§ 1–623.24. Time for making claim; finding of facts; award; right to hearing; conduct of hearing.
(a) The Mayor or his or her designee shall determine and make a finding of facts and an award for or against payment of compensation under this subchapter within 30 days after the claim was filed based on the following guidelines:
(1) The claim presented by the beneficiary and the report furnished by the employee’s immediate superior; and
(2) Any investigation as the Mayor or his or her designee considers necessary, provided that the investigation shall not extend beyond 30 days from the date that the Mayor received the report of the injury.
(a-1) Failure of an employee’s immediate superior to report an injury shall not prejudice a claimant’s right to benefits, nor relieve the Mayor or his or her designee of the duty to make a finding of facts and an award for or against payment of compensation within 30 days after the date the claim was filed.
(a-2) Failure of the Mayor or his or her designee to complete an investigation under subsection (a) of this section shall not prejudice a claimant’s right to benefits.
(a-3)(1) If the Mayor or his or her designee fails to make a finding of facts and an award for or against payment of compensation on a newly filed claim within 30 calendar days, the claim shall be deemed accepted, and the Mayor or his or her designee shall commence payment of compensation on the 31st day following the date the claim was filed. This section shall not apply if the Mayor provides notice in writing that extenuating circumstances preclude the Mayor from making a decision within this period, which shall include supporting documentation stating the reasons why a finding of facts and an award for or against compensation cannot be made within this period.
(2) If after the commencement of payment, the Mayor makes a determination against payment of compensation, payment shall cease; provided, that the Mayor or his or her designee may recoup benefits under § 1-623.29. The claimant shall not be required to repay monies received until all administrative remedies to the Department of Employment Service have been exhausted under subsection (b) of this section and under § 1-623.28.
(b)(1) Before review under § 1-623.28(a), a claimant for compensation not satisfied with a decision of the Mayor or his or her designee under subsection (a) of this section is entitled, on request made within 30 days after the date of the issuance of the decision, to a hearing on the claim before a Department of Employment Services Disability Compensation Administrative Law Judge. At the hearing, the claimant and the Corporation Counsel are entitled to present evidence. Within 30 days after the hearing, the Mayor or his or her designee shall notify the claimant, the Corporation Counsel, and the Office of Personnel in writing of his or her decision and any modifications of the award he or she may make and the basis of the decision.
(2) In conducting the hearing, the representative of the Mayor is not bound by common law or statutory rules of evidence, or by technical or formal rules of procedure, or by the provisions of the District of Columbia Administrative Procedure Act (D.C. Code, § 2-501 et seq.), except as provided by this subchapter, but may conduct the hearing in such manner as to best ascertain the rights of the claimant. For this purpose, he or she shall receive such relevant evidence as the claimant adduces and such other evidence as he or she determines necessary or useful in evaluating the claim.
(3) The Mayor or his or her designee shall begin payment of compensation to the claimant within 30 days after the date of an order from the Department of Employment Services Administrative Law Judge.
(d)(1) The Mayor may modify an award of compensation if the Mayor or his or her designee has reason to believe a change of condition has occurred. The modification shall be made in accordance with the standards and procedures as follows:
(A) The Mayor shall provide written notice to the claimant of the proposed modification with the supportive documentation relied upon for the modification;
(B) The claimant shall have at least 30 days to provide the Mayor with written information as to why the proposed modification is not justified; and
(C) The Mayor shall conduct a full review of the reasons for the proposed modification and the arguments and information provided by the claimant.
(2) If the Mayor determines that modification of the award is required, the Mayor shall provide written notice to the claimant of the modification, including the reasons for the modification and the claimant’s right to seek review of that decision under subsection (b) of this section.
(3) The Mayor may not modify benefits until requirements under this subsection have been completed, or until any deadline established by the Mayor for the submission of additional information has expired, whichever is later, except that the following modifications may be made contemporaneously with the provision of a notice under this subsection:
(A) The award of compensation was for a specific period of time which has expired;
(B) The death of the claimant;
(C) The claimant has been released to return to work or has returned to work based upon clear evidence;
(D) The claimant has been convicted of fraud in connection with the claim; or
(E) Payment of compensation has been suspended due to the claimant’s failure to participate in vocational rehabilitation, failure to follow prescribed and recommended courses of medical treatment from the treating physician, or failure to cooperate with the Mayor’s request for a physical examination.
(4) An award for compensation may not be modified because of a change to the claimant’s condition unless:
(A) The disability for which compensation was paid has ceased or lessened;
(B) The disabling condition is no longer causally related to the employment;
(C) The claimant’s condition has changed from a total disability to a partial disability;
(D) The employee has been released to return to work in a modified or light duty basis; or
(E) The Mayor or his or her designee determines based upon strong compelling evidence that the initial decision was in error.
(e) The Mayor shall provide a claimant and his or her attorney with access to the claimant’s file within 5 business days after a request to review the file is made. The claimant shall be provided, upon request, with one set of copies of the documents in the file.
(f) A claimant who is not satisfied with a decision under subsection (d) of this section may, within 30 days after the issuance of a decision, request a hearing on the claim before a Department of Employment Services Disability Compensation Administrative Law Judge under subsection (b) of this section.
(g) If the Mayor or his or her designee fails to make payments of the award for compensation as required by subsection (a-3)(1), (a-4)(2), or (b)(3) of this section, the award shall be increased by an amount equal to one month of the compensation for each 30-day period that payment is not made; provided, that the increase shall not exceed 12 months’ compensation. In addition, the claimant may file with the Superior Court of the District of Columbia a lien against the Disability Compensation Fund, the General Fund of the District of Columbia, or any other District fund or property to pay the compensation award. The Court shall fix the terms and manner of enforcement of the lien against the compensation award.