Energy Employees Occupational Illness Compensation Program

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Energy Employees Occupational Illness
Compensation Program
May, 2007
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Administration of the EEOICPA

• Part B
• Administered by DOL continues operation
• Over 1.8 billion in compensation paid to date
• Part E
• Replaced Part D all 25,000 cases transferred to
  DOL
• System of federal payments
• Administered by DOL

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Part B Benefits Overview

• Whos eligible Current and Former employees of
• DOE
• DOE Contractors/Subcontractors
• Atomic Weapons Employers (AWE)
• Beryllium Vendors (BV)
• Uranium miners, millers, and ore transporters who
  worked at facilities covered by Section 5 of RECA
• Certain family members of deceased workers

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Part B Benefits Overview, contd

• When eligible
• Worker made sick as a result of exposure to
  radiation or developed beryllium sensitivity,
  chronic beryllium disease, or silicosis.
• What benefits are provided under Part B
• 150,000 maximum compensation (radiogenic cancer,
  chronic beryllium disease, chronic silicosis)
• Medical benefits are available in addition to
  compensation
• No monetary compensation for beryllium
  sensitivity, medical monitoring only

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Part B Benefits Overview, contd

• RECA under Part B
• If an employee or survivor received an award
  under RECA Section 5, DOL pays 50,000 maximum
  compensation.
• Medical benefits are available in addition to
  compensation.

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Part E Benefits Overview

• Whos eligible
• Contractor and subcontractor employees of covered
  DOE facilities
• Uranium miners, millers, and ore transporters who
  worked at facilities covered by Section 5 of RECA
• Certain RECA Section 4 Awardees
• Certain family members of deceased workers
• When eligible
• Worker made sick as result of exposure to toxic
  substance
• What benefits are provided under Part E
• 250,000 maximum compensation
• Medical bills for accepted illnesses

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Basic Part B Claim Criteria

• Employment proof of contractor or subcontractor
  employment at a qualifying DOE, AWE, BV or RECA
  facility exposure to radiation, beryllium or
  silica.
• Medical Diagnosed Illness
• e.g. radiogenic cancer, chronic beryllium disease
  or sensitivity, or chronic silicosis.
• Burden of Proof
• DOL will assist in collection of evidence i.e.
  employment exposure records - medical
  documentation
• Ultimate responsibility for claim rests with
  claimant

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Basic Part E Claim Criteria

• Employment proof of contractor or subcontractor
  employment at a qualifying DOE or RECA facility
  exposure to toxic substance
• Medical Diagnosed Illness
• e.g. asbestosis, cancer, chronic beryllium
  disease, dermatitis, asthma, etc.
• Burden of Proof
• DOL will assist in collection of evidence i.e.
  employment exposure records - medical
  documentation
• Ultimate responsibility for claim rests with
  claimant

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Proving Causation

• Automatic approval for some cases living
  employees
• Part D condition accepted by DOE
• Part B condition accepted by DOL
• RECA Section 5 condition accepted by DOJ
• At least as likely as not (50 or greater) that
  exposure to a toxic substance (including
  radiation) was a significant factor in
  aggravating, causing or contributing to illness
  or death of the employee

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Cancer Solely Caused by Radiation

• Dose Reconstruction NIOSH
• Analysis of historical radiation dose
• Employee favorable dose estimate
• Probability of Causation (POC) Calculation for
  both Parts B and E
• Approved with POC of at least 50
• NIOSH model includes causation contribution

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Cancer Caused by Radiation and Other Toxic
Exposure

• Dose reconstruction outcome?
• Effect of toxic substance
• DOL will evaluate via qualitative medical
  evidence
• Synergistic or additive effect (radiation
  exposure from toxin)

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Causation Toxic ExposuresWhat DOL Will Do to
Help

• Covered Illness Matrices
• Toxin potential to cause, aggravate, or
  contribute to covered illness - death
• Medical analysis conducted by specialists
  toxicology, occupational medicine, etc.
• Site Exposure Matrices (SEM)
• Based on documents obtained from DOE former
  worker programs
• Other sources i.e. unions, worker groups, etc.
• A portion of the SEM database is available to the
  public on the DEEOIC website at
  http//www.sem.dol.gov/

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Radiation Exposure CompensationAct (RECA) Part
E

• Part E eligibility added for uranium workers
  employed at facilities covered by RECA Section 5
  - who were awarded benefits
• RECA administered by DOJ
• Other illnesses due to exposure to toxic
  substances at a Section 5 mine or mill

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RECA Coverage

• - Who -
• Miners, millers, ore transporters
• - Where -
• Colorado, New Mexico, Arizona, Wyoming,
  North/South Dakota, Washington, Utah, Idaho,
  Oregon, and Texas
• - When -
• January 1, 1942 through December 31, 1971

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Adjudication of RECA Claim

• Section 5 award accept under Part E
• No Section 5 award development for causation
• Different criteria for employment and covered
  illnesses compared to DOJ program
• Same benefits as other Part E awards

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SEM Roundtable Meetings

• Workers invited to provide firsthand toxic
  exposure knowledge
• Information gathered, evaluated, and verified for
  possible inclusion in database
• An abridged version of the SEM database available
  at http//www.sem.dol.gov/

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Claimant Responsibilities - Causation

• Provide pertinent medical evidence listing
  diagnosis/treatment of occupational illness
• List job titles, known exposures, period of
  employment
• EE-3 Employment History Form
• Occupational History Interview
• Respond to DOL requests for information

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Benefit Process

• Maximum Employee/Survivor Payment - 250,000
• impairment wage loss survivor benefit
• Medical benefits not counted against 250,000 cap
• Does not count award received under Part B
• Offsets
• Coordinate with state workers compensation to
  determine possible offset of state award
• No offset for payments under Part B
• Tort Claims DOL offsets net payment from tort
  action

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Impairment Award

• Determination of permanent impairment due to
  covered illness
• Standard Applied AMAs Guides to the Evaluation
  of Permanent Impairment
• Decreased function in a body part or organ
  established by medical evidence - whole person
• Claimant may request re-evaluation every two
  years or upon acceptance of new illness that
  increases impairment
• 2500 for each of impairment

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Impairment Rating Procedures

• Criteria for physician selection
• Board-certified in relevant medical specialty
• Knowledge and experience in performing impairment
  ratings
• Options for getting rating
• Claimant submits tests-DOL reviews for impairment
• Claimant physician meeting criteria completes
  impairment
• DOL refers for testing and impairment to
  physician

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Maximum Medical Improvement

• 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 to proceed immediately to determine
  impairment rating and issue compensation

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Establishing Wage Loss Due to Accepted Illness

• Medical evidence must show decreased capacity to
  work
• Medical reports describing history, diagnostic
  tests, diagnosis, treatment plan, doctor opinion,
  etc.
• Physician notes, statements, narratives

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Wage Loss Award

• Calculations are based on evidence from multiple
  sources - SSA earnings, tax documents, wage
  earning records
• Earnings are adjusted for inflation to determine
  years qualifying for a wage loss award
• Payments for additional qualifying years of wage
  loss after initial payment - if claimed proven
  by claimant

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Survivor Claims

• Eligible Survivors (at time of employees
  death)
• Living spouse married to covered employee for
  at least one year immediately prior to death
• Covered child, if no surviving spouse
• Under the age of 18 years
• Under the age of 23 years and full time student
• Any age and incapable of self-support
• Statutorily defined DOL has no authority to
  modify Congressional definition

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Survivor Compensation Categories

• Category 1 employee death was caused,
  contributed to, or aggravated by toxic exposure
• Category 2 Category 1 plus employee had 10
  years or more wage loss due to covered illness
• Category 3 Category 1 plus employee had 20
  years or more wage loss due to covered illness

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Computation of Wage-Loss Years Survivors

• Same as with living employees
• Exception counts years following death as wage
  loss up to SSA retirement age
• Maximizes years of wage loss

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Decision Making

• District Office manages case and issues decision
• All claims (Part B E) combined into one file
• Includes any documentation collected by DOE
  during administration of Part D
• Handling Objections
• Review of the Written Record
• Request for Hearing
• Federal District Court

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Filing Claims

• 4 District Offices
• 11 Resource Centers
• Website http//www.dol.gov/esa/regs/compliance/o
  wcp/eeoicp/main.htm