When used in this chapter, the following terms shall have the following meanings:

Act -- Title XXIII of the District of Columbia Comprehensive Merit Personnel Act of 1978, effective March 3, 1979, D.C. Law 2-139, D.C. Official Code § 1-623.01, et seq. (2001).

Best practices -- practices that reflect well-established methods of adjustment for weighing evidence, consulting industry reference materials, seeking advice from medical consultants, and engaging in the other steps of adjustment commonly known in the Public Sector Workers' compensation field.

Claim File -- all program documents, materials, and information, written and electronic, pertaining to a claim, excluding that which is privileged or confidential by law or custom within the Public Sector Workers' Compensation industry.

Controversion -- holding a claim in abeyance due to insufficient information to either accept or deny.

Eligibility Determination (ED) -- a decision concerning, or that results in, the termination, suspension or reduction of a claimant's existing Public Sector Workers' compensation benefits, excluding de minimus modifications and corrections of technical errors that affect five percent (5%) or less of the claimant's monetary benefits.

Good Cause -- 'excusable neglect,' as defined in the Federal Rules of Civil Procedure, Rule 6(b)(2) and interpretive case law.

Initial Determination (ID) -- a decision regarding initial eligibility for benefits under the Act, including decisions to accept, deny, or controvert new claims, pursuant to this subchapter.

Medical opinion-- a statement from a physician, psychiatrist, psychologist or other acceptable medical source that reflects judgments about the nature and severity of an impairment, including: symptoms, diagnosis and prognosis, physical or mental restrictions, and what the employee is capable of doing despite his or her impairments.

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 or its designee.

Qualified health professional-- includes a surgeon, podiatrist, dentist, clinical psychologist, optometrist, orthopedist, neurologist, psychiatrist, chiropractor or osteopathic practicing within the scope of their 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.

Treating physician-- the physician, psychiatrist, psychologist, or other medical source who provided the greatest amount of treatment and who had the most quantitative and qualitative interaction with the employee.

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); as amended by Notice of Emergency and Proposed Rulemaking published at 57 DCR 9540 (October 8, 2010)[EXPIRED]; as amended by Notice of Final Rulemaking published at 57 DCR 12224, 12239 (December 24, 2010).