D.C. Mun. Regs. tit. 7, r. 7-119

Current through Register Vol. 71, No. 43, October 25, 2024

Rule 7-119 - EVIDENCE AND BURDEN OF PROOF; CLAIMS

119.1

For initial claims, the forms identified in § 115 of this chapter describe the basic evidence required. The Program may send a request for additional evidence to the claimant and to his or her representative, if any; however the burden of proof still remains with the claimant. Evidence should be submitted in writing. The evidence submitted must be reliable, probative, and substantial. Each claimant seeking compensation must establish, by a preponderance of the evidence, the following:

(a) The claim was filed within the time limits specified or otherwise permitted by the Act;

(b) The injured person was, at the time of injury, an employee within the meaning of § 2301(1) of the Act;

(c) The fact that an injury, disease, or death occurred;

(d) The injury, disease or death occurred while the claimant was in the performance of duty;

(e) The medical condition for which compensation or medical benefits is claimed is causally related to the claimed injury, disease or death. Neither the fact that the condition manifests itself during a period of District government employment, nor the belief of the claimant that factors of employment caused or aggravated the condition, is sufficient in itself to establish causal relationship; and

(f) If the claimant seeks indemnity compensation, the nature, extent, and duration of his or her inability to work and its causal connection to the work related injury, disease, or death.

119.2

For a claim of recurrence of disability, the employee has the burden of establishing by a preponderance of the evidence that

(a) The claim was timely filed within the time limits prescribed in this chapter;

(b) That the disability is causally related to an original injury that has been accepted by the Program; and

(c) If the claimant seeks indemnity compensation, the nature and extent of his or her inability to work.

119.3

In seeking to file a supplemental claim pursuant to § 115.11 of this chapter, the claimant must establish the following by a preponderance of the evidence:

(1) Good cause for the delay in reporting;

(2) That the additional disability or condition is timely reported in accordance with § 115.11 of this chapter;

(3) That the additional disability or condition is compensable under Section 2302 of the Act;

(4) If the claimant seeks indemnity compensation, the nature and extent of his or her inability to work and its causal connection to the work-related injury, disease, or death; and

(5) That the additional disability or condition is directly related to the original injury for which the claim was initially accepted.

119.4

For claims for permanent disability, including those filed pursuant to Section 2306 a of the Act, the claimant must establish, by a preponderance of the evidence, that he or she has reached maximum medical improvement and suffers a permanent impairment that is compensable pursuant to Section 2307 of the Act.

119.5

In all claims, the employee is responsible for submitting, or arranging for submittal of, a medical report from the treating physician. For indemnity compensation benefits, the employee must also submit medical evidence showing that the condition claimed is disabling and the nature and extent of the disability to justify continued payment of indemnity compensation.

D.C. Mun. Regs. tit. 7, r. 7-119

Final Rulemaking at 43 DCR 1466(March 22, 1996); as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 9540 (October 8, 2010)[EXPIRED]; as amended by Notice of Final Rulemaking published at 57 DCR 12224, 12232 (December 24, 2010); repealed and replaced by Final Rulemaking published at 59 DCR 8766, 8785 (July 27, 2012); amended by Final Rulemaking published at 64 DCR 6325 (7/7/2017); amended by Final Rulemaking published at 66 DCR 4246 (4/5/2019)

Authority: Chief Risk Officer of the Office of Risk Management (ORM), Executive Office of the Mayor, pursuant to the authority set forth in section 2344 of the District of Columbia Government Merit Personnel Act of 1978 (CMPA), effective March 3, 1979 (D.C. Law 2-139; D.C. Official Code § 1-623.44 (2012 Supp.)); section 7 of Reorganization Plan No. 1 of 2003 for the Office of Risk Management, effective December 15, 2003; and Mayor's Order 2004-198, effective December 14, 2004