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While the Department of Energy Employees Occupational Illness Compensation processes claims fairly, Terminally Ill EEOICPA Claimants are given priority. This refers to claimants eligible under Part B and Part E of the Act who are in the end stage of a covered illness. The Energy Employees Occupational Illness Compensation Program Act (EEOICPA) outlines compensation for current and former Department of Energy (DOE) employees, agencies, and contractors or their survivors diagnosed with radiogenic cancer, chronic beryllium disease (CBD), beryllium sensitivity, chronic silicosis, after exposure to radiation, beryllium, or silica during their employment at DOE covered facilities. The act also recognizes claimants awarded benefits under Section 5 of the Radiation Exposure Compensation Act (RECA).
Processing claims of end-stage terminally ill claimants
During claims’ processing, the DO and FAB HRs should watch for indicators of an end-stage terminally ill claimant when reviewing a case file or preparing a decision. Indicators of an end-stage terminally ill claimant include requests for hospice care, medical evidence of an illness at end-stage, or telephone calls or letters from RCs, congressional offices, ARs, family members, or medical providers regarding the claimant’s illness.
Once the DO or FAB HR receives a claim from an eligible employee with an end-stage illness, they must notify the DD (or ADD) or FAB Manager (depending on the file location). The DD/ADD or FAB Manager determines if priority handling is necessary. They can review medical documents or other information to determine if the claimant is in the illness end-stage or if death is imminent. Suppose the end-stage terminally ill claimant case is confirmed. In that case, the DO or FAB HR should direct for a case action to occur expeditiously and notify the ECS to include the terminal indicator.
In cases involving terminally ill claimants, all the DEEOIC staff must conduct claim adjudication activities expeditiously. In memos to the Director for reopening or policy clarification cases requiring NO referral, the DO or FAB must identify the claimant as terminally ill.
Suppose the claimant’s terminal medical status is unclear. In that case, the DD/ADD or FAB manager must initiate development to obtain medical evidence to establish the claimant’s status at the end-stage of a disease or illness.
Handling new claims for Terminally Ill EEOICPA Claimants
Designated DEEOIC staff at the DO or RC take new claim documentation, including the postmarked envelope, to mail a claim form and affix an inked date stamp on all documents. The date stamp is to identify the receiving office location and received date. Once the date is stamped, CMR contract staff make an electronic image of the documents and upload them into the Energy Document Portal (EDP), which goes directly into the Case Create Queue in OIS. The CMR then notifies the Centralized Case Create (CCC) office. Claimants, their attorneys, AR, or family members can also upload claim documentation into OIS.
Case create clerks at the CCC promptly identify incoming claims by checking the Case Create Queue daily. The CCC records ECS claims relevant demographic data, such as personal, medical, employment, and other component data. Upon completion, the staff uploads a copy of the claim form into OIS, automatically generating a unique ECS Case Identification Number (Case ID number).
Once the DEEOIC office or an RC claim from a terminally ill claimant, the claim form and supporting documentation are date-stamped, scanned, converted to a PDF attachment, and immediately sent via e-mail to zzOWCP-DEEOIC-Centralized Case Create Group. The e-mail subject line for terminal claims is indicated as “Terminal Case Create,” followed by the office sending the claim and the claimant’s last name or the case number of an existing case. The DO office should give priority to claims with a terminal status.
If the DD or FAB Manager determines a delay in processing the forms, they should telephone the OIS Coordinator or Cleveland DD. Once the RC receives a terminal claim, they upload all the relevant documentation to the EDP. The DD reviews the documentation to determine if the medical records qualify for claim expedition. Claims eligible for expedition go through the process outlined above. After reviewing claims, the DO forwards claims that do not qualify for an expedition to the CMR for processing.
Occupational illness under Part B is presumed to occur from a toxic substance exposure under Part E in all DOE contractor or subcontractor employees at a covered DOE or RECA Section 5 facility.
Critical factors determining a claimant’s eligibility for Part E claims include establishing verified covered employment, diagnosed medical condition(s), and survivor (if applicable) relationship to the deceased employee. Part B survivors must establish the distinct survivorship criteria under Part E and provide evidence that it is “at least as likely as not” that the employee’s exposure to a toxic substance was a significant factor that aggravated, contributed to, or caused the death.
What is the difference between Part B and Part E covered conditions?
The initial covered employment determines whether a condition is covered under Part B, Part E, or both. Conditions covered under Part B are beryllium sensitivity, CBD, chronic silicosis, and cancer. Part E-covered illnesses are those occurring from occupational toxic substance exposure, including those covered under Part B, such as diagnosed cancers, respiratory illnesses, cardiac illnesses, and mental illnesses originating from a physical condition, such as a neurological condition. Illnesses or injuries arising from a Part B or Part E condition are recognized as a consequential condition. Part B coverage extends to AWEs, beryllium vendors, DOE federal employees, and contractors/subcontractors. Alternatively, Part E coverage extends to DOE subcontractor/contractor employees but does not cover employees of AWE, beryllium vendors, or federal agencies.
Part B eligibility
- The claimant must suffer from beryllium sensitivity or CBD after exposure to beryllium at the workplace.
- Special Exposure Cohort (SEC) employees who suffer from specific cancers are also eligible for part B benefits. SEC-eligible claimants are not required to complete the NIOSH radiation dose reconstruction and determination of the probability of causation. Qualified employees must have an SEC-specific cancer and have worked at a SEC work site for a specified duration. SEC worksites include gaseous diffusion plants in Kentucky, Paducah, Ohio, Portsmouthor Oak Ridge, Tennessee(for at least 250 days before February 1, 1992), and in Amchitka Island, Alaska (before January 1, 1974).
- The claimant must have a non-specified cancer that is “at least as likely as not” related to radiation exposure from employment at a covered facility.
- Suffering from chronic silicosis after exposure to silica from covered employment at a DOE facility in Nevada or Alaska. The employee must have worked at the facility for at least 250 workdays mining tunnels for atomic weapons tests or experiments.
- Qualified claimants under RECA Section 5, where the US Attorney General has determined entitlement to an award of $100,000.
Part E of the EEOICPA compensates for occupational illnesses causally linked to toxic exposures in the DOE or mining work for contractor and subcontractor employees, their eligible survivors, and uranium miners, millers, and ore transporters as defined by RECA Section 5.
Part E eligible claimants must prove that “at least as likely as not” exposure to a toxic substance at a DOE facility significantly aggravated, contributed to, or caused the illness. Secondly, it is “at least as likely as not” that the exposure to the toxic substance was related to the claimant’s employment at a DOE facility.
Qualified claimants are entitled to medical care, which includes the necessary services, supplies, and appliances as prescribed by a qualified physician, which the DEEOIC considers likely to cure, provide relief or reduce the period or degree of the illness. The provider charges are subject to a fee schedule. Eligible Part B claimants (employees or survivors) are entitled to a lump-sum payment of $150,000, while uranium workers get a lump-sum payment of $50,000.