D.C. Workers Compensation Claims: Eligibility, Filing and Appeals

All employers with employees are required to provide coverage for workers. There are few exemptions, although domestic workers who work less then 240 hours per calendar quarter for a private employer do not have to be covered, although an employer can purchase optional worker’s compensation insurance for these domestic workers.

A special or second injury fund is also available for injured employees whose employers are uninsured or underinsured. This special injury fund, administered by the Worker’s Compensation Office, also provides benefits to worker’s whose existing injury was exacerbated by a work related injury, resulting in a disproportionately large disability in relation to the injury. 

Common Covered Work Related Injuries

Workers compensation laws in D.C. cover injury, occupational disease, or medical conditions that arise out of and in the course of employment. An occupational disease is defined as an illness or infection that the medical professional recognizes as arising out of a particular industry.

Coverage is excluded for workers who were intoxicated or for injuries that occur as a result of a third party’s willful injury of an employee because of non-work related animosity.

How to file a District of Columbia Workers Compensation Claim

You must notify your employer immediately after the injury, but at most no later then 10 working days after the injury occurs. You must include both the nature and cause of the injury, the names of witnesses, and other relevant information regarding the extent of the disability and the doctor’s statement on whether the injury will result in temporary or permanent disability.

Claims must be made within one year of the injury or death or one year of the employee becoming aware of the work related illness. A claim is made by filing a Claims Application with the Office of Worker’s Compensation

Workers Compensation Claim Denials

Common reasons for denials include insufficient notice to employees or questions of whether the injury arose out of or in the context of employment.

Appealing a District of Columbia Workers Compensation Denial

Employers must notify you of denials of claims within 14 days of the claim being filed. If your claim is denied, you can file an appeal with the Office Of Workers Compensation. In order to file an appeal, you must file a written request for a formal hearing. Forms to do so are available from your employer or from the Office of Workers Compensation.

If you inform the Office of Workers’ Compensation of the dispute prior to filing a formal request for a hearing, the Office of Worker’s Compensation may request an informal conference to facilitate settlement. These informal conferences are voluntary. If an agreement is reached at an informal conference, the Office of Workers’ Compensation will put the agreement in writing in a Final Order within 14 days. If no settlement is reached, the Office of Worker’s Compensation will review the records o the informal conference and prepare a Memorandum of Informal Conference making suggestions. Both parties then have 14 days to review this memorandum and either file notice in writing of their agreement or disagreement. If you disagree with the suggestions in the memorandum, you have 34 days to file a request for a formal hearing before the suggestions become binding.

You can make a request for a formal hearing at any time. This will end the informal conferences and a formal hearing will be scheduled in which you can present information and make an argument for benefits. The Office of Workers’ Compensation will investigate denied claims and attempt to resolve disputes. The Office may conduct investigation, including telephone conferences and requests for additional evidence and/or medical exams.

Collecting District of Columbia Workers Compensation Benefits

The District of Columbia workers compensation program provides for full payment of medical bills incurred as a result of a work related illness or injury. There is no maximum time limit on the amount of coverage, and all bills will be paid that result from the injury regardless of how far in the future they are incurred.

Temporary and permanent disability is also available. Temporary disability is calculated based on your previous wages. Benefits pay 66 2/3 of wages of 80% of wages less taxes and social security, whichever is greater, up to the state maximum of $1357 (as of 2009). Temporary disability benefits usually will only pay for 500 words.

Permanent disability benefits for total disability pay 66 2/3 percent of your average wage, up to a maximum of $1357 (as of 2009). Partial disability benefits are also available and the compensation is calculated based on the extent of the disability.

Permanent disfigurement benefits up to $3500 are also available, as are death benefits, which include burial expenses, and wages to surviving depends.

Hiring a District of Columbia Workers Compensation Lawyer

Hiring a workers compensation attorney is optional. It may be advisable to hire an attorney, especially in the event of a disputed claim, to guide you through the informal conferences and to make requests for a formal hearing. Because of the time sensitive nature of workers compensation claims and the complexity of proving your claim, having an attorney can make recovering workers compensation benefits much easier.

District of Columbia Workers Compensation Office Locations

DC Department of Employment Services

Labor Standards Bureau

Office of Workers' Compensation
64 New York Avenue, NE, 2nd Floor
Washington, DC 20002
Phone: (202) 671-1000
Fax: (202) 541-3595