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 (30th) 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.

SOURCE: Final Rulemaking published at 28 DCR 2307 (May 22, 1981); as amended by Emergency and Proposed Rulemaking published at 57 DCR 9540 (October 8, 2010)[EXPIRED]; as amended by Final Rulemaking published at 57 DCR 12224, 12229 (December 24, 2010); as amended by Final Rulemaking published at 59 DCR 8766, 8771 (July 27, 2012); as amended by Final Rulemaking published at 64 DCR 6325 (July 7, 2017).