D.C. Mun. Regs. r. 7-121

Current through Register Vol. 71, No. 23, June 7, 2024

Rule 7-121 - DECISIONS ON ENTITLEMENT TO BENEFITS; AB EYANCE STATUS

121.1

Unless a decision is held in abeyance due to extenuating circumstances, a newly filed claim for benefits shall be deemed accepted by the Program if the Program does not issue findings and an award for or against payment of compensation within thirty (30) days of the date the claim was first filed. A claim shall be deemed accepted only until such time as the Program issues an initial determination (ID), at which time the claim may be denied as though it had never been deemed accepted. This subsection only applies to newly filed claims, including supplemental claims and claims of recurrences of disability.

121.2

When a claim is deemed accepted pursuant to § 121.1 of this chapter, payment of compensation shall become effective on the thirty- first (31st) day after it is filed.

121.3

For purposes of this section "extenuating circumstances" means the Program is unable to make findings of fact in order to accept or deny an award for payment of compensation due to any of the following:

(a) The Program does not have sufficient medical evidence to make a determination;

(b) The employee has failed to cooperate with the Program in the assessment of the claim; or

(c) There is a delay in receiving information from the Employing Agency that is beyond the reasonable control of the Employing Agency.

121.4

If a decision is held in abeyance due to extenuating circumstances, the Program shall issue a notice prior to the expiration of the thirtieth (30^th) day following the filing of the claim stating in detail the reasons for the abeyance. If the notice results from insufficient medical evidence to make a determination, the claimant shall promptly provide the Program with necessary medical records and appear for any additional medical examination requested by the Program.

D.C. Mun. Regs. r. 7-121

Final Rulemaking published at 47 DCR 9675 (September 15, 2000); as amended by Notice of Final Rulemaking published at 52 DCR 11902 (December 23, 2005); repealed and replaced by Final Rulemaking published at 59 DCR 8766, 8787 (July 27, 2012); amended by Final Rulemaking published at 64 DCR 6325 (7/7/2017)

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