Section 7-299. DEFINITIONS

 

299.1The definitions found in §2 of the Act [§36-301, D.C. Code, 1981 ed.], shall apply to this chapter. In addition, the following terms shall have the meaning ascribed:

 

Act - the District of Columbia Workers' Compensation Act, as amended, (D.C. Law 3-77, effective July 1, 1980, §36-301 et seq., D.C. Code, 1981 ed.).

 

Amendment - the Workers' Compensation Equity Amendment Act of 1990 (D.C. Law 8-198).

 

Attending Physician - the treating physician selected by the claimant to treat the injury or disability. Treatment given by a physician initially selected by the employer or on an emergency basis shall not be considered the selection of an attending physician.

 

Beneficiary - the surviving spouse, children or other relatives set forth in §10(d) of the Act [§36-309(4), D.C. Code, 1981 ed.] of an employee whose job related injury results in death and shall include any person claiming to be entitled to compensation for the death of an injured employee.

 

Benefits - compensation for death, wage loss, medical and hospital treatment, health insurance coverage, and vocational rehabilitation provided pursuant to the Act.

 

Binder - an agreement, or memorandum thereof, whereby an agency or carrier undertakes to provide coverage to an employer pending filing of notice of coverage with the Office.

 

Certified Safety Professional - any person who has been certified by the American Society of Safety Engineers, American Industrial Hygiene Association or other nationally recognized health and safety industry organization.

 

Claim - an application for benefits made by an injured employee or his or her beneficiary under Section 8, 9, and 10 of the Act (D.C. Code §36-307, 36-308, and 36-309, (1981) and (1991 Suppl.)).

 

Claimant - an individual who files a claim for benefits under Section 8, 9, or 10 of the Act (D.C. Code §36-307, 36-308, and 36-309).

 

Compensation Order - an order of a Hearing or Attorney Examiner of the Office which rejects a claim or which makes an award of compensation in respect of a claim under the Act.

 

Council - the National Council on Compensation Insurance, one of whose functions is to assign involuntary coverage to an employer for which coverage cannot be obtained on a voluntary basis in accordance with a voluntary plan.

 

Coverage - an insurance or other securities to secure the payment of benefits to the employees of employers as defined in this section.

 

Day - a calendar day, unless otherwise specified in the Act or this chapter.

 

Department - the Department of Employment Services.

 

Director - the Director of the District of Columbia Department of Employment Services or his or her designated agent.

 

Establishment - the place where the activities of an enterprise are conducted.

 

Final Order - an order issued by the Office which formalizes the outcome of an informal or vocational rehabilitation conference.

 

Formal Hearing - the formal adjudicative processes which are conducted by an Administrative Law Judge or a Hearing or Attorney Examiner in accordance with the District of Columbia Administrative Procedure Act, the Act, and subsequent amendments.

 

Hearing - the formal adjudicative process conducted by a Hearing or Attorney Examiner in accordance with the District of Columbia Administrative Procedure Act [§1-1501 et seq., D.C. Code, 1981], and the Act.

 

Hearings and Adjudication Section - the office responsible for conducting pre-hearing conferences and formal hearings on claims for benefits.

 

Identification Number - the employer's numerical designation of an establishment assigned by the Federal Government.

 

Injury - an injury as defined in §2(1) of the Act [§36-301(12), D.C. Code, 1981 ed.], which combined with a previous occupational or non-occupational disability or physical impairment causes substantially greater disability or death.

 

Insurance Commissioner - the head of the District of Columbia Department of Insurance and Securities Regulation agency.

 

Insurer - a "carrier" as defined in §2(c) of the act or a self-insured employer.

 

Interested Party - the District of Columbia, and an employer, a carrier, an employee, or a beneficiary whose rights or obligations pursuant to a claim under the Act shall be determined in a particular proceeding, including a mediation conference. Any person appearing at the mediation conference who does not have authority to settle is not an interested party.

