115.1 The claimant or claimant's representative shall provide all information required by the Program to make a determination on the claim.
115.2 A claim for compensation is deemed filed only upon:
(a) The filing of a claim for workers' compensation through the Program's online portal, as designated on the Office of Risk Management's website, or the filing of Form CA7, Part A in hard copy with the Program; and(b) The Program's receipt of the following completed documents: (1) Form 3 - Physician's Report of Employee's Injury;(2) Form 3A - Employee's Statement of Medical History;(3) Form 4 - Employee Authorization for Release of Medical Records; and(4) IRS Form 4506-T - Request for Transcript of Tax Return.115.3 Forms shall be deemed incomplete for the purpose of § 115.2, if any information is omitted or incomplete upon submission.
115.4 At the time the claimant or claimant's representative submits a claim, an email address and physical mailing address must be provided for the claimant and if applicable the claimant's representative, for the purpose of receiving Program notices and correspondence. Any notice or correspondence sent to the designated email address or physical mailing address shall be presumed received, unless returned.
115.5 In the case of the death of an employee, the claimant or claimant's representative shall also provide documentation establishing the claimant's relationship to the deceased. Documentation may include:
(a) A certified copy of a birth certificate;(b) A certified copy of a marriage license;(c) Documentation of the executor of the employee's estate; or(d) Other documentation satisfactory to the Program.115.6 The employee or employee's representative shall have the employee's health care professional complete and return to the Program a Form 3, Physician's Report of Employee's Injury, which shall comport with the requirements of §§ 125.2 and 137.3.
115.7 The employee shall complete, sign, and return to the Program, Form 3A, Employee's Statement of Medical History, which shall:
(a) Describe any and all accidents the employee was involved in, or physical disability or illness the employee suffered, prior or subsequent to the reported injury;(b) For each accident, illness, or physical disability, identify the time, date, circumstance, and location of the accident or incident, the parties involved, the disposition of any subsequent trial or legal action(s), any injuries relating from the previous accident(s) or incident(s), and the hospital, medical facilities, doctors, physicians, dentists, or any other individual that treated any injury, illness, or physical disability;(c) Identify the physician who treated the employee and the approximate dates of such treatments, if employee alleges aggravation of a previous injury or condition;(d) Describe in detail each instance during the past five (5) years that the employee has been absent from employment due to an illness or injury, including the nature and dates of each such illness or injury. The employee or employee's representative shall specify the date and time for all absences from employment due to each illness and injury claimed; and(e) Describe any similar condition, disability, or injury that occurred prior to the alleged injury or any pre-existing condition that may be related to the condition or disability caused by the injury.115.8 The claimant or claimant's representative shall submit proper medical documentation as requested by the Program to document the employee's ongoing injury and substantiate the employee's absence from work to justify continued payment of wage- loss compensation. These documents shall include, but are not limited to, the following:
(a) Statements and medical documentation regarding any similar condition, disability, or injury that occurred prior to the alleged injury or any preexisting condition that may be related to the injury;(b) Statements and medical documentation regarding any other injury or incident of a similar character; and(c) A written statement showing why there was a delay in seeking medical care, if applicable.115.9 After a claim is initiated, a claimant who wishes to continue representation by his or her representative must complete and return Form 15 - Declaration of Representative Form to the Program, so the claimant's representative may continue to receive communication and information related to the claim, unless the representative is appointed by a court of law or is the claimant's attorney, and a court order or retainer agreement, respectively, is submitted to the Program in lieu of Form 15. If the claimant is a minor child, documentation establishing legal guardianship may be submitted in lieu of Form 15.
115.10 The claimant or claimant's representative shall file supplemental reports when required by the Program or when there is any change in information provided to the Program.
115.11 A claimant seeking to supplement his or her original claim to add additional disabilities or conditions arising out of the same injury, but not already reported, shall:
(a) File a supplemental claim to add the additional disability or condition within two (2) years after the earlier of:(1) The date on which the claimant first sought medical attention for the additional disability or condition and was aware or, by the exercise of reasonable diligence should have been aware, of the causal relationship between the claimant's condition and employment, whether or not the claimant ceased work; or(2) The date on which the claimant became disabled and was aware or, by the exercise of reasonable diligence should have been aware, of the causal relationship between the claimant's disability and employment.(b) The supplemental claim shall include a signed statement under penalty of perjury explaining the cause for delay in reporting the additional disability or condition.115.12 Claims for aggravated injury shall be filed as an original claim for compensation pursuant to Section 2321 of the Act (D.C. Official Code § 1-623.21 ) and §§ 115.1 through 115.10 of this chapter within two (2) years from the injury that aggravated, worsened or exacerbated the employee's pre-existing disease, illness or condition, unless otherwise authorized by law.
115.13 Claims for latent disability shall be filed pursuant to Section 2322 of the Act (D.C. Official Code § 1-623.22) and §§ 115.1 through 115.10 of this chapter within two (2) years after the earlier of:
(a) The date on which the claimant first sought medical attention for the claimant's condition and was aware or, by the exercise of reasonable diligence should have been aware, of the causal relationship between the claimant's condition and employment, whether or not the claimant ceased work; or(b) The date on which the claimant became disabled and was aware or, by the exercise of reasonable diligence should have been aware, of the causal relationship between the claimant's disability and employment.115.14 A claim for recurrence of disability:
(a) Shall include medical evidence to establish that the recurrence is for the same condition and injury for which the claim was originally accepted and be filed pursuant to §§ 115.1 through 115.10 of this chapter within one (1) year after the date wage-loss and medical compensation terminates or, if such termination is appealed, within one (1) year after the date a final order is issued by a judicial entity, and(b) Shall not obtain where the inability to work occurred because a modified duty assignment made specifically to accommodate the employee's physical limitations due to his or her work-related injury or illness is withdrawn or when the physical requirements of such an assignment are altered so that they exceed his or her established physical limitations.115.15 All other original claims for compensation for disability or death arising out of a single injury shall be filed within two (2) years after the injury or death pursuant to Section 2321 of the Act and § 115 of this chapter, except as provided bySection 2322(a) of the Act (D.C. Official Code § 1-623.22(a) ).
D.C. Mun. Regs. tit. 7, r. 7-115
Notice of Final Rulemaking published at 28 DCR 2307 (May 22, 1981); 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, 8782 (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); amended by Final Rulemaking published at 67 DCR 7481 (6/12/2020)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