3134.1 An employee who is dissatisfied with an ID or ED may either submit a request for reconsideration to the ORM, or, appeal the ID or ED as provided in the Act, but not both at the same time.

3134.2 An employee shall be entitled to receive continued benefits pending a decision on a request for reconsideration unless:

(a) The employee has died;

(b) The employee has returned to work;

(c) The claim has been controverted;

(d) The employee's compensation benefits have been suspended for non-cooperation;

(e) The employee is no longer entitled to augmented compensation pursuant to the Act;

(f) The employee has voluntarily retired and been awarded retirement benefits in lieu of disability compensation benefits;

(g) The employee knowingly and willfully received benefits to which he or she was not entitled under the Act; or

(h) The claim has been abandoned, as defined in subsection 3132.8.

3134.3 If a request for reconsideration is properly and timely submitted pursuant to this section, the ORM may affirm, modify, vacate, or remand the ID or ED for further examination by claims examiners within the Program, in full, or in part.

3134.4 A request for reconsideration shall be written and shall contain medical, vocational, or factual justification.

3134.5 A Request for Reconsideration shall be delivered to the ORM by hand, or by United States Mail, postage prepaid, within thirty (30) days of the date of issuance of the ID or ED that is the subject of the Request for Reconsideration. If a Request for Reconsideration is hand-delivered, the ORM shall provide the claimant with a dated receipt. Requests for Reconsideration shall not be accepted by facsimile or email.

3134.6 If the ORM receives a Request for Reconsideration after the 30th day

following the issuance of the ID or ED, it shall deny the Request for Reconsideration as untimely without ruling on the merits.

3134.7 An employee may request a waiver of the filing deadline in subsection 3134.6 on the grounds that good cause existed during the thirty (30) days following the ID or ED decision sufficient to justify the ORM's late receipt of the Request for Reconsideration. The employee shall provide factual justification and supporting documentation required by ORM to support the request for the waiver. In no event shall a request for a waiver of the deadline be considered after one hundred eighty (180) days from the date of issuance of an ID or ED.

3134.8 The ORM shall rule on the merits of a Request for Reconsideration. The standard to prevail on a Request for Reconsideration shall be preponderance of the evidence, based on the Act, best practices, and applicable case law. If the ORM's decision on the Request for Reconsideration is based in whole or in part on medical information, the ORM shall, in making its ruling, adhere to the requirements of subsection 3132.9.

3134.9 If the ORM grants a Request for Reconsideration and the employee has been receiving continued benefits during the pendency of the ORM's decision, such benefits shall continue without interruption. If the employee has not been receiving benefits during the pendency of the ORM's decision, all current and any retroactive benefits due to the employee shall be paid.

3134.10 If the ORM denies a Request for Reconsideration, the ORM shall direct the Program to issue a new ID or ED from which the employee shall have thirty (30) calendar days from the date of the ORM's reconsideration decision to appeal to the Department of Employment Services (DOES).

3134.11 The ORM shall, using a standard form developed by the ORM, provide a brief written explanation of its decision and serve a copy on the employee.

3134.12 The ORM decision shall not be binding upon a DOES Administrative Law Judge.

SOURCE: Notice of Emergency and Proposed Rulemaking published at 52 DCR 5481(June 10, 2005) [Expired]; and Notice of Emergency and Proposed Rulemaking published at 52 DCR 5771(June 17, 2005) [Expired]; and Notice of Emergency and Proposed Rulemaking published at 52 DCR 8964(October 7, 2005) [Expired]; and Notice of Emergency and Proposed Rulemaking published at 53 DCR 940(February 10, 2006) [Expired];Final Rulemaking published at 53 DCR 4290 (May 26, 2006).