In the District of Columbia, workers with occupational injuries or illnesses may be eligible for workers’ compensation benefits. Depending on the severity of your injuries, you may be entitled to weekly wage loss payments, medical treatment, and other financial assistance. However, you may lose your right to benefits if you do not follow the District’s claim procedures.
In the District of Columbia, most private sector employers must have workers’ compensation coverage. Employers either purchase a workers’ comp policy from a private insurance company or receive certification from the District to self-insure. (Typically, only large, financially stable employers will qualify to self-insure because they have to directly pay their workers’ benefits.) The D.C. Office of Workers’ Compensation oversees all workers’ comp claims in the district.
Unlike personal injury lawsuits, workers’ compensation is a no-fault system. You do not need to show that your employer acted carelessly in order to receive benefits. By the same token, you may still be eligible for workers’ compensation even if your actions caused the injury. As long as your injury happened on the job or was caused by your work activities, you will typically be eligible for benefits.
However, in exchange for this no-fault system, workers are only entitled to specific benefits. You cannot receive compensation for your pain and suffering in a workers’ compensation claim. However, eligible workers may receive:
Every workers’ compensation claim is different. The amount of your benefits depends on the facts of your claim and the severity of your injuries. If you need help calculating your benefits, contact a workers’ comp lawyer. Or, to learn more, see our article on the different types of workers' comp benefits.
You cannot receive workers’ comp benefits until you notify your employer. In D.C., you must notify your employer of a work-related injury as soon as possible. You must also file an Employee’s Notice of Accidental Injury or Occupational Disease (Form 7) within 30 days of the injury or the date you discovered its connection to work. You must send a copy of the form to both your employer and the Office of Workers’ Compensation.
It is important to give notice and request medical treatment as quickly as possible. Prompt medical treatment may lead to a faster and fuller recovery. Additionally, employers and insurance companies are skeptical of delayed claims and tend to deny them. Giving notice and getting treatment early on will reduce the likelihood of a claim denial.
Your completed Form 7 must include the following information:
You must also sign the form. When completing the form, be as accurate as possible. Form 7 will become part of the record in your case, and any inconsistencies may be used against you.
In D.C., simply notifying your employer does not result in a properly filed claim for workers’ compensation. To file a claim, you must submit Employee’s Claim Application (Form 7A) to both your employer and the Office of Workers’ Compensation. To protect your right to benefits, you must file this form within a year of your injury or last benefit payment.
Once the insurance company receives your claim, it will investigate your claim and determine your eligibility for benefits. This may involve:
Under D.C. law, the insurance company must either approve or deny your workers’ compensation benefits within 14 days of receiving your claim. If your claim is approved, you will start receiving disability payments and other benefits. Unfortunately, insurance companies deny many workers’ compensation claims. (For common grounds for a denial, see Denied Workers’ Compensation Claims.)
If your claim is denied, you should receive a written Notice of Controversion from the insurance company. You have the right to appeal this decision with the Office of Workers' Compensation. Workers’ comp appeals in the District of Columbia typically involve a series of informal and formal hearings. For more details on the process, see What to Do If Your Workers' Compensation Claim Is Denied in the District of Columbia.
Unless your claim is very simple, you should consider hiring a workers’ compensation lawyer. A lawyer can ensure that your case is properly developed and presented at your hearings. To learn more, see Should I Hire a Workers' Comp Attorney or Can I Handle My Own Case?