D.C. Code § 1-623.01

Current through codified legislation effective October 30, 2024

Section 1-623.01 - Definitions

For the purpose of this subchapter:

(1) The term "employee" means:

(A) A civil officer or employee in any branch of the District of Columbia government, including an officer or employee of an instrumentality wholly owned by the District of Columbia government;

(B) An individual rendering personal service to the District of Columbia government similar to the service of a civil officer or employee of the District of Columbia, without pay or for nominal pay, when a statute authorizes the acceptance or use of the service or authorizes payment of travel or other expenses of the individual, but does not include a member of the Metropolitan Police Department or the Fire Department of the District of Columbia who is pensioned or pensionable under §§ 5-701 through 5-724; and

(C) An individual selected pursuant to Chapter 121 of Title 28 of the United States Code and serving as a petit or grand juror and who is otherwise an employee for the purposes of this subchapter as defined by subparagraphs (A) and (B) of this paragraph.

(2) The term "physician" includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by law. The term "physician" includes chiropractors only to the extent that their reimbursable services are limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist, and subject to rules and regulations issued by the Mayor.

(3) The term "medical, surgical, and hospital services and supplies" includes services and supplies by podiatrists, dentists, clinical psychologists, optometrists, chiropractors, osteopathic practitioners, and hospitals within the scope of their practice as defined by District or state law and as designated by the Mayor to provide services to injured employees. Reimbursable chiropractic services are limited to treatment consisting of manual manipulation of the spine, to correct a subluxation as demonstrated by X-ray to exist, and subject to rules and regulations issued by the Mayor.

(4) The term "monthly pay" means the monthly pay at the time of injury or the monthly pay at the time disability begins or the monthly pay at the time compensable disability recurs if the recurrence begins more than 6 months after the injured employee resumes regular full-time employment with the District, whichever is greater, except when otherwise determined under § 1-623.13 with respect to any period.

(5)

(A) The term "injury" means:

(i) Accidental injury or death arising out of and in the course and scope of employment; and

(ii) Occupational disease or infection as arises naturally out of such employment or as naturally or unavoidably results from such accidental injury.

(B) The term "injury" includes:

(i) An injury caused by the willful act of third persons directed against an employee because of his or her employment; and

(ii) Damage to, or destruction of, eyeglasses, hearing aids, medical braces, artificial limbs, and other medical devices and such time lost while such device or appliance is being replaced or repaired.

(6) Repealed.

(7) The term "parent" includes stepparents and parents by adoption.

(8) The terms "brother" and "sister" mean one who at the time of the death of the employee is under 18 years of age or over that age and incapable of self-support, and include stepbrothers and stepsisters, half brothers and half sisters, and brothers and sisters by adoption, but does not include married brothers or married sisters.

(9) The term "child" means one who at the time of the death of the employee is under 18 years of age or over that age and incapable of self-support, and includes stepchildren, adopted children and posthumous children, but does not include married children.

(10) The term "grandchild" means one who at the time of the death of the employee is under 18 years of age or over that age and incapable of self-support.

(11) Repealed.

(12) The term "compensation" includes the money allowance payable to an employee or his or her dependents and any other benefits paid for from the Employees' Compensation Fund, but this does not in any way reduce the amount of the monthly compensation payable for disability or death.

(13) The term "student" means an individual under 23 years of age who has not completed 4 years of education beyond the high school level and who is regularly pursuing a full-time course of study or training at an institution which is:

(A) A school, college, or university operated or directly supported by the United States, by the District, by a state or local government, or political subdivision thereof;

(B) A school, college, or university which has been accredited by the District, by a state, by a state-recognized or nationally-recognized accrediting agency or body;

(C) A school, college, or university not so accredited, but whose credits are accepted on transfer by at least 3 institutions which are so accredited for credit on the same basis as if transferred from an institution so accredited; or

(D) An additional type of educational or training institution as defined by the Mayor.

Such an individual is deemed not to have ceased to be a student during an interim between school years if the interim is not more than 4 months and if he or she shows, to the satisfaction of the Mayor, that he or she has a bona fide intention of continuing to pursue a full-time course of study or training during the semester or other enrollment period immediately after the interim or during periods of reasonable duration during which, in the judgment of the Mayor, he or she is prevented by factors beyond his or her control from pursuing his or her education. A student whose 23rd birthday occurs during a semester or other enrollment period is deemed a student until the end of the semester or other enrollment period.

(14) Repealed.

(15) Repealed.

(16) The term "organ" means a part of the body that performs a special function, and for purposes of this subchapter excludes the brain, heart, and back.

(17) "Utilization review" means the evaluation of the necessity, character, and sufficiency of both the level and quality of medically related services provided an injured employee based upon medically related standards.

(18)

(A) The term "managed care organization" means an organization of physicians and allied health professionals organized to and capable of providing systematic and comprehensive medical care and treatment of injured employees which is designated by the Mayor to provide such care and treatment under this subchapter.

(B) The term "allied health professional" means a medical care provider (including a nurse, physical therapist, laboratory technician, X-ray technician, social worker, or other provider who provides such care within the scope of practice under applicable law) who is employed by or affiliated with a managed care organization.

(19) The term "claimant" means a person who has applied for benefits under this subchapter.

(20) Repealed.

(21) The term "surviving spouse or domestic partner" means the spouse or domestic partner living with or dependent for support on the decedent at the time of his or her death, or living apart for reasonable cause or because of his or her desertion.

(22) The term "accident" means an unexpected traumatic event during a single work shift identifiable by time and place of occurrence and producing objective symptoms of an injury.

D.C. Code § 1-623.01

Amended by D.C. Law 24-6,§ III-302, 68 DCR 003198, eff. 5/13/2021, exp. 12/24/2021.

Mar. 3, 1979, D.C. Law 2-139, § 2301, 25 DCR 5740; Mar. 6, 1991, D.C. Law 8-198, § 3(a), 37 DCR 6890; Sept. 26, 1995, D.C. Law 11-52, § 810(a), 42 DCR 3684; Nov. 19, 1997, 111 Stat. 2181, Pub. L. 105-100, § 150(c)(4); Mar. 26, 1999, D.C. Law 12-175, § 2102(a), 45 DCR 7193; Oct. 3, 2001, D.C. Law 14-28, § 1203(a), 48 DCR 6981; Mar. 13, 2004, D.C. Law 15-105, § 2(c), 51 DCR 881; Sept. 12, 2008, D.C. Law 17-231, § 3(f), 55 DCR 6758; Sept. 24, 2010, D.C. Law 18-223, § 1062(b)(2), 57 DCR 6242.

Mayor authorized to issue rules: Section 4 of D.C. Law 8-198 provided that "(a) The Mayor shall, pursuant to subchapter I of Chapter 15 of Title 1, issue rules to implement the provisions of this act within 90 days from the date of enactment of this act. The proposed rules shall be submitted to the Council for a 45-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules, in whole or in part, by resolution within this 45-day review period, the proposed rules shall be deemed approved.

"(b) The proposed rules shall include standards for:

"(1) A coding system for medical reports and bills; and.

"(2) The implementation of utilization review."

Application of § 150(c) of Pub. L. 105-100 : Section 150(c)(5) of Pub. L. 105-100, 111 Stat. 2181, the District of Columbia Appropriations Act, 1998, provided that the amendments made by subsection (c) shall apply with respect to services, supplies, or appliances furnished under title XXIII of the District of Columbia Merit Personnel Act of 1978 on or after the date of the enactment of this Act. Public Law 105-100 was approved November 19, 1997.

This section is set out more than once. See also 1-623.01, effective until 12/24/2021.