D.C. Mun. Regs. tit. 7, r. 7-145

Current through Register Vol. 71, No. 44, November 1, 2024

Rule 7-145 - ADJUSTMENTS TO BENEFITS

145.1

A claimant's benefits shall be adjusted, where the claimant's PSWCP file and records establish substantial evidence that:

(a) The claimant's benefits shall be forfeited for failure to:

(1) Complete a report of earnings pursuant to § 138 of this chapter; or

(2) Accept a modified duty assignment offered within the time prescribed at § 142 of this chapter.

(b) The claimant's benefits shall be terminated because the claimant's compensation benefits have been subject to forfeiture for failure to complete a report of earnings for more than ninety (90) days;

(c) The claimant's eligibility for wage- loss compensation is subject to limitations provided at Section 2316 of the Act (D.C. Official Code § 1-623.16 ) and § 134 of this chapter; or

(d) The claimant is no longer eligible for benefits for reasons not otherwise prescribed at Section 2324(d) of the Act (D.C. Official Code § 1-623.24(d) ).

145.2

The Program shall provide a written notice to a claimant when benefits are adjusted pursuant to § 145.1 of this chapter and inform the claimant of his or her right to appeal to the Chief Risk Officer.

145.3

Prior written notifications pursuant to Section 2324(d) of the Act (D.C. Official Code § 1-623.24(d) ) shall not apply to adjustments to benefits issued pursuant to § 145 of this chapter.

145.4

The Program shall provide a written Notice of Benefits to a claimant if there is an adjustment in the claimant's wage- loss compensation benefits or a correction of a technical error that results in a change to the claimant's wage- loss compensation benefits and inform the claimant of his or her right to appeal to the Chief Risk Officer.

145.5

Compensation benefits that have been forfeited under this section may be resumed if a claimant cures the deficiency that gave rise to the forfeiture, unless benefits have been terminated. Resumption of compensation benefits that have been forfeited shall occur on a prospective basis; except, that compensation benefits may be restored on a retroactive basis where a good cause determination has been made, pursuant to § 147 of this chapter, for reversal of the suspension or forfeiture decision.

145.6

Periods of forfeiture shall be counted toward the five hundred (500)-week limitation in Section 2306 a of the Act (D.C. Official Code § 1-623.06 a).

145.7

[REPEALED]

145.8

[REPEALED]

145.9

[REPEALED]

D.C. Mun. Regs. tit. 7, r. 7-145

Final Rulemaking published at 64 DCR 6325 (7/7/2017); amended by Final Rulemaking published at 66 DCR 4246 (4/5/2019)