D.C. Mun. Regs. r. 7-136
The Program may require a claimant to participate in an Additional Medical Examination (AME) with a physician selected by the Program.
The Program shall maintain a list of AME physicians. AME physicians shall have expertise and board certification in various specialties that are consistent with employees' most common injuries, as determined by the Program. AME physicians shall be selected on the basis of several factors, including:
AME physicians may be added to and removed from the Program's list of AME physicians at the discretion of the Program.
An AME shall consist of a case file review, and/or an in-person assessment or examination, by a qualified health professional other than the treating physician.
The Program may schedule an AME when:
The Program shall inform a claimant in writing of the requirement that he or she attend an AME appointment, and that failure to attend the appointment, failure to bring medical records under the employee's possession and control, or any other obstruction of the examination, will result in a suspension of the claimant's benefits.
If the claimant does not attend the AME appointment, fails to bring medical records under the claimant's possession and control, or otherwise refuses or obstructs the examination, the Program may suspend the claimant's benefits.
Claimant may have a physician designated and paid by the claimant participate in the examination pursuant to Section 2323 of the Act.
Obstruction under this section means impeding or any attempt to hinder the physician's medical examination of the claimant, including not appearing for a medical examination, refusing to answer the physician's questions, refusing to cooperate with the examining physician's request, and providing the physician with false statements.
Indemnity benefits suspended under this provision shall be:
If the claimant attends a newly scheduled appointment, provides requested records, or otherwise cooperates with the examination as directed by the Program, the claimant's benefits shall be reinstated as of the date of compliance. The date of compliance is the date the claimant attends the newly scheduled appointment, the date the Program receives requested records, or the date the claimant otherwise cooperates with the examination as directed by the Program.
An AME report shall be conclusive and responsive to the requests from the Program as part of a complete professional evaluation and shall comply with the requirements of § 137.3.
Claimant may request for reimbursement of reasonable and necessary lost wages incident to AMEs by submitting a written request to the Program with supporting documentation. Requests for such reimbursement shall be made the earlier of three (3) days after receiving the AME notification or seven (7) days after the AME. "Reasonable and necessary," means:
The Program may enter into a working agreement to provide AME services under this section. Each such agreement shall set forth terms and conditions to ensure appropriate evaluations, including fee and payment guidelines.
D.C. Mun. Regs. r. 7-136