 

Joint Pre-Hearing Statement Form - a form prepared by the party applying for formal hearing and signed by both interested parties that is required to be filed with OHA that includes a brief statement of facts; lists of all uncontested or stipulated facts, contested issues of fact and law, exhibits, witnesses; and statements that discovery is complete and that settlement was actively considered.

 

Maintenance Expense - an additional payment (not to exceed fifty dollars ($50) a week) made under §8(a) of the Act [§36-307(a), D.C. Code, 1981 ed.], by an employer to an injured employee which the Office has determined is necessary for the maintenance of an employee undergoing vocational rehabilitation.

 

Mediation - the process authorized by this Chapter whereby a claims examiner acts as a mediator to encourage and facilitate the resolution of workers' compensation disputes or claims between two (2) or more parties by assisting such parties in reaching a mutually acceptable and voluntary agreement, thereby dispensing with the need for adjudication by formal hearing.

 

Medical Services and Supplies - a medical, surgical, vocational rehabilitation services (including necessary travel expenses and other attendance or treatment), nurse and hospital service, medicine, crutches, false teeth or the repair thereof, and any artificial or prosthetic appliance.

 

Occupational Disease - a disease or infection generally recognized by the medical profession as a disease or infection arising naturally out of a particular employment. The term includes, but is not limited to, pneumoconiosis, silicosis, asbestosis, and radiation diseases.

 

Office - the Private Sector Branch of the Office of Workers' Compensation in the Labor Standards Division of the Department of Employment Services.

 

Office of Hearings and Adjudication (OHA) - the administrative entity responsible for conducting formal hearings on claims for benefits.

 

Physician - a physician, dentist, osteopath, podiatrist, or chiropractor licensed in:

 

(a)accordance with the District of Columbia Health Occupations Revisions Act of 1985, effective January 26, 1986 (D.C. Law 6-99; D.C. Code §2-3301 et seq.) or;

 

(b)any state or jurisdiction of the United States, in accordance with the laws of that state or jurisdiction.

 

Poster - the employer's notice of compliance with the Act, prescribed by the Department, which is to be conspicuously posted for the information of all employees in accordance with §37 of the Act [§36-336, D.C. Code, 1981 ed.].

 

Pre-Hearing Conference - a conference conducted by a Hearing or Attorney Examiner for the purpose of defining issues set for formal hearing and/or resolving issues prior to conducting the formal hearing.

 

Rehabilitation Conference - a conference conducted for the purpose of determining the adequacy, feasibility, and sufficiency of the vocational rehabilitation services.

 

Reinstatement - the restoring of coverage to effective status.

 

Scheduling Order - an Order issued by OHA to all interested parties within ten (10) working days of receipt. of an application for formal hearing which mandates the parties to submit a Joint Pre-Hearing Statement and sets a date by which a Motion to Amend the Joint Pre-Hearing Statement must be served on the opposing party, a date for the discovery period to close, and a date by which all documentary exhibits will be exchanged and submitted.

 

Second Injury - an injury as defined in Section 2 (1) of the Act (D.C. Code §36-301 (1981) which combined with a previous occupational or non-occupational disability or physical impairment causes substantially greater disability or death. For injuries occurring on or after April 16, 1999, the second injury fund is repealed.

 

Self-insurer - an employer who has supplied satisfactory proof of financial ability to pay and has been authorized under §35(a)(2) of the Act (§36-334(a)(2), D.C. Code, 1981 ed.) and §217 of this Chapter to pay compensation for disability or death benefits directly to a claimant or beneficiary instead of securing insurance coverage through a carrier.

 

Termination - the cessation of coverage for one of the reasons set forth in Section 216.8 of this chapter.

 

Utilization Review - evaluation of only the necessity, character, and sufficiency of both the level and quality of medically related services provided an injured employee based upon medically related standards (D.C. Code Section 36-301(r-1) and §36-307(b)).

 

Vocational Rehabilitation Services - those services required and designed, within reason, to return an injured employee to employment at a wage as close as possible to the wage or greater than what the employee may include the following: vocational counseling, retraining and job skills development, and job placement.

 

Working Days - the District of Columbia Government business days, excluding Saturdays, Sundays and legal holidays.

 

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).