interested party present, shall ensure that a complete written report is made of all matters discussed.

 

219.12Informal conferences may be scheduled by the Office upon not less than ten (10) working days notice to all interested parties, unless the parties agree to meet at an earlier date.

 

219.13Notice of informal conference may be given by telephone, but shall be confirmed in writing on a form prescribed by the Office which sets forth the date, time and place of the conference, and the matters to be discussed. For good cause shown, conferences may be rescheduled.

 

219.14No stenographic record shall be made of any informal procedure and no witnesses shall be called.

 

219.15Informal conferences shall be held at the Office unless otherwise designated.

 

219.16Following an informal conference at which an agreement is reached, the Office shall, within fourteen (14) working days after the conclusion of the conference, prepare a Final Order which embodies the agreement.

 

219.17If a claim is resolved by telephone discussion or by exchange of written correspondence, the parties shall be notified in the same manner and the Office shall prepare a Final Order setting forth the terms agreed upon.

 

219.18If at the close of an informal conference, the parties have not reached an agreement on all of the disputed issues, the Office shall evaluate all the available information and prepare a Memorandum of Informal Conference containing recommendations.

 

219.19Copies of the Memorandum of Informal Conference shall be sent by certified mail to the parties and their representatives.

 

219.20The parties shall have fourteen (14) working days after receipt of the Memorandum of Informal Conference within which to signify in writing whether they agree or disagree with the terms of the memorandum.

 

219.21If the parties agree with the Memorandum of Informal Conference, the parties shall prepare, and submit to the Office within fourteen (14) working days, a joint statement signed by the parties indicating their acceptance of the terms of the memorandum and their intent to be bound by the terms. The Office shall issue a Final Order consistent with the provisions of §219.16 of this chapter.

 

219.22If an application for formal hearing is not filed in accordance with §220 of the chapter within thirty-four (34) working days after the issuance of the Memorandum of Informal Conference, said Memorandum shall become final. Thereafter, the Office shall issue a Final Order which shall be sent by certified mail to the parties and their representatives, and the Hearings and Adjudication Section. An aggrieved party may request a review by the Director, DOES.

 

219.23All informal procedures shall terminate when an application for formal hearing is filed.

 

source

Notice of Final Rulemaking published at 41 DCR 3213 (June 3, 1994); as amended by Final Rulemaking published at 47 DCR 6454 (August 11, 2000).