D.C. Mun. Regs. tit. 7, § 199
The definitions set forth in Section 2301 of Title 23 (Workers’ Compensation) of the District of Columbia Government Comprehensive Merit Personnel Act of 1978, effective March 3, 1979 (D.C. Law 2-139; D.C. Official Code §§ 1-623.01 et seq. (2014 Repl. & 2016 Supp.)) shall apply to this chapter. In addition, for purposes of this chapter, the following definitions shall apply and have the meanings ascribed:
connection with a claim under the Act or this chapter.
(j) Controversion -- means to dispute, challenge or deny the validity of a claim for Continuation of Pay.
(k) Disability -- means the incapacity, because of an employment injury, to earn the wages the employee was receiving at the time of injury. It may be partial or total.
(l) Earnings -- for the purposes of § 138, any cash, wages, or salary received from self-employment or from any other employment aside from the employment in which the worker was injured. It also includes commissions, bonuses, and cash value of all payments and benefits received in any form other than cash. Commissions and bonuses earned before disability but received during the time the employee is receiving workers' compensation benefits do not constitute earnings that must be reported.
(m) Eligibility Determination (ED) -- a decision concerning, or that results in, the termination or modification of a claimant's existing Public Sector Workers' Compensation benefits that is brought about as a result of a change to the claimant's condition.
(n) Employee – means
(1) A civil officer or employee in any branch of the District of Columbia government, including an officer or employee of an instrumentality wholly owned by the District of Columbia government, or of a subordinate or independent agency of the District of Columbia government;
(2) An individual rendering personal service to the District of Columbia government similar to the service of a civil officer or employee of the District of Columbia, without pay or for nominal pay, when a statute authorizes the acceptance or use of the service or authorizes payment of travel or other expenses of the individual, but does not include a member of the Metropolitan Police
Department or the Fire and Emergency Medical Services Department who has retired or is eligible for retirement pursuant to D.C. Official Code §§ 5-707 through 5-730 (2012 Repl. & 2016 Supp.). The phrase “personal service to the District of Columbia government” as used for the definition of employee means working directly for a District government agency or instrumentality, having been hired directly by the agency or instrumentality; it does not mean working for a private organization or company that is providing services to the District government or its instrumentalities; and
(3) An individual selected pursuant to federal law and serving as a petit or grand juror and who is otherwise an employee for the purposes of this chapter as defined by paragraphs (i) and (ii) above.
(o) Employee’s Representative -- means an individual or law firm properly authorized by an employee in writing of this chapter to act for the employee in connection with a request for continuation of pay under the Act or this chapter.
(p) Employing agency -- the agency or instrumentality of the District of Columbia government which employs or employed an individual who is defined as an employee by the Act.
(q) Good cause -- omissions caused by “excusable” neglect or circumstances beyond the control of the proponent. Inadvertence, ignorance or mistakes construing law, rules and regulations do not constitute “excusable” neglect.
(r) Health care professional -- means a person who has graduated from an accredited program for physicians, advance practice nurses, physician assistants, clinical psychologist, and is licensed to practice in the jurisdiction where care is provided.
(s) Immediate supervisor -- the District government officer or employee having responsibility for the supervision, direction, or control of the claimant, or one acting on his or her behalf in such capacity.
(t) Indemnity compensation -- the money allowance paid to a claimant by the Program to compensate for the wage loss experienced by the claimant as a result of a disability directly arising out of an injury sustained while in the performance of his or her duty, calculated pursuant to the provisions of this chapter.
(u) Initial Determination (ID) -- a decision regarding initial eligibility for benefits under the Act, including decisions to accept or deny new claims, pursuant to this chapter.
(v) Latent disability -- a condition, disease or disability that arises out of an injury caused by the employee's work environment, over a period longer than one workday or shift and may result from systemic infection, repeated physical stress or strain, exposure to toxins, poisons, fumes or other continuing conditions of the work environment.
(w) Mayor -- the Mayor of the District of Columbia or a person designated to perform his or her functions under the Act.
(x) Medical opinion -- a statement from a physician, as defined in Section 2301 of the Act that reflects judgments about the nature and severity of impairment, including symptoms, diagnosis and prognosis, physical or mental restrictions, and what the employee or claimant is capable of doing despite his or her impairments.
