D.C. Workers’ Compensation: What Every Injured Worker Needs to Know



Hurt on the job or diagnosed with an occupational illness in Washington, D.C.? You may be entitled to workers’ compensation. The skilled workers’ compensation attorneys with May Lightfoot, PLLC can help you fight for the benefits you deserve.

As the nation’s capital, Washington, D.C. is best known for its historical and political significance. However, while local, state, and federal government agencies are among the region’s largest employers, the District is also a major hub for private-sector employment in industries such as finance, healthcare, technology, communications, and scientific research.

Sadly, workplace hazards exist everywhere, and if you’re injured while carrying out the duties of your employment or develop a work-related disease, you can find yourself in need of treatment and unexpectedly missing work while your medical and household bills mount. Fortunately, if you were injured or became ill as a result of your private-sector job, workers’ compensation can provide the medical care and wage replacement benefits you need to heal, return to the workforce, and make ends meet in the meantime.

Unfortunately, the workers’ compensation claims process can be complex, confusing, and rife with potential pitfalls. In this book, we address common D.C. workers’ comp questions and concerns, work to banish myths and misconceptions that could hurt your claim, and explain why you need experienced legal representation to ensure your rights are protected.

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D.C. Workers’ Compensation Basics

First time dealing with an occupational injury or illness? Find out what workers’ comp is and whether you’re covered by it.

What is workers’ compensation?

Workers’ comp is a no-fault insurance system that compensates employees for injuries or illnesses sustained on the job. Employers carry this insurance for the protection of their employees.

Can I sue my employer for an injury caused by work? 

If your injuries were caused by your employer or a coworker, workers’ comp is generally the sole legal remedy. However, when the injuries are caused by the negligence of someone employed by another company, you may have grounds for a personal injury lawsuit against that party. This is known as a third-party claim. While the benefits of a third-party claim include being able to seek compensation for pain and suffering, you’ll have to prove that the defendant was negligent. For that, you’ll need an experienced injury attorney. At May Lightfoot, PLLC, our knowledgeable legal team would be happy to review your case and discuss your options.

💡Pro Tip: If you’ve been injured at work, you must follow specific procedures to handle your claim; you can’t rely on your employer to manage the process for you. You have to notify your employer of your injury or illness and file a claim with the Office of Workers’ Compensation within specified time frames. Even if you’re on top of your paperwork, that doesn’t mean that your employer will be equally diligent—and there’s always the chance that the insurance company or OWC will decide to fight your claim. Don’t risk missing out on much-needed benefits; hire a skilled attorney to handle your claim.

How do I know if my employer has workers’ comp insurance?

Washington, D.C. requires all employers with one or more employees to carry workers’ compensation insurance. This requirement applies to all businesses—from coffee kiosks to large consulting firms and everything in between. Even homeowners are required to carry a workers’ comp insurance policy if they employ one or more domestic workers for 240 hours or more in a calendar quarter.

What if my employer doesn’t carry workers’ compensation insurance?

You may be able to receive compensation for medical care or lost wages from the Office of Workers’ Compensation’s Special Fund Unit. Additionally, you may have grounds to file a personal injury lawsuit against your employer. Injured or ill employs are generally prohibited from suing their employers directly. However, by failing to carry the required workers’ comp insurance, employers open themselves to personal liability for injuries and damages.

At May Lightfoot, PLLC, our exceptional attorneys can help you understand your rights and explore all of your options for compensation.

Does D.C. workers’ compensation only cover full-time employees?

No. D.C.’s workers’ comp law covers all employees who are injured or develop a serious illness due to their job, regardless of whether they work full or part time or are a temp or seasonal worker.

Do I have to be 18 to collect workers’ comp benefits in D.C.?

No. The workers’ compensation law also protects minor teen employees. Was your teen hurt on the job or diagnosed with a work-related illness? Find out how the knowledgeable legal team at May Lightfoot, PLLC can help.

How long do I have to work in a job before I’m covered by my employer’s workers’ compensation policy?

