135.1 Once the Program has advised the employee that it has accepted a claim and has either approved COP or paid medical benefits or compensation, the Program may modify an award of compensation if the Program has reason to believe a change of condition has occurred for one of the following reasons:

(a) The disability for which compensation was paid has ceased;

(b) The disabling condition is no longer causally related to the employment injury;

(c) The claimant is only partially disabled;

(d) The claimant has returned or been released to return to work;

(e) The claimant was convicted of fraud in connection with a claim under the Act, or the claimant was incarcerated based on any felony conviction; or

(f) The Program's initial decision regarding disability was in error.

135.2 The Program shall continue to investigate the claim throughout the life of the claim to confirm that a claimant or employee is still entitled to benefits under the Act.

135.3 Claimants and employees are required to cooperate with all aspects of the Program's investigation, including participating in "alive and well checks," attending physical examinations, and providing documentation of all medical services, earnings information, current medical releases, and dependent and marital status.

135.4 The Program may conduct any investigation that is necessary to monitor medical agreements, services and costs incurred.

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).