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Ashcraft & Gerel
LLP
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This web page will discuss workers compensation claims for private sector (non-government) employees in the District of Columbia. Unfortunately, we do not handle Federal Employee or DC Government Employee workman's compensation claims.
The District of Columbia (Washington, DC) has had a workers compensation law covering private sector employees in place since 1928. Initially, job related injuries were covered by the Longshoremen's & Harbor Workers Compensation Act, a Federal workers comp law that was applied to private sector employees in the District of Columbia by the Federal Government. Following limited home rule, the District of Columbia City Council in 1979 passed the District of Columbia Workers Compensation Act of 1979 which became effective in 1982. That Act was based primarily on the provisions of the Longshoreman & Harbor Workers Compensation Act. The District of Columbia Workers Compensation Act applies to the job related injury, death or occupational disease of any private sector worker that occurs in Washington, DC, if that worker performed work for the employer on a regular basis in the District of Columbia. Likewise, the Act covers the injury, occupational disease or death of a private sector worker that occurs outside of the District of Columbia if, at the time of the injury or death, the employment was principally localized in the District of Columbia. The Act does not include coverage for casual workers or for independent contractors in Washington, DC. A casual employee is a worker hired on a short term, temporary basis to perform services which are not in the ordinary course of the employer's business. The failure of an employer to obtain workers comp insurance or an appropriate self-insured bond is punishable by civil fines up to $10,000.00.
For an injury, occupational disease or medical condition to be covered under the District of Columbia Workers Compensation Act, it is sufficient that the injury or medical condition arise out of and in the course of the employment. If the employment aggravated, accelerated or worsened an already existing condition, that aggravation is compensable as well. Workman's compensation for covered injuries is often denied and contested by insurance carriers based on a number of defenses: jurisdiction, notice, medical causation or statute of limitations. The insurance company for an employer, however, does not make the final decision as to whether an injury or case is or is not covered. That question is answered by the District of Columbia's Department of Employment Services, which is the agency designated to administer and adjudicate cases under the Act. If the compensability of an accident or medical condition is denied by the workers comp insurance company for an employer, the injured Washington, DC worker would be well advised to retain a Washington, DC lawyer experienced in handling workers compensation cases in the District of Columbia. Both parties to contested claims are often represented by workers comp lawyers. In fact, as will be seen below, the District of Columbia Workers' Compensation Act is set up in such a way that all lawyers fees come out of workmans compensation benefits obtained for the injured worker by the attorney, and it is, therefore, very common for lawyers to enter their appearance on behalf of injured workers even at a stage of the proceedings in a case where everything is going smoothly, and there is, at that time, no dispute. Waiting until a dispute arises to obtain a lawyer risks not only substantial delay but also may result in the injured Washington, DC worker jeopardizing the case by doing things or failing to do things that would hurt or help the workers comp claim.
Under the Act, an employer or its insurance company is required in all cases to provide temporary wage loss benefits, if appropriate, payment of all medical expenses related to the compensable injury and, possibly, permanent partial disability in the form of wage loss benefits or scheduled loss benefits, vocational rehabilitation or death benefits.
As with many workmens' compensation schemes, there are five types of compensation benefits payable under the Washington, DC Act:
The Act provides that an injured worker who is temporarily and totally disabled (TTD) is entitled to receive two-thirds or 66 2/3% of his average weekly wage at the time of injury calculated by determining the injured worker's total earnings over the twenty six (26) weeks preceding the injury. There are a number of other ways a workers comp attorney may approach this calculation if the injured worker had not been with the employer for the six months preceding the injury. There is also a cap on the weekly amount of workmans compensation that can be received, based on a formula that takes into account the average weekly wage of all workers in the District of Columbia during the year of injury. Unlike some jurisdictions, the District of Columbia Act allows wage stacking in the formula used to calculate the injured worker's average weekly wage. If an injured worker held two jobs at the time of his or her accident, the workers comp lawyer may submit the earnings from both jobs as part of the calculation of the appropriate average weekly wage and comp rate.
The Act requires that temporary partial disability compensation benefits based on a partial wage loss be paid at the rate of two-thirds or 66 2/3% of the difference between the worker's average weekly wage calculated for the period before the injury, and the actual earnings of the worker upon returning to light duty or part-time work. This compensation benefit is paid for as long as the injured worker has not reached maximum medical improvement and his medical condition is affecting his ability to earn wages.
