D.C. Mun. Regs. tit. 7, r. 7-209

Current through Register Vol. 71, No. 50, December 13, 2024

Rule 7-209 - VOLUNTARY PAYMENT OF COMPENSATION

209.1

Under § 16(a) of the Act [§ 36 -315(a), D.C. Code, 1981 ed.], compensation shall be paid directly to an employee or beneficiary by the insurer on behalf of the employer without an award unless the employer controverts in writing, on a form prescribed by the Office, the liability to pay under § 16(d) of the Act [§ 36 -315(d), D.C. Code, 1981 ed.] and § 210 of this chapter.

209.2

The first voluntary payment of compensation, including accrued benefits, if any, shall be made within fourteen (14) working days after the employer has knowledge of the injury.

209.3

Compensation shall be paid promptly every two (2) weeks thereafter.

209.4

The insurer shall file Memo of Payment with the Office upon making the initial voluntary payment.

209.5

The insurer shall file Notice of Controversion with the Office upon stopping payment for any reason no later than three (3) working days after the payments are suspended.

209.6

The Notice of Controversion shall contain the information required by § 210.3 of this chapter.

209.7

If final payment of compensation is the reason for stopping payment, Notice of Final Payment shall be filed by the insurer with the Office within sixteen (16) working days, in lieu of Notice of Controversion.

209.8

The Notice of Final Payment shall contain the following:

(a) The name of the employee and of the employer;

(b) The date of the injury;

(c) The total amount of compensation paid;

(d) The person to whom payments were made;

(e) The date of the first payment;

(f) The date to which the final payment has been made; and

(g) Any other information required by the Office.

209.9

To the extent possible, the Office shall monitor voluntary payments to ensure that the amount paid is proper.

209.10

The Office may, on its own initiative and shall upon written request of an injured employee, determine if a ten percent (10%) penalty for late payment under § 16(e) of the Act [§ 36 -315(e), D.C. Code, 1981 ed.] shall be imposed or if nonpayment shall be excused.

209.11

Interest on accrued benefits shall be calculated at the same rate as that utilized by the Superior Court of the District of Columbia for civil judgments.

209.12

If an employer delays, in bad faith, the payment of any installment of compensation, the employer shall pay as an additional penalty, the actual weekly wage of the employee for the period that the employee is eligible for benefits. The additional penalty shall be payable for the duration of the delay.

209.13

Pursuant to Section 6(b) of the Act, (D.C. Code § 36-305(b) disability benefits for any 1 injury causing temporary or permanent partial disability shall be limited to 500 weeks. However, within 60 days of the expiration of the 500 week duration, an employee may petition the Mayor for an extension of up to 167 weeks.

209.14

Upon receipt of a petition for an extension, the Office shall arrange for an independent medical examination as set forth in subsections 212.15 and 212.16 of this chapter.

209.15

Upon receipt of the medical report, the Office shall notify the parties if an extension is to be granted and if so, the number of weeks.

209.16

The cost of independent medical examinations conducted pursuant to this section shall be paid by the insurer.

209.17

Pursuant to Section 9(c)(22) of the Act (D.C. Code § 36 -308 (3)(V)) for injuries occurring on or after April 16, 1999, the periods of compensation set forth in Section 9(c)(1) thru (19) of the Act (D.C. Code § 36-308(3) (A) thru (S)) shall be as follows:

(a) Arm lost, 234 weeks compensation;

(b) Leg lost, 216 weeks compensation;

(c) Hand lost, 183 weeks compensation;

(d) Foot lost, 154 weeks compensation;

(e) Eye lost, 120 weeks compensation;

(f) Thumb lost, 57 weeks compensation;

(g) First finger lost, 35 weeks compensation;

(h) Great toe lost, 29 weeks compensation;

(i) Second finger lost, 23 weeks compensation;

(j) Third finger lost, 19 weeks compensation;

(k) Toe other than great toe lost, 12 weeks compensation;

(l) Fourth finger lost, 12 weeks compensation;

(m) Compensation for loss of hearing of 1 ear 39 weeks compensation. Compensation for loss of hearing of both ears 150 weeks, provided that the Mayor may establish a waiting period, not to exceed 6 months, during which an employee may not file a claim for loss of hearing resulting from non- traumatic causes in the occupational environment until the employee has been away from such environment for such period, and provided further, that nothing in this sub-paragraph shall limit an employee's right to file a claim for temporary partial disability pursuant to section 9(e) of the Act (D.C. Code § 36-308(5);

(n) Compensation for loss of more than 1 phalange of a digit shall be the same as for loss of the entire digit. Compensation for loss of the 1st phalange shall be one half of the compensation for loss of the entire digit;

(o) Compensation for an arm or a leg, if amputated at or above the elbow or the knee, shall be the same as for a loss of the arm or leg; but if amputated between the elbow and the wrist or the knee and the ankle, shall be the same as for loss of a hand or foot;

(p) Compensation for loss of binocular vision or for 80% or more of the vision of an eye shall be the same as for loss of the eye;

(q) Compensation for loss of 2 or more digits, or 1 or more phalanges of 2 or more digits, of a hand or foot, may be proportioned to the loss of use of the hand or foot occasioned thereby, but shall not exceed the compensation for loss of a hand or foot;

(r) Compensation for permanent total loss of use of a member shall be the same as for loss of the member;

(s) Compensation for permanent partial loss or loss of use of a member may be for proportionate loss or loss of use of the member. Benefits for partial loss of vision in 1 or both eyes, or partial loss of hearing in 1 or both ears shall be for a period proportionate to the period benefits are payable for total bilateral loss of vision or total binaural loss of hearing as such partial loss bears to total loss.

209.18

[Reserved for professional athlete work life expectancy tables]

D.C. Mun. Regs. tit. 7, r. 7-209

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)