Energy Employees Occupational Illness Compensation Program by djz44927

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									Energy Employees Occupational
 Illness Compensation Program




          September 2009
       Mission of EEOICPA
 To deliver benefits to eligible employees and
former employees of the Department of Energy
(DOE), its contractors and subcontractors or to
certain survivors of such individuals, as provided
                in the EEOICPA.

The mission also includes delivering benefits to
    certain beneficiaries of Section 5 of the
Radiation Exposure Compensation Act (RECA).

                                                 1
       Background of EEOICPA
   Part B – became effective July 31, 2001
   Part E – became effective October 28, 2004;
    created to replace Part D Program
   Agencies
     Department of Labor (DOL)
     Department of Energy (DOE)
     Department of Health & Human Services
      (HHS)
     Department of Justice (DOJ)

                                                  2
       EEOICPA COMPENSATION

      $5 Billion Total                     MEDICAL
                                              7%
       Compensation
           $3 Billion Part B
                                   PART E
           $1.65 Billion Part E    32%
                                                      PART B
                                                       61%

           $350 Million Medical




                                                               3
Data as of July 27, 2009
     A Quick Look at Part B
 Radiation induced cancer
 “Special Exposure Cohort”

 Beryllium Disease

 Silicosis (for miners in Nevada and
  Alaska)
 “Supplement” for RECA uranium
  workers

                                        4
       Part B: Who’s Eligible?
 DOE   employees (Feds)
 DOE contractors/subcontractors

 Atomic Weapons Employers (AWE)

 Beryllium vendors (BV)

 Certain survivors of deceased
  workers
   RECA Section 5 uranium workers
                                     5
Part B: Who’s Eligible? (cont’d)
 Presumptive coverage for workers
 with 22 specified cancers at
 SPECIAL EXPOSURE COHORT
 (SEC) sites
 Fourlegislated – 3 Gaseous Diffusion
 Plants, plus Amchitka
 44   SEC classes added by HHS so far
                                         6
Under Part B Eligible Survivors (at time
     of compensation payment):
   Spouse – married to covered employee for at
    least one year immediately prior to death
   Children (if there is no surviving spouse)
   Parents (when there is no surviving spouse or
    child)
   Grandchildren (when there are no preceding
    survivors)
   Grandparents (when there are no preceding
    survivors)
                                                    7
        Basic Part B Claim Criteria –
               Employment
   DOE Employee
   DOE Contractor or Subcontractor
   Beryllium Vendors
   Atomic Weapons Employer
   Approved Section 5 RECA claims

                                        8
         Basic Part B Claim Criteria –
              Medical Illnesses
   Any malignant cancer (at least as likely as not
    caused by radiation exposure)
   Chronic Beryllium Disease
   Chronic Silicosis (only for employees who
    worked during the mining of atomic weapon test
    tunnels in Nevada or Alaska)
   Beryllium Sensitivity

                                                      9
        Basic Part B Claim Criteria –
              Burden of Proof

   Claimant carries the burden to prove the
    elements of the claim
   DOL will assist in collection of evidence,
    i.e. medical documentation, employment &
    exposure records



                                               10
             Part B Benefits
 $150,000   lump sum compensation
 payment
 Medicalbenefits for covered
 conditions
 Medical treatment and monitoring
 only for beryllium sensitivity
                                     11
     Uranium Worker Part B Benefits
          under the EEOICPA
   DOL verifies RECA Section 5 award with
    the DOJ to determine coverage and
    compensation
   Section 5 awardees from DOJ receive $50,000
    and medical benefits under Part B of the
    EEOICPA


                                                  12
         A Quick Look at Part E
   Any occupational illness with causal relationship to toxic
    substance/chemical supported by well reasoned and
    rationalized medical evidence
   DOE contractor/subcontractor or worker at RECA
    Section 5 facility
   Certain survivors of deceased workers; eligible spouse; if no
    spouse, eligible child
   Available compensation based on permanent impairment,
    years of eligible wage loss, medical care for covered
    conditions, and for survivors, if employee’s death caused,
    contributed to, or aggravated by covered illness

                                                                 13
         Part E: Who’s Eligible?
   DOE contractors and subcontractors
     Does NOT include AWE, BV workers
     EXCEPTION: if AWE/BV is designated as a
      DOE contractor for remediation, and the
      employee worked on the remediation
   Eligible survivors