Coverage begins immediately. Even if you’re injured on your first day on the job, within the first few minutes of your shift, you’re protected by D.C.’s workers’ comp law.

Can I still receive benefits if the accident and injury were my fault?

Yes! Workers’ compensation is a “no-fault” insurance system, which means that employees are typically eligible for benefits, even if they were responsible for their injuries. However, there are exceptions. Think you may be to blame for your workplace accident and injury? Contact us to discuss your case and options.

💡Pro Tip: Even if you have reasonable expectations, the insurance company may not compensate you fairly. When it comes to workplace injuries or illnesses, trusting your employer’s workers’ compensation insurer to act in your best interest can cost you. Insurance companies are profit-driven businesses intent on maintaining their bottom line, and adjusters have a wide range of tactics they use to try to reduce the financial obligation to claimants. From fishing for information that could hurt your claim to withholding information that could help it, insurance adjusters are anything but an ally in your quest for fair compensation. Fortunately, with the representation of an adept D.C. injury and workers’ comp attorney, you have a much better chance of overcoming the barriers standing between you and the benefits you deserve.

Is your on-the-job injury or illness compensable? Here’s a look at the types of injuries and conditions D.C. workers’ comp usually covers, as well as those it typically does not.

What injuries and conditions does workers’ compensation cover?

In Washington, D.C., workers’ comp recognizes three categories of compensable workplace-related medical conditions:

  • Physical injuries resulting from on-the-job accidents or repetitive stress
  • Occupational diseases developed as a result of workplace exposure to asbestos, mold, dangerous chemicals, and other hazards
  • Mental health issues, such as post-traumatic stress disorder (PTSD), depression, or severe anxiety, arising from an on-the-job trauma or event

Can I collect workers’ comp benefits if I contracted COVID-19 in the workplace?

The coronavirus pandemic is a rapidly evolving situation. However, at May Lightfoot, PLLC, our knowledgeable and experienced injury attorneys anticipate that cases involving essential employees who were diagnosed with COVID-19 after regularly interacting with the public will fall under D.C.’s workers’ compensation law.

Were you or a loved one diagnosed with the novel coronavirus after presumed exposure in the workplace? Contact us for a complimentary review of your case to discuss your legal rights and options.

Are there any types of injuries that generally aren’t covered by D.C. workers’ compensation?

Yes. While most on-the-job injuries are compensable by workers’ comp, there are exceptions. For example, though injuries that occur when actively carrying out your work-related duties are covered, those sustained while commuting to or from work—or on your lunch break—usually are not. There are other exceptions, so you should speak to an attorney about your case. May Lightfoot, PLLC, offers free, no-obligation consultations. Contact us today.

Other workplace injuries typically not covered by workers’ compensation include those that are intentionally self inflicted or sustained during a physical altercation with another employee that you started over non-work-related personal matters (such as fights over romantic partners or sports team wins or losses). However, you may be entitled to benefits if you were the victim of workplace violence.

Still not sure if the circumstances of your work injury make you eligible for workers’ comp benefits? Let us help!

💡Pro Tip: The workers’ compensation claims process is complicated, and unless your injuries are minor, you’ll need an experienced workers’ compensation attorney to look out for your best interests. D.C. workers’ comp statutes are dense and often unclear, particularly to those without a legal background. With your energy rightfully focused on your health and physical recovery, it’s far too easy to miss key claims deadlines or run afoul of other bureaucratic rules. And if your claim is challenged or denied, you’ll need a fierce legal advocate in your corner. 

D.C. Workers’ Compensation Benefits

Hurt on the job and wondering what benefits may be available through workers’ comp? Here’s what you should know about the various types of workers’ compensation benefits, including when they start, what they include, and how long they last.

What kinds of benefits does workers’ comp pay?

The insurance system provides medical treatment for workplace injuries and occupational diseases. You may also be eligible for temporary disability payments, a permanent partial disability award, vocational rehabilitation, and death benefits.

What do medical treatment benefits include?

