NWCDN DISTRICT OF COLUMBIA WORKERS' COMPENSATION UPDATE
New District of Columbia Benefit Rates
Effective January 1, 2009, the following are the benefit
rates for District of Columbia:
Maximum Weekly Compensation Rate: $1,355.00
Minimum Weekly Compensation Rate: $ 338.75
Supplemental Allowance for Permanent Total and Death
Benefits: 5.21% increase
If you would like benefit rate cards prepared
by Franklin & Prokopik detailing the District of
Columbia benefit rates from 2000-2009, please contact F&P principal, John P.
Rufe, on (301) 745-3900, or by email at
jrufe@fandpnet.com.
To show that an injury is compensable,
the employee must “establish that the work
event or condition at
issue was the cause of the claimed injury,” that is, that the injury is in
fact work-related. An
accidental injury is compensable under the Workers’
Compensation Act if it “aris[es] out of and in the course of employment.” D.C. Code §
32-1501 (12). Because the statute
is remedial in nature, it affords the claimant a presumption
that the injury
constitutes a compensable workplace injury. To raise the statutory
presumption of compensability, a
claimant must make an “initial demonstration” of “both
an injury and a relationship between that
injury and the employment.”
“The presumption then operates to
establish a causal connection between the disability
and the work-related
event, activity, or requirement.” In other words, the statute creates a
two-pronged
presumption that (I) the event causing (or contributing to)
the disability arose out of and in the course of employment,
and (ii) that a medical causal relationship exists between
the claimed disability and a work related
event.
If the employer proffers substantial
evidence to rebut the presumption, then the presumption
drops out of the case
entirely, and the burden reverts to the claimant to prove his entitlement
to benefits by the
preponderance of the evidence.
In cases where an employee’s injury
arises neither out of a risk directly associated
with employment nor out
of a risk personal to the employee, this court has employed the
positional risk doctrine,
explaining that an employee’s injury arises out of his employment
“so long as it
would not have happened but for the fact that
conditions and obligations of the
employment placed claimant in a
position where he was injured.”
The unexplained fall rule of
compensability, even if deemed a corollary to the positional risk doctrine, is
not applicable when
there is evidence of a
possible idiopathic origin to the fall.
On 10/2/07 the District of Columbia
Department of Insurance, Securities and Banking (DISB) announced its approval
of the 2008 workers’ compensation rate filings by the National Council on
Compensation Insurance (NCCI). They include a decrease of 7.6 percent for the
industrial classes in the voluntary market, and a decrease of 10.6 percent for
the industrial classes in the residual market (those in the assigned risk
category).
The Compensation Order Review Board has affirmed the statutory
requirement that, when an issue arises as to the reasonableness and
necessity of medicaltreatment, the issue must first
be referred to utilization review, prior to requesting a formal
administrative hearing thereon. This provision had not been enforced
for many years.(2/21/2007)
Standard of Compensability for Psychological
Injury
McCamey v. DOES, (DC, May 15, 2008)
The
DC Court of Appeals sitting en banc
has overruled several of its prior cases dealing with the standard for compensability
of psychological injury.There are now
currently two different standards depending on whether there is a physical
injury involved.In the context of physical-mental disabilities, the physical accident is the
unexpected occurrence supplying the necessary (and objective) workplace
connection. Thus, in cases of physical injury, so long as the claimant proffers
competent medical evidence connecting the mental disability to the physical
accident (legal causation), the claimant has either established a prima facie
case of aggravation or a new injury. The court did not have before it the issue
of mental-mental disabilities, where
traditionally the question is whether the stresses of the job were so great
that they could have caused harm to an average worker. Job stresses are to be
measured against the usual stressors or mental stimuli of employment in
general. Thus, a claimant must show that his current job conditions are
unusually stressful as compared to employment conditions in general, not as compared
to his work history. The court appears to question the application of this
standard even to mental-mental claims, its primary concern being that the
concept seems to conflict with cases of aggravation of a pre-existing
condition. The court suggested that the objective standard may not be
appropriate in such an instance. No doubt this issue will be addressed in the
near future.
For further inquiries regarding District of Columbia law contact Mr. Rufe on (301) 745-3900, or by email at jrufe@fandpnet.com.