This is what you need to know if you’re injured on the job in D.C.
Workers’ compensation is a type of insurance that provides financial benefits to workers who are injured on the job.
In Washington, D.C., workers’ compensation insurance is provided at no cost to the vast majority of employees.
Unfortunately, you won’t receive workers’ compensation benefits automatically following a workplace injury. There are certain steps you must take to ensure you receive the benefits you deserve.
Let’s take a close look at workers’ compensation insurance in the District of Columbia, including the types of injuries that are covered, the types of benefits that may be available, and the steps required to file a claim.
What is the purpose of workers’ compensation?
Although the focus of workers’ compensation legislation is on injured workers, the laws provide a benefit to employers as well. Mainly, workers’ compensation laws provide employers with a certain level of protection by limiting the amount employees can recover and by prohibiting, in most cases, injured employees from suing their employers or co-workers.
Who’s required to carry workers’ compensation insurance in Washington, D.C.?
All employers with at least one employee are required to carry workers’ compensation insurance.
The D.C. Workers’ Compensation Act defines an employee as “every person, including a minor, in the service of another under any contract of hire or apprenticeship, written or implied, in the District of Columbia.”
There are, however, a few exceptions:
- Certain federal and state employees
- Any secretary, stenographer, or other person performing services for a member of Congress
- Certain railroad employees
- Certain licensed real estate salespersons
- Employees engaged in employment that’s casual and not in the usual course of trade, business, occupation, or profession of the employer
D.C. is one of the only places in the country where workers’ compensation insurance must be provided to domestic workers (nannies, house cleaners, etc.) who are employed for 240 hours or more during any calendar quarter.
What types of injuries are covered by workers’ compensation insurance?
The vast majority of injuries and illnesses are covered by workers’ compensation insurance so long as the injury or illness arose out of the employee’s employment.
An injury is NOT considered to have arisen out of your employment if it occurred at work but would have occurred anywhere. For example, if you have a heart attack while driving a school bus due to high cholesterol, you probably won't receive workers' compensation benefits because the heart attack did not arise strictly out of your employment.
Under the D.C. Workers’ Compensation Act, employees can receive workers’ compensation benefits for psychological injuries that are caused by employment-related stress or workplace physical injuries. To receive benefits, the claimant must show (1) a psychological injury, and (2) actual workplace conditions or events that could have caused or aggravated the psychological injury.
Charlene McCamey was employed by the District of Columbia Public Schools as a visiting instructor for students who were unable to leave their homes to attend school.
While on the job, Ms. McCamey suffered significant injuries to her head, lower back, and neck when she fell as a result of a table that collapsed.
As a result of her injuries, Ms. McCamey was afflicted with depression, panic attacks, confusion, auditory hallucinations, and memory loss.
Ms. McCarmey’s workers’ compensation claim, which sought benefits for her psychological injuries, was denied on the basis that Ms. McCamey had a “pre-existing psychological condition.”
Ms. McCamey appealed the denial.
On appeal, the District of Columbia Court of Appeals ruled that Ms. McCamey should have been awarded benefits for her psychological injury because (1) Ms. McCamey presented substantial evidence of a cognizable psychological injury, and (2) the stressors that aggravated Ms. McCamey’s pre-existing psychological condition arose out of her employment.
How do I file a workers’ compensation claim in Washington, D.C.?
To properly file a workers’ compensation claim, it’s imperative that you provide your employer with the requisite notice.
An injured worker in D.C. must file DCWC Form 7 (“Employee’s Notice of Accidental Injury or Occupational Disease”) with their employer and the Office of Workers’ Compensation within 30 days of sustaining their injury.
Workers must also file DCWC Form 7A within one year of the date of their injury.
If you’re a District of Columbia government employee, the claims process is different. Contact the public-sector workers’ compensation program at the D.C. Office of Risk Management at (202) 727-8600.
Workers’ compensation benefits
Employees who are injured in D.C. can receive the following workers’ compensation benefits:
• Medical expenses. Injured workers can receive “reasonable and necessary medical expenses.” These expenses include things like doctor’s visits, hospital bills, prescriptions, prosthetic devices, and physical therapy sessions.
Unlike many states, you may choose your own physician in D.C. However, once you choose a treating physician, you may not change the physician unless you get approval from your employer’s insurance company or the Office of Workers’ Compensation.
• Wage loss benefits. You can receive wage loss benefits if you’re unable to return to work for more than three days. Wage loss benefits are determined based on your average weekly wage prior to the accident but cannot exceed the maximum weekly benefit amount (this amount changes annually).
• Death benefits. In the case of a fatal work injury, the insurer is required to pay up to $5,000 for funeral expenses. What’s more, weekly benefits must be paid to the employee’s dependents. Weekly benefits are computed at 66 ⅔ percent of the deceased worker’s average weekly wage (subject to the maximum weekly benefit amount).
• Vocational rehabilitation services. Your employer must provide rehabilitation services for injured workers who need help returning to work. Vocational rehabilitation services may include counseling, on-the-job training, and job placement support.
What can I do if my workers’ compensation claim is denied?
Try to stay calm if your workers’ compensation claim is denied. Although it’s frustrating to have your claim denied, this may merely be a bump in the road.
You have two initial options if your workers’ compensation claim is denied:
- Request an informal conference with a claims examiner. An informal hearing is not binding on the employee or employer, but it may help resolve the issue.
- Skip the informal conference and file an application for a formal hearing with the Administrative Hearings Division (AHD).
If you're dissatisfied with the decision of the AHD, you may file a “Request for Review” with the Compensation Review Board within 30 calendar days of the decision. Appeals of the Compensation Review Board decisions must be made with the District of Columbia Court of Appeals.
Finding a workers’ compensation attorney in Washington, D.C.
You’re not required to hire an attorney to handle your workers’ compensation claim or appeal. However, your workers’ compensation claim decision is one of the most important decisions you’ll ever receive. At the very least, it’s a good idea to schedule a free initial consultation with an experienced workers’ compensation attorney.
If you choose to hire an attorney, keep in mind that the attorney’s fees are capped at 20 percent of the actual benefit secured.
To find an experienced workers’ compensation attorney in Washington, D.C., visit our free online legal directory.
The basis for personal injury law is fairly straightforward:
If you're injured because of someone's negligence, then you're entitled to recover for your financial losses related to the injury.
The premise for the workers' compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you're injured at work.