Workers’ compensation covers all reasonable and medically-necessary treatments related to your work injury or occupational disease, including the cost of emergency transportation and care, visits with doctors and specialists, hospitalizations, surgical procedures, physical therapy, prescriptions, prosthetic and assistive devices, prescription drugs, and reasonable vehicle or home modifications. You’ll also be reimbursed for mileage incurred traveling to and from medical appointments.

When do workers’ compensation medical benefits begin, and how long do they last?

Workers’ comp will cover all reasonable and necessary medical care associated with your on-the-job injury or occupational illness, including emergency treatment following a workplace accident. Medical treatment benefits essentially begin immediately. However, they are not automatic; you’ll need to notify your employer and complete paperwork to start the claims process. Medical care can continue indefinitely, as long as the treatment is related to the accident.

What are temporary total disability benefits, when are they appropriate, and how much can I receive?

D.C. workers’ compensation temporary total disability (TTD) benefits are wage replacement payments paid to employees who are unable to work as the result of a workplace injury, but are expected to return to the workforce once they’ve recovered. TTD payments are equal to two-thirds of your average weekly wage, subject to minimum and maximum payment amounts. These benefits can last for up to 500 weeks and end when your doctor determines that you’ve reached maximum medical improvement (MMI), which indicates that your condition is unlikely to improve any further, and you’re released to work without restrictions.

What are temporary partial disability benefits, and what should I know about them?

Like TTD benefits, temporary partial disability (TPD) benefits are wage replacement payments. However, unlike TTD benefits, which are paid to workers who are completely unable to work due to an on-the-job injury, TPD benefits are paid to those who are only partially disabled by their injury and choose to work part-time or in a light-duty job while they recover.

If you find yourself in this position after a workplace accident, you may be entitled to TPD benefits totaling two-thirds of the difference between what you were making before your injury and what you’re making now. These benefits are available for a maximum of 260 weeks.

What if I suffered a permanent injury but am able to return to work? 

If your on-the-job accident caused a disability that your doctor says is “partial in nature, but permanent in quality,” you may be entitled to permanent partial disability (PPD) benefits consisting of two-thirds of your average weekly wage. This payment is made after you reach maximum medical improvement (MMI), and the amount varies depending on your level of disability. Contact us today for a free consultation to discuss your D.C. workers’ comp claim and find out what benefits you may be entitled to collect.

What’s the difference between schedule and non-schedule permanent partial disabilities, and how do these categorizations affect how long I can receive PPD benefits?

The law categorizes permanent partial disabilities as either schedule or non-schedule. Schedule disabilities are those involving the loss (or loss of use) of a specific body part, for which you’re entitled to benefits for a specified number of weeks. For example, the complete loss of use of a hand makes you eligible for 244 weeks of PPD payments. However, if you haven’t lost full use of your hand, your doctor will assign an impairment rating that determines how long you can collect these benefits. Thus, a 50 percent impairment rating for your hand would make you eligible to receive PPD benefit payments for 122 weeks. Injury to other body parts, such as legs, arms, eyes, toes, and fingers also qualify for payment after a return to work.

Non-schedule permanent partial disabilities don’t correspond to a specific number of weeks of PPD benefits. You may be entitled to two-thirds of the difference between your average weekly wage and the reduced wages you’re earning after being diagnosed with a permanent impairment.

If you believe that you suffered a permanent injury on the job, you should consult with an attorney because the law is complicated.

What if I can never return to the workforce in any capacity as a result of my injuries?

If you suffered catastrophic injuries on the job and are found to be totally and permanently disabled, you may be entitled to permanent total disability (PTD) benefits indefinitely. However, these benefits are only available for workers with disabling conditions who are unable to find suitable alternative employment. PTD benefits are paid at the same weekly amount as TTD benefits.

When do my benefit payments start?

There is a three-day waiting period before D.C. workers’ comp benefit payments begin. If you’re out of work for 14 days or longer due to your workplace injury, you can recover compensation from the date of the accident and receive payment for the first three days you were absent.

