Section 7-231. SPECIAL FUND

 

231.1The Associate Director for the Office of Workers' Compensation, or his or her designee, shall be the custodian of the Special Fund and, in administering the provisions of §41 of the Act [§36-340, D.C. Code, 1981 ed.], shall observe the customary duties and obligations of a fiduciary.

 

231.2For purposes of this section, the term "award" means any final order issued under §21 of the Act [§30-320, D.C. Code, 1981 ed.] finding the employer liable for any of the following:

 

(a)Compensation benefits under §9 of the Act [§36-308, D.C. Code, 1981 ed.];

 

(b)Death benefits under §10 of the Act [§36-309, D.C. Code, 1981 ed.];

 

(c)Supplemental allowances under §7 of the Act [36-306, D.C. Code, 1981 ed.];

 

(d)Medical services and supplies under §8 of the Act [§36-307, D.C. Code, 1981 ed.]; and

 

(e)Attorneys' fees under §31 of the Act [§36-330, D.C. Code, 1981 ed.].

 

231.3The term "award" shall not apply to any order finding an employer in violation of the discriminatory discharge provision of Section 43 of the Act (D.C. Code §36-342).

 

231.4Under §41(a) of the Act [§36-340(a), D.C. Code, 1981 ed.], payments may be made from the Special Fund for any of the following:

 

(a)For the provision of vocational rehabilitation services ordered by the office under §8(c) of the Act [36-307(c), .D.C. Code, 1981 ed.;

 

(b)For the expenses of medical examinations required by the Office under §8(e) of the Act [§36-307(e), D.C. Code, 1981 ed.];

 

(c) For supplemental compensation benefits due an employee whose injury occurred prior to April 16, 1999 and is a second injury under Section 9(f) of the Act (D.C. Code §36-308(d));

 

(d)For the satisfaction of a judgment for an award, including reasonable medical expenses and attorney fees under §20(b) of the Act [§36-319(b), D.C. Code, 1981 ed.].

 

(e)For Utilization Review.

 

231.5The Office may pay from the Special Fund, the medical expenses of an examination ordered by the Associate Director, pursuant to §8(e) of the Act [36-307(e), D.C. Code, 1981 ed.] and §212.19, only after making an unsuccessful demand upon the self-insured employer or the carrier to pay the expenses and only after determining either that the carrier or employer is insolvent or that it would further the interest of justice to make the payment from the Special Fund.

 

231.6An employer liable for compensation payments in connection with a second injury may file with the Associate Director, an application for an order finding the Special Fund liable for supplemental compensation payments under §9(f) of the Act [§36-308(d), D.C. Code, 1981 ed.].

 

231.7All issues of an employer's liability and the extent and nature of compensation payable under an approved claim shall be in final disposition prior to filing a request for relief for the second injury from the Special Fund.

 

231.8Upon the filing of an application for an order finding the Special Fund liable for supplemental compensation benefits, the Associate Director shall investigate the matter to ensure, among other things, that there are no substantial matters in dispute and that the employer has made or is making appropriate payments to the disabled employee or beneficiary.

 

231.9Within sixty (60) days following the filing of the application, the Associate Director shall issue an order which determines the liability of the Special Fund for compensation benefits; Provided, that the Associate Director may order the submission of additional evidence.

 

231.10If additional evidence is ordered to be submitted pursuant to §231.9, the Associate Director shall issue an order within thirty (30) days of receipt of the evidence. The order shall state the reasons for its determination.

 

231.11An employer aggrieved by an adverse determination, pursuant to §231.8, may request, within thirty (30) days, a formal hearing pursuant to §220 of this chapter.

 

231.12An employer who has obtained an order finding the Special Fund liable for compensation payments for a second injury disability may file, on a quarterly basis, a request for reimbursement for compensation payments.

 

231.13The request for reimbursement shall be in a manner prescribed by the Associate Director and shall be accompanied by invoices, payment records, cancelled checks or such other documents as the Associate Director may require.

 

231.14The Associate Director may require any additional proof as he or she deems necessary to complete an investigation of the reimbursement request.

 

231.15Upon completion of his or her review and within thirty (30) days of the receipt of the request for reimbursement, the Associate Director shall disburse from the Special Fund the payments to which he or she finds the employer entitled.

 

231.16Under §20(b) of the Act [§36-319(b), D.C. Code, 1981 ed.], the Associate Director may make from the Special Fund, payments upon any award if the employer is insolvent and had defaulted. Special Fund payments may provide for necessary medical, surgical or other treatment required by §8 of the Act [§36-307, D.C. Code, 1981 ed.]

 

231.17A claimant, beneficiary or attorney who has obtained an award and a judgment based thereon may apply for Special Fund payments pursuant to §20 of the Act [§36-319, D.C. Code, 1981 ed.].

 

231.18The application for Special Fund payments pursuant to §231.17 shall be filed with the Associate Director within twenty-four (24) months of the date of the judgment together with a statement of the efforts made to enforce the judgment under §23(c) of the Act [§36-322(c), D.C. Code, 1981 ed.] and copies of the award, the declaratory supplementary default order, any mandatory injunction, and a certified copy of the judgment.

 

231.19Upon receipt of the application for Special Fund payment, the Associate Director shall investigate the allegations contained in the application, the financial position of the employer or carrier, and such matters which the Associate Director deems necessary to a just decision.

 

231.20Within twenty (20) working days of receipt of the application for Special Fund payment pursuant to §231.17, the Associate Director shall issue an order granting or denying the relief sought in the application.

 

231.21In investigating any request for payments from the Special Fund under this section, the Associate Director is authorized under §30(a) of the Act [§36-329(a), D.C. Code, 1981 ed.] to issue any orders, subpoenas, interlocutories, or other process to any person as may be necessary to discharge his or her duties.

 

231.22The total assessment amount shall be allocated between self-insured employers and insured employers based on paid losses for the fiscal year preceding the year in which the assessment is based.

 

231.23The method of assessing self-insured employers shall be based upon paid losses. The method for assessing insured employers shall be a surcharge based upon a premium as set forth in the subsection.

 

231.24The portion of the total aggregate assessment to be collected from self-insured employers shall be equal to that proportion of the total paid losses during the preceding fiscal year, which the total paid losses of all self-insured employers and insurers on behalf of all insured employers during the preceding fiscal year.

 

231.25The portion of the total aggregate assessment that shall be collected from insured employers shall be equal to that proportion of the total paid losses during the preceding fiscal year, which the total paid losses made on behalf of all insured employers bore to the total paid losses made by self-insured employers and insurers on behalf of all insured employers during the preceding fiscal year.

 

231.26The method for determining the total paid losses and the proportions shall be based upon the quarterly reports required pursuant to subsection 233.12 of this Chapter.

 

231.27On or after September 1st each year, the Office shall notify each self-insured employer of its assessed prorata share and shall notify insurers of the premium surcharge rate applicable to policies of insured employees.

 

231.28Each self-insured's assessment shall be payable upon receipt of the notice of assessment and be paid no later than thirty (30) days after receipt of the assessment notice.

 

231.29At the end of each quarter, each insurer shall submit to the Office, an amount equal to the premium surcharge collected from its policyholders during that quarter. The payment shall be submitted no later than thirty (30) days after each quarter ends.

 

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).