D.C. Mun. Regs. tit. 7, r. 7-159

Current through Register 71, No. 45, November 7, 2024

Rule 7-159 - HEARINGS, BURDEN OF PROOF

159.1

Burden of Proof, Initial Determination. Claimant has the burden to prove, by a preponderance of the evidence (more likely than not)

(a) That the injury was work related; and

(b) The extent and nature of Claimant's injuries and disability.

159.2

Burden of Proof, Termination, or Modification of Award.

(a) If the Program seeks to terminate or modify an award, it must present substantial evidence that the Program had reason to believe:

(1) Claimant's accepted medical condition or other circumstance that affects the claimant's ability to earn wages has sufficiently changed to warrant modification or termination of benefits; or

(2) The claimant's medical condition had sufficiently changed to warrant modification or termination of benefits;

(3) The claimant had been convicted of fraud in connection with the claim; or

(4) The initial decision was in error.

(b) Once the Agency presents such evidence, the claimant shall have the burden to prove, by a preponderance of the evidence, the entitlement to ongoing benefits, as well as the nature and extent of disability.

159.3

Burden of Proof, Recurrence of Disability. The claimant has the burden to prove by clear and convincing evidence that a recurrence of disability is causally related to the original injury.

159.4

Burden of Proof, Permanent Disability. The claimant shall have the burden to prove, by a preponderance of the evidence, that he or she is entitled to an award for permanent disability, when requesting a permanent disability award pursuant to Section 2306 a of the Act (D.C. Official Code § 1-623.06 a).

159.5

Burden of Proof, Necessity, Character, Sufficiency of Medical Service, Supply, or Care. The party that requests the hearing has the burden to prove, as applicable, by a preponderance of the evidence, that the medical care or service furnished or sought to be furnished:

(a) Is proper to treat a condition that has been accepted by the Program as compensable under the Act;

(b) Is improper to treat a condition that has been accepted by the Program as compensable under the Act; or

(c) Treated or would treat a condition that has not been accepted by the Program as compensable under the Act.

159.6

Burden of Proof, Healthcare Provider Fees. The healthcare provider shall have the burden to prove, by a preponderance of the evidence, that the healthcare provider is entitled to t he relief sought.

D.C. Mun. Regs. tit. 7, r. 7-159

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