What if my injury results in disfigurement?

If your injury causes serious disfigurement to your face or another exposed part of the body, you may be eligible for a lump sum award of up to $7,500.

Does D.C. workers’ compensation include rehabilitation benefits?

Yes. Both physical therapy and vocational rehabilitation benefits are available to injured employees through workers’ comp. Contact our skillful D.C. injury attorneys to discuss your options.

What death benefits does workers’ comp provide, and who can collect them?

In D.C., if an on-the-job injury or occupational disease results in death, the deceased worker’s surviving dependents may be entitled to funeral expenses and partial wage replacement payments. Eligible dependents include surviving spouses or domestic partners, children under 18 (or those unable to support themselves due to a physical or mental disability), and full-time students under age 23. In the absence of such dependents, alternative beneficiaries may include siblings, parents, grandparents, or grandchildren.

Do workers’ comp benefits include compensation for pain and suffering?

D.C. workers’ compensation benefits are limited to medical treatment, wage replacement payments, scheduled loss awards, vocational rehabilitation, and death benefits.

What is my case worth?

Every workers’ comp case is unique. With so many variables at play, it’s difficult—if not impossible—to accurately estimate the value of your claim without having thoroughly reviewed it. Contact us today to schedule a free consultation to discuss your case and potential benefits.

💡Pro Tip: Filing a workers’ compensation claim isn’t the same as suing your employer. It’s important to note that you’re not filing a lawsuit against your employer; you’re filing a claim against their workers’ comp insurance policy. In fact, the workers’ compensation insurance system is specifically set up to protect injured workers while shielding employers from personal liability.

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Filing a Workers’ Comp Claim and Protecting Your Right to Benefits

Immediately after a serious work injury or occupational disease diagnosis, the intricacies of the workers’ compensation claims process is probably the last thing on your mind. However, what you do after you’re hurt on the job and when you file your claim matters—and if you make a mistake, it could jeopardize your ability to collect the benefits you need and deserve.

What should I do if I’ve been hurt at work?

Following these simple steps can help protect your right to workers’ comp benefits after a workplace accident:

  • Mention your injury to a supervisor
  • Go see a doctor right away—you can see any doctor for urgent or emergency treatment
  • Inform your employer of your work-related injury or illness in writing; an email should suffice
  • Complete OWC Form 7—Employee’s Notice of Accidental Injury or Occupational Disease—and file it with the Office of Workers’ Compensation (and provide a copy to your employer) within 30 days
  • Complete OWC Form 7A—Employee’s Claim Application—and provide it to your employer and the Office of Workers’ Compensation within one year

Note: See Appendix A for copies of the D.C. workers’ compensation forms.

How long do I have to file a D.C. workers’ compensation claim?

You have 30 days to inform your employer and the OWC of your injury or illness in writing, using OWC Form 7, and up to one year to file OWC Form 7A to start your claim (you can find these workers’ comp forms in Appendix A). However, there are exceptions. Request a complimentary consultation to speak with a member of our knowledgeable legal team.

Do I have to comply with my company’s internal injury or illness reporting process?

While there’s no legal statute that requires you to do this, your boss or company may require it as a condition of your employment. You can participate in your employer’s internal reporting process if it’s necessary or you chose to do so. However, if the process seems unreasonable, or you have concerns or questions about your rights, contact an attorney. You still have the right to select your treating doctor. We offer free initial consultations without obligation. Call or visit our website today.

Can I still get workers’ comp if I didn’t immediately know that my injury would prevent me from working?

Yes. You can follow the regular process to file a claim for workers’ comp benefits as soon as it becomes apparent that the injury affects your ability to work and may result in wage loss.

How long will I have to wait for a decision?

After receiving notice of your injuries, your employer must submit OWC Form 8—Employer’s First Report of Injury or Occupational Disease—within 10 days. Your employer or its workers’ compensation insurer then has 14 days to accept your claim and start payments or send you a notice of denial.

What if my employer denies my claim?