                                            14
          Part E Eligible Survivors
       (at time of employee’s death)
   Spouse – married to covered employee for at
    least one year immediately prior to death
   Covered Child – if no surviving spouse, a child
    is eligible for compensation if at the time of the
    employee’s death the child was:
      Under the age of 18,
      Under the age of 23 and a full-time student,
       continuously enrolled in an educational
       institution since age 18, or
      Any age, if incapable of self support
                                                     15
       Basic Part E Claim Criteria
Employment:
     Proof of Section 5 employment (uranium mining,
      uranium milling, or ore transporting) at a Section 5
      facility (uranium mine or uranium mill), and
      exposure to a toxic substance
Medical:
     Diagnosed illness, e.g. asbestosis, cancer,
      dermatitis, asthma, etc.



                                                             16
  Basic Part E Claim Criteria cont’d
Proof of Survivorship Eligibility:
     i.e. Marriage Certificate, Birth Certificate
Burden of Proof:
     Claimant carries the burden to prove the elements of
      the claim
     DOL will assist in collection of evidence, i.e. medical
      documentation, employment & exposure records



                                                            17
              Part E Benefits
 $250,000 maximum lump sum compensation payment
  per covered employee (includes wage loss and/or
  impairment
 $175,000 Maximum survivor benefit
    $125,000 standard survivor lump sum compensation
     benefit
    + additional $25,000 or $50,000 for established wage
     loss
 State Workers’ Compensation/Tort offset can be
  applied
 Medical benefits for covered conditions

                                                       18
Survivor – Compensation Categories

                    Category 1 – employee death was
                     caused, contributed to, or
      Category 1
       $125,000      aggravated by toxic exposure

      Category 2    Category 2 – Category 1 plus
       $150,000
                     employee had 10 years- 19 years
                     wage loss due to covered illness

      Category 3
       $175,000     Category 3 – Category 1 plus
                     employee had 20 years or more
                     wage loss due to covered illness

                                                    19
Section 5 Uranium Workers and Part
         E of the EEOICPA
   Part E expands eligibility for Section 5 uranium
    workers (uranium miners, millers, and ore
    transporters) and their eligible survivors
   Treated same as covered DOE
    contractor/subcontractor employees and eligible
    for same benefits
   An award under Section 5 of RECA administered
    by DOJ is NOT required for consideration under
    Part E of the EEOICPA

                                                   20
        Means of Verifying Exposure

   DOL Resource Centers
       Occupational History Questionnaires (OHQ)
 DOE Document Acquisition Request (DAR)
 Former Worker Protection Records (FWP)

 Claimant Records




                                                    21
Means of Verifying Exposure cont’d
Site Exposure Matrices (SEM)
   Identifies toxic substances related to labor categories,
    processes, buildings, and major incidents
   Designed to assist with exposure evaluation and
    houses exposure information for uranium sites
   4,170 Uranium Mines
   48 Uranium Mills
   17 Ore Buying Stations
   A version of the SEM database is available to the
    public on the DEEOIC website at
    http://www.sem.dol.gov/
                                                          22
           Proving Causation Under
           Part E of the EEOICPA
   “At least as likely as not” that exposure to a toxic
    substance (including radiation) at a Section 5
    facility (uranium mine or uranium mill) was a
    significant factor in causing, contributing to, or
    aggravating the worker’s illness
   Automatic establishment of causation for the
    condition
        Part B condition accepted by DOL
   For survivor claims, causation between covered
    condition and death must also be established
                                                      23
                    Part E: Impairment
   Determination of % of permanent whole body
    impairment due to covered illness
       Impairment rating performed at maximum medical improvement
        (MMI)
       Well-stabilized and unlikely to improve with medical treatment
       Covered illness in terminal stage prior to MMI
            DOL proceeds to determine impairment rating
       Standard Applied – 5th Edit. AMA’s Guides to the Evaluation of
        Permanent Impairment
       Decreased function in a body part or organ established by medical
        evidence
       Claimant may request re-evaluation every two years or upon
        acceptance of new illness
   $2,500 awarded for each percentage point of
    impairment
                                                                         24
    Impairment Rating Procedures
   Options For Getting Impairment Rating:
       Option 1- Physician of the employee’s choice OR
       Option 2- DOL gathers appropriate tests and has a
        qualified physician complete an impairment evaluation
        based on the medical records
   Criteria for Physician Selection:
       Trained and certified to perform impairment ratings
        using the AMA’s Guides to the Evaluation of Permanent
        Impairment, or experience using the Guides

