On March 10, 2016, the U. S. Government Accountability Office (GAO) published the results of its recent study of the Department of Labor (DOL) EEOICPA claims adjudication process. Using a random sample of 200 Part E claims from among 15,932 filed from 2010 through 2014, excluding claims still in process, claims which had already been accepted under Part B, and Special Exposure Cohort (SEC) claims, the GAO assessed the extent to which the DOL follows its own adjudication procedures. The study was conducted between May 2014 and February 2016, drawing from the most recent claims at the time.
The GAO’s findings concluded that while the adjudication process generally followed the DOL’s guidance and procedures in around 90% of the claims studied, inconsistencies were identified in an estimated ten percent of claims. These included sometimes inaccurate, conflicting, or incomplete information, as well as errors in correspondence with claimants and in development of claims.
Certain decisions listed the wrong medical condition, and others did not include accurate searches of the Site Exposure Matrix (SEM), the DOL’s online database of facilities, toxic substances, and associated illnesses. The SEM documents causal links between toxins and diseases on the basis of medical research. According to the DOL, since 2006 the number of such links listed in the SEM has increased from about 300 to over 3,000. Because of the large volume of new information continually being added to the SEM, the DOL provides limited notification to claims examiners and the public when additions to the database are made. Therefore it must be continuously checked for updates by both Claims Examiners and Claimants.
According to the DOL’s own monitoring, their process for adjudication of Part E claims is functioning satisfactorily, though persistent deficiencies remain, such as insufficient use of program resources to fully develop claims and improperly written decisions.
The GAO concluded their study with a recommendation that DOL take steps to ensure that all decision letters receive supervisory review, a process now at the discretion of each district office. It also recommended that there be a requirement for claims examiners to document that they checked whether the SEM had been updated just prior to issuing a decision to deny a claim.
The full GAO report is available at http://www.gao.gov/products/GAO-16-74?utm_medium=email&utm_source=govdelivery.