You can file an appeal with the District of Columbia Administrative Hearings Division (AHD). The process is as follows:

  • Informal conference. Essentially mediation, this process consists of you and the insurance company meeting with a claims examiner who issues a written, non-binding recommendation within 30 days. The recommendation can become binding if neither party contests it.
  • Formal hearing. If either party rejects the non-binding recommendation, they can file a form with the AHD requesting a formal hearing. After receiving the request, the AHD will schedule a hearing and notify the involved parties. Held at the Office of Hearings and Adjudication, this hearing allows both sides to make legal arguments, present evidence, and question witnesses before an administrative law judge. Having an adept workers’ comp attorney by your side increases your chances of a successful outcome.
  • Further appeals. Disagree with the administrative law judge’s decision? You have 30 days to file an appeal with the Compensation Review Board, which will review the evidence and issue a decision. Still don’t agree? You have 30 days to file an appeal with the D.C. Court of Appeals, which has the final say in the matter.

What are the benefits of settling a workers’ compensation claim?

In some cases, a workers’ comp insurer may offer you a lump sum settlement in lieu of making regular payments. If you accept the settlement, it effectively ends your claim, meaning you can go about your life without concern as to how your actions may affect your case. Additionally, a lump sum settlement can make it easier to catch up on bills if you’ve fallen behind, and it gives you a greater degree of control. Unfortunately, if you spend the lump sum before you’re fully recovered, you won’t be able to pursue additional compensation. Always consult an attorney before agreeing to a settlement.

Seeking Medical Treatment for Workplace Injuries and Occupational Illnesses

Getting the medical treatment you need is vital to your recovery. Fortunately, D.C. workers’ compensation covers all reasonable and necessary medical care associated with your work injury. Here’s what you should know.

Do I have to use an approved doctor when seeking initial treatment?

No. You can see any qualified medical professional for urgent or emergency treatment.

Can I choose my own doctor for non-emergent care? 

Yes. You can choose any doctor who accepts workers’ compensation insurance. However, once you’ve chosen, you can’t jump around from doctor to doctor. Changing doctors requires authorization from your employer’s workers’ comp carrier.

What is an insurance medical examination (IME)?

IMEs are medical exams conducted by a doctor chosen by the insurance company and are a common tactic insurance companies use to try to cut off benefits to injured or ill workers. If the insurance company notifies you that they want an IME, you have to comply. Fortunately, the opinion of your treating physician generally takes precedence.

What is MMI, and how does it affect my workers’ compensation claim?

Maximum medical improvement—or MMI—indicates that recovery of your injury or illness has plateaued and is unlikely to improve. Your doctor will determine when you’ve reached MMI, usually after all possible treatments have been tried.

After reaching MMI, temporary partial disability (TPD) or temporary total disability (TTD) payments will stop, and your doctor will evaluate whether you can return to work—either in your previous job or in a position with different duties. If your disability is permanent, you may be entitled to permanent disability benefits.

Who pays my medical bills?

Your employer’s workers’ compensation insurer is responsible for paying the medical bills related to your workplace injury or illness. Discuss your claim with us to learn more about this process and how we can help.

💡Pro Tip: Lying is a loser’s game. Of all the potential mistakes you can make when filing a workers’ comp claim, lying is the worst, as it can result in devastating consequences. If you lie about your injury, how it happened, your preexisting conditions, or your recovery, you will lose your case and be denied benefits. It’s as simple as that. Don’t risk it—be honest and transparent throughout the claims process.

Returning to Work After an On-the-Job Injury

Going back to work is often one of the most challenging parts of the workers’ compensation process. Learn about your rights and options below.

What if the doctor tries to get me to go back to work before I’m ready?

Make sure your doctor understands your job and how your injury affects your ability to perform your work-related duties. Explain everything you do in your role at work, as well as the physical or mental difficulty of your tasks—and be specific. Keeping a journal that describes your symptoms and limitations can help.

What if I’m unable to go back to the job I was doing?

