Effective January 1, 2010, 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
These same rates have been retained from 2009.
If you would like benefit rate cards prepared by Franklin & Prokopik detailing the District of Columbia benefit rates from 2001-2010, please contact F&P principal, John P. Rufe, on (301) 745-3900, or by email at jrufe@fandpnet.com.
COMPENSABILITY
- 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.
UTILIZATION REVIEW
The Compensation Order Review Board has affirmed the statutory requirement that, when an issue arises as to the reasonableness and necessity of medical treatment, 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.
In April 2010, the DC Court of Appeals ruled that, if reconsideration of the Utilization Review opinion is not timely sought by the medical provider, nevertheless, either party to the Claim may seek a Formal Hearing on the medical reasonableness and necessity issue.
Standard of Compensability for Psychological Injury
McCamey v. DOES
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.