D.C. Workers’ Compensation Claims: Eligibility, Filing, and Appeals

D.C.'s workers comp insurance provides medical benefits, temporary disability payments, and a permanent disability award, at a higher rate than in many states.

By , Attorney

Updated January 7, 2019

The workers' compensation system in D.C. is a no-fault system designed to compensate injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must take certain steps required by D.C. law.

Who Is Eligible for Workers' Comp Benefits in D.C.?

Private employers with one or more employees are required to carry workers' compensation insurance in the District of Columbia, and workers' comp covers all injuries or illnesses that happen in the course of employment. In general, injuries that happen while you are performing your work duties or running work errands are covered by workers' comp. On the other hand, if you were injured during your lunch break or during your commute to and from work, you will typically not be covered by workers' comp. For more information, see our article on what types of injuries are covered by workers' comp.

Workers' comp covers both injuries that result from a one-time accident at work, such as a broken bone from a slip and fall and injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).

What Should I Do if I'm Injured at Work?

If you're injured at work, you must report your injuries to your employer within 30 days of your injury or within 30 days of realizing that your injuries are work related (for example, in the case of occupational illness). You must complete Form 7 – Employee's Notice of Accidental Injury or Occupational Disease, and you must provide a copy to your employer and to the Office of Workers' Compensation.

In addition to giving notice, you will have to file an official workers' comp claim by completing Form 7A – Employee's Claim Application. You must provide this form to your employer and the Office of Workers' Compensation within one year of your injury or one year from the date of your last benefit payment. In most cases, though, it's in your best interests to report your injuries immediately. The sooner you give notice, the sooner your workers' comp benefits can start. And, insurance companies are less skeptical of claims when they are reported right away.

Once your employer receives notice of your injuries, it must complete a form called an "Employer's First Report of Injury or Occupational Disease" and file it with the Office of Workers' Compensation within ten days. Your employer, or its insurance company, must accept and begin payments on your claim within 14 days or send you notice of denial.

How Do I Get Medical Treatment?

In an emergency, you can choose which doctor or hospital to seek treatment from. You may also select your treating physician for non-emergency care. However, once you select a doctor, you may not change doctors unless you get the approval of the insurance company or the D.C. Office of Workers' Compensation.

What Benefits Can I Receive?

All reasonable and necessary medical treatment related to your work injury will be covered through workers' comp, including the cost of doctors' visits, hospital bills, prescriptions, and prosthetic devices. You'll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive temporary disability payments and a permanent disability award.

Temporary Disability

You will be eligible to receive compensation for wage loss during the time you are temporarily disabled and unable to work. Temporary total disability payments are two-thirds of your average weekly wages, subject to a maximum of $1,469.95.46 per week (for 2018).

You can continue to receive temporary total disability until your doctor finds that you've reached maximum medical improvement (MMI), meaning that your condition has plateaued and is not expected to improve. These benefits are available for a maximum of 500 weeks.

If you're able to return to part-time or light-duty work while you're recovering, but earn less than your normal wages, you may eligible for temporary partial disability benefits. Temporary partial disability benefits are two-thirds of the difference in your average weekly wages, subject to the same maximum weekly amount. These benefits are available for a maximum of 260 weeks.

Permanent Disability

If you are found to be totally and permanently disabled, you will receive the same weekly amount that you received in temporary total disability payments, but permanent total disability benefits are available for as long as the disability continues. These benefits are available only to workers with severely debilitating injuries, such as the loss of both hands, feet, arms legs, or eyes. Workers are considered totally disabled only if they cannot earn any wages in the same job or another job.

For most other workers, permanent partial disability benefits are available. You will receive two-thirds of your average weekly wage, up to the maximum weekly amount described above. For injuries to certain body parts, such as the arms, legs, hands, and feet, D.C. has a schedule that lists the maximum number of weeks that a worker may receive benefits. For example, a worker can receive 312 weeks for a total loss of use of an arm. If your doctor gives you a 50% permanent impairment rating of the left arm, you will receive benefits for 156 weeks.

For injuries not listed on the schedule, you will receive benefits only if you can show an actual wage loss. In general, you will receive two-thirds of the difference between your average weekly wage and the wages you are able to earn post-disability.

You may receive temporary partial disability and permanent partial disability for a combined maximum of 500 weeks.

You may also receive a lump sum award of up to $7,500 for a serious disfigurement to the face, head, neck, or other exposed body part.

What if My Workers' Comp Claim Is Denied?

If your workers' comp claim has been denied, or you have a dispute with the insurance company about your benefits, you can file an appeal with the District of Columbia Administrative Hearings Division. The first step is requesting an informal conference.

Informal Conference

You may request an informal conference before a claims examiner by filing an Application for Informal/Mediation Conference with the Office of Workers' Compensation. You and the insurance company will meet with the claims examiner, who will hear from both sides. The process is very informal, and the claims examiner will issue a written recommendation within 30 days of the conference. The recommendation is not binding, though, if either party contests it and requests a formal hearing. If neither party requests a formal hearing within the time limits set forth in the decision, the recommendation will become binding.

Requesting a Formal Hearing

Instead of requesting an informal conference, you can also immediately request a formal hearing before a workers' comp judge. To file your appeal, you must complete an Application for Formal Hearing, attach a copy of your workers' comp claim form, and sign the document to verify that everything you have provided is accurate. You must file the form with the Administrative Hearings Division (AHD). Once the AHD receives your request, it will schedule an in-person hearing before a workers' comp judge and send notice to the parties. Hearings are typically scheduled within 90 days.

The Workers' Compensation Hearing

The appeal hearing will take place at the Office of Hearings and Adjudication. Workers' compensation hearings typically last at least a few hours, but can be several hours depending on the complexity of the issues or how much evidence there is to present.

During the hearing, each party will have the opportunity to question witnesses, submit documents, and make legal arguments. A workers' comp judge will preside over the hearing and mail a written decision to the parties.

Although workers' compensation hearings are less formal than court proceedings, there are still procedural rules that must be followed. And your employer will have a lawyer representing its interests. To avoid being at a disadvantage, you should consult with a workers' compensation attorney to represent you. In most cases, you won't have to pay for attorneys' fees out of pocket. Workers' comp attorneys typically work on a contingency fee basis, which means that they take a percentage of anything recovered on your behalf.

Further Appeals

If you disagree with the judge's decision, you may appeal to the Compensation Review Board. To do so, you must file an Application for Review within 30 days. The Board will review the evidence presented at the initial hearing and make a decision. For questions, and for the Application for Review form, contact the Compensation Review Board at (202) 671-1394. If you're not satisfied with the Board's decision, you may file an appeal with the D.C. Court of Appeals within 30 days.

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