D.C. workers’ compensation benefits include vocational rehabilitation, so you can work with a counselor to find new jobs to apply for and continue collecting wage replacement benefits until you can find suitable alternative employment. If you receive a letter asking you to do vocational rehab, as long as the requests are reasonable, you have to comply —otherwise, you risk having your benefit payments terminated.

If I’m sent back to work with restrictions, does my employer have to accommodate my limitations?

No. Your employer has the option to accommodate your restrictions or continue to pay you temporary total disability (TTD) benefits.

If my employer fires me, do I still get benefits?

Yes. Even if your employer fires you, their workers’ compensation insurer still has to cover your medical treatment and provide disability wage replacement payments while you’re unable to work due to your injuries.

💡Pro Tip: Not all workers’ compensation attorneys have the same abilities. Hiring an attorney to represent you is essential, but not all D.C. workers’ comp attorneys are created equally. You need an attorney who understands the intricacies of the law and has experience handling your type of case. Additionally, the attorney you choose should be well versed in the various aspects of workers’ compensation cases and take continuing legal education (CLE) training courses to ensure they stay at the top of their game.

You Need—and Can Afford—a Workers’ Comp Attorney 

With much-needed benefits at stake, you simply can’t afford to go it alone. Find out how a skillful workers’ compensation attorney can help your case and how contingency fee agreements mean you can afford their services.

Why should I hire a workers’ compensation attorney?

Seasoned attorneys have the knowledge and experience necessary to interpret dense legal statutes, and they are highly skilled in the art of negotiation. You need someone like this by your side to ensure your claim is handled fairly and that you’re able to take advantage of any and all available benefits.

What will an attorney do to help my case?

The list of everything an attorney will do to help your case is long. Here are just a few of the things you can expect your attorney to do to assist you:

  • Conduct an initial interview with you to discuss your case and the workers’ compensation claims process, as well as your rights and options
  • Gather documentary evidence, such as employer incident reports and medical and earnings records
  • Gather information about potential witnesses
  • Analyze the legal issues of your claim to pinpoint strengths and weaknesses
  • Obtain written records from your doctor to better understand your condition
  • Work with you to decide whether to negotiate with the insurance company
  • Prepare you—as well as doctors and witnesses—for depositions and hearings
  • Represent you at hearings
  • Draft motions, statements, discovery documents and requests, opening and closing statements, etc.
  • Preparing settlement documentation, if applicable
  • Coordinate receipt of benefits from Medicare, Medicaid, Social Security disability, and unemployment
  • Prepare appeals and rebuttals, if needed
  • Recommend whether to appeal the case in the event your claim is denied
  • Handle your case throughout the appeals process
  • And much, much more.

How much does it cost to hire a workers’ comp attorney?

D.C. workers’ compensation attorneys work on contingency, which means that you don’t pay unless we win your case. Rather than paying for legal services up front, our fee is subtracted from your compensation. The attorney’s fee is never more than 20% of the amount recovered.  Have questions? We’d be happy to discuss the details of our contingency fee agreement with you.

Request a Consultation 

If you have additional questions, please call our law office at 202-919-6463 to schedule an appointment for a free, no-obligation initial consultation. We look forward to discussing your case and how we can assist you.

Appendix A: D.C. Workers’ Compensation Forms for Private Sector Employees

This Appendix contains the two forms that you will need to file your D.C. Workers’ Compensation Claim. Print them out and follow the instructions on the forms to preserve your rights.

  • DCWC Form 7 (Employees Notice of Accidental Injury or Occupational Disease). Use this form to report a job-related injury or illness in writing to the Office of Workers’ Compensation within 30 days of occurrence or awareness. Keep a copy of the completed form for your records, file a copy with your employer, and send the original to the Office of Workers’ Compensation.
  • DCWC Form 7A (Employee’s Claim Application). File this form within one year after injury or death.

Do you have questions about the workers’ compensation claim process? Please call our office at 202-919-6463 to schedule a complimentary case evaluation.

 

D.C. Workers’ Compensation: What Every Injured Worker Needs to Know

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