If an injured worker reaches maximum medical improvement and is still unable to return to his regular employment, he is entitled to ongoing permanent partial disability in the form of wage loss compensation benefits of two-thirds, or 66 2/3%, of the difference between his average weekly wage prior to the accidental injury, and his actual wages upon his return to light duty or part-time work, assuming the injury was to the body as a whole. The District of Columbia Workers Compensation Act also includes a Schedule of Injuries for which an injured worker is entitled to permanent partial disability compensation benefits based on a calculation using his compensation rate, the body part injured, and the percentage of permanent partial disability based on a rating from the treating or an evaluating physician. Furthermore, the worker remains entitled to temporary total disability compensation benefits even if he has reached maximum medical improvement following a scheduled injury until he has returned to some type of gainful employment. Scheduled losses are paid for injuries to the fingers, hands, arms, toes, feet, legs, eyes and ears. Injuries to the head, neck, shoulder, hip, back and any other part of the body not included on the schedule are entitled to wage loss compensation benefits on a permanent basis. There are some cases in which both scheduled and nonscheduled parts of the body have been injured in the same accident, and in those cases, workers comp attorneys representing injured workers have been able to obtain both a scheduled loss award as well as a wage loss award in the same case, depending on the opinions of the doctors with regard to whether there are permanent disabilities in connection with both the scheduled and nonscheduled injuries. Furthermore, a lawyer may be able to obtain for a worker a scheduled loss award where the shoulder or hip and even the back may be the site of the original injury, but the permanent disability resulting from those injuries affects a scheduled member.
A finding of permanent total disability will be entered if the workers comp attorney is able to demonstrate that the injured worker is permanently unable to return to any type of substantial gainful employment. The weekly benefit at the outset of this disability is calculated in the same manner as for a temporary total disability, but once a determination has been made that an injured workman's disability is permanent, under the permanent total disability provisions, the injured worker is entitled to annual cost of living increases. While there is presently a 500 week limit on the payment of permanent partial disability wage loss compensation benefits, a permanently and totally disabled worker is entitled to be paid for the rest of his or her life. If a compensable accident, injury or medical condition results in the death of the injured Washington, DC worker, the spouse and dependents of the injured worker are entitled to file a workmens' comp claim for death benefits.
Under the District of Columbia Workers Compensation Act, the injured worker who has sustained a compensable accident is also entitled to have all of his or her reasonable and causally related medical expenses paid for as long as there is a need for such medical services. There is no per accident or annual deductible or dollar limit on the total of medical expenses, and while compensation insurers generally pay medical expenses according to a Fee Schedule, the injured worker cannot be made to pay any balance due on a doctor or hospital bill for services causally related to a compensable injury. Although most medical bills are paid voluntarily by the insurance carrier, in the absence of such voluntary payment, the attorney representing the injured worker may obtain a hearing at which the reasonableness and necessity of the medical services and the fees charged may be adjudicated by the Department of Employment Services.
Attorney's fees in connection with representation of an injured worker are regulated by the District of Columbia Workers Compensation Act and the Department of Employment Services. Any attorney representing an injured Washington, DC worker in a workers compensation claim in the District of Columbia cannot take a fee unless that fee is approved by the Department of Employment Services. No fee will be approved unless the lawyer obtains some benefit for the injured worker, because the attorneys fees are based on the compensation benefits obtained and are limited to 20% of the value of those compensation benefits.
Ashcraft & Gerel's lawyers have been handling District of Columbia Workers Compensation claims on behalf of private sector employees for over 50 years. Our lawyers have a reputation for being aggressive and for being familiar with the finer points of the Washington, DC Workers Compensation Act. Often this experience can make a difference in the amount of compensation benefits an injured worker receives, including the amount of any award or settlement in a case. Our District of Columbia offices are located at 2000 L Street, NW, Suite 400, in the District of Columbia. If you would like to speak to an attorney about a District of Columbia Workers Compensation claim, please feel free to click here to complete the help form on this web site, click here to email us or telephone us at the District of Columbia office. The telephone number of our D.C. office is (202) 783-6400.