                                                                25
               Part E: Wage Loss
   Evidence must show reduced earned wages prior to
    reaching normal SSA retirement age as a result of a covered
    illness due to exposure to a toxic substance at a DOE
    facility or RECA Section 5 facility
   Calculations based on evidence from multiple sources
    including SSA earnings, tax documents, & wage earnings
    records
   Earnings adjusted for inflation to determine years qualifying
    for wage loss award
   Claimants may file for additional qualifying years of wage
    loss 1 year after initial payment
   Employee potentially eligible for $10,000 or $15,000 per
    year in wage loss benefit depending on level of wage loss
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            Issuing Decisions
 Recommended decision – issued by the District
  Office (DO)
     Waive objections
     File objections
           Review of Written Record
           Oral Hearing
 Final decision – issued by the Final Adjudication
  Branch (FAB)
     Reconsideration within 30 days
     Reopening at any time (with new evidence or
        change in Program)
     Federal Court

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             Claimant Resources
   Resource Centers – 11 locations
      Takes claims and provides customer service

      Newly expanded assistance capabilities

   District Offices – 4 locations
   Toll Free Phone Numbers
   DEEOIC Website
      General program information

      Forms

      Sample decisions

      SEM Website
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             Program Statistics
   For Part B and Part E available at DOL’s
    web site:
    http://www.dol.gov/esa/owcp/energy/regs/compliance
    /weeklystats.htm

   By state and worksite available at:
    http://www.dol.gov/esa/owcp/energy/regs/compliance
    /statistics/Statistics.htm

   Updated daily

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              Resource Center Contact Info
     Las Vegas Resource Center                    Idaho Resource Center
Office Manager                         Office Manager
Name: Joe Krachenfels                  Name: Steve Beehler
E-mail: vegas.center@rrohio.com        E-mail: idaho.center@rrohio.com
Resource Center Address/Phone          Resource Center Address/Phone
Flamingo Executive Park                Exchange Plaza
1050 East Flamingo Road, Suite W-156   1820 East 17th Street, Suite 375

Las Vegas, NV 89119                    Idaho Falls, ID 83404
Telephone: (702) 697-0841              Telephone: (208) 523-0158
Fax: (702) 697-0843                    Fax: (208) 557-0551
Toll Free: (866) 697-0841              Toll Free: (800) 861-8608

       Denver Resource Center                   Espanola Resource Center
Office Manager                         Office Manager
Name: Janele Horner                    Name: Karen Martinez
E-mail: denver.center@rrohio.com       E-mail: espanola.center@rrohio.com
Resource Center Address/Phone          Resource Center Address/Phone
8758 Wolff Court, Suite 101            412 Paseo De Onate, Suite "D"
Westminster, Colorado 80031            Espanola, NM 87532
Telephone: (720) 540-4977              Telephone: (505) 747-6766
Fax: (720) 540-4976                    Fax: (505) 747-6765
Toll Free: (866) 540-4977              Toll Free: (866) 272-3622
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District Office Jurisdictional Map




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           District Office Contact Info
                                        District Office 3 -- Denver, Colorado

(Arkansas, Colorado, Iowa, Kansas, Louisiana, Missouri, Montana, Nebraska, North Dakota, Oklahoma, South Dakota,
Texas, Utah, Wyoming and all claims from RECA Section 5 awardees)
Address                                      Phone Numbers
U. S. Department of Labor, DEEOIC            (720) 264-3060 (Main)
1999 Broadway, Suite 1120                    (720) 264-3099 (Fax)
P.O. Box 46550                               (888) 805-3389 (Toll Free)
Denver, Colorado 80201-6550


                                       District Office 4 -- Seattle, Washington
(Alaska, Arizona, California, Idaho, Hawaii, Marshall Islands, Nevada, New Mexico ,Oregon and Washington)
Address                                      Phone Numbers
U. S. Department of Labor, DEEOIC            (206) 373-6750 (Main)
719 2nd Avenue, 6th floor Suite 601          (206) 373-6798 (Fax)
Seattle, Washington 98104                    (888) 805-3401 (Toll Free)




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