(y) Office of Administrative Hearings (OAH) -- the office where Administrative Law Judges adjudicate public sector workers' compensation claims under Sections 2323(a-2)(4), 2324(b)(1), and (d)(2) of the Act, pursuant to jurisdiction under D.C. Official Code § 2-1831.03 (b)(1) (2012 Repl.), Section 2306a of the Act, and rules set forth in this chapter.
(z) Office of Hearings and Adjudication (OHA) -- the office in the Administrative Hearings Division of the Department of Employment Services where Administrative Law Judges adjudicate workers' compensation claims, including public sector workers' compensation claims under Sections 2323(a-2)(4), 2324(b)(1), and (d)(2) of the Act , and rules set forth in this chapter.
(aa) Office of Risk Management (ORM) -- the agency within the Government of the District of Columbia that is responsible for the District of Columbia's Public Sector Workers' Compensation Program (PSWCP).
(bb) Panel physician – means a physician approved by the Program pursuant to § 124.2 of this chapter to provide medical treatment to persons covered by the Act.
(cc) Pay rate for compensation purposes -- means the employee's pay, as determined under Section 2314 of the Act, at the time of injury, the time disability begins, or the time compensable disability recurs if the recurrence begins more than six months after the injured employee resumes regular full-time employment with the District of Columbia government, whichever is greater, except as otherwise determined under Section 2313 of the Act with respect to any period. Consideration of additional remuneration in kind for services shall be limited to those expressly authorized under Section 2314(e) of the Act.
(dd) Permanent partial disability payment (PPD) -- schedule award indemnity compensation payable to a partially disabled claimant pursuant to Section 2307 of the Act and § 139.3 of this chapter.
(ee) Permanent total disability payment (PTD) -- schedule award indemnity compensation payable to a completely disabled claimant pursuant to Section 2307 of the Act and § 139.3 of this chapter, when a qualified physician has determined that a claimant has reached maximum medical improvement and is unable to work on a permanent basis.
(ff) Program -- the Public Sector Workers' Compensation Program of the Office of Risk Management, including a third party administrator thereof.
(gg) Qualified health professional or qualified physician -- includes a surgeon, podiatrist, dentist, clinical psychologist, optometrist, orthopedist, neurologist, psychiatrist, chiropractor, or osteopath practicing within the scope of his or her practice as defined by state law. The term includes a chiropractor only to the extent that reimbursable services are limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist and subject to regulation by the Mayor.
(hh) Recurrence of disability – means a disability that reoccurs within one (1) year after the date indemnity compensation terminates or, if such termination is appealed, within one (1) year after the date of the final order issued by a judicial entity, caused by a spontaneous change in a medical condition which had resulted from a previous injury or illness without an intervening injury or new exposure to the work environment that caused the illness. This term also means an inability to work that takes place when a modified duty assignment made specifically to accommodate an employee's physical limitations due to his or her work-related injury or illness is withdrawn or when the physical requirements of such an assignment are altered so that they exceed his or her established physical limitations. A recurrence of disability does not apply when a modified duty assignment is withdrawn for reasons of misconduct, non-performance of job duties or other downsizing or where a loss of wage-earning capacity determination is in place.
(ii) Recurrence of medical condition -- means a documented need for further medical treatment after release from treatment for the accepted condition or injury when there is no accompanying work stoppage. Continuous treatment for the original condition or injury is not considered a “need for further medical treatment after release from treatment,” nor is an examination without treatment.
(jj) Return to “Regular Full-Time” position -- means the claimant returned to employment or a position that is established and not fictitious, odd-lot or sheltered, not a job created especially for a claimant, for the same number of hours of work per week as prior to injury.
(kk) Traumatic injury -- means a condition of the body caused by a specific event or incident, or series of events or incidents, within a single workday or shift. Such condition must be caused by external force, including physical stress or strain, which is identifiable as to time and place of occurrence and member or function of the body affected.
(ll) Temporary partial disability payment (TPD) -- indemnity compensation payable to a claimant, who has a wage earning capacity and has not reached maximum medical improvement, calculated pursuant to Section 2306 of the Act and § 130 of this chapter.
(mm) Temporary total disability payment (TTD) -- indemnity compensation
payable to a claimant, who has a complete loss of wage earning capacity and has not reached maximum medical improvement, calculated pursuant to Section 2305 of the Act and § 129 of this chapter.
(nn) Treating physician -- the physician, as defined in Section 2301 of the Act, who provided the greatest amount of treatment and who had the most quantitative and qualitative interaction with the employee or claimant.
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); repealed and replaced 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).