We have been considering a post or two about what we think are some of the best practices for EEOICPA claim presentation and development. With that in mind, this post will start to present some best practices to employ when making a claim for benefits under the EEOICPA.
When making a claim under Part B, one of the first steps is the filing of the claim, which necessarily includes information about the relevant period of employment. We tend to be expansive in our view of what should be included in the relevant period of employment. For example, if you are claiming benefits as a survivor, you might include 1950 to 1955 as your best recollection of your parent’s period of employment. However, employment that you did not know about in 1945 may be inadvertently excluded from the social security records search. Therefore, searching the broader period of 1944 through 1961 might lead to more information from social security.
The Department of Labor (DOL) will assist claimants with requests for records from Social Security. This is useful because the turn around is likely to be much quicker than if you take this record collection task on yourself. The Claims Examiner (CE) has prepared many requests for Social Security earnings statements and will obtain that record quite quickly. If the CE uses a restrictive potential employment period, the effort involved in making the new request can be significant and unnecessary, so we generally tend to include the dates around the period of known employment to attempt to capture unknown employment especially where we represent survivors who are not completely sure of where their relative worked and when. The employment usually occurred long ago, so we should try not to assume we know exactly when it commences and when it was completed unless we have pretty specific information.
From time to time our claimants learn late in the claims process that the worker involved had qualifying employment outside the time period addressed in the initial social security earnings statement. If you find yourself in this circumstance or have questions about obtaining a social security earnings statement, give us a call at (716) 852-7590.
With respect to claims for benefits under Part E, we often find that difficulties can arise after a doctor has been asked to write a letter linking occupational exposure to a toxic or otherwise hazardous substance to a current illness or condition such as asbestosis or COPD. Many claimants, doctors, and advocates know the standard under Part E which requires a showing that the occupational exposure be at least as likely as not (50% or greater likelihood), a significant factor in, the aggravation of, contribution to, or causation of, the illness or condition.
However, many claimants, doctors and advocates do not focus on the statutory requirements:
(1) that the letter report contain detailed objective findings, based, if possible, in part on clinical testing, imaging and other tests and
(2) a detailed rationale, supported by citations to relevant peer reviewed literature, for the finding that describes the objective testing and other relevant information which supports the conclusion that there is a causal connection between the occupational exposure and the illness or condition.
We encourage claimants, advocates and doctors to treat the government like any other business or insurance company that seeks to require detailed support before paying claims. The Final Adjudication Branch (FAB) is required by the EEOICPA to make their decisions based on very specific information. This information must include the scientifically backed conclusions of medical experts that your Chronic obstructive pulmonary disease (COPD) is at least as likely as not caused by your three year exposure to cement dust 30 years ago, not the opinion of a physician who has simply treated you generally over the years.
While it might sometimes seem that the Department of Labor is never satisfied, the payments made under the program are significant and the procedures are designed to prevent the payment of claims without sufficient evidence, in order that benefits will continue to be available for all deserving parties.
Learn more about our EEOICPA claim support services.