U.S. Department of Labor's Employee Occupational Illness Compensation Program
Program overview: the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) provides benefits to nuclear weapons workers and their survivors. It offers lump-sum compensation, medical benefits, and wage loss assistance for eligible claimants affected by work-related illnesses and injuries. The program's eligibility criteria are based on employment history and exposure to hazardous materials during work. Workers or survivors can receive benefits for conditions such as cancer, chronic beryllium disease, chronic silicosis, and more. Detailed processes for verifying employment and medical eligibility are outlined, along with the assistance available for various categories of workers under the program.
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Presentation Transcript
U.S. Department of Labor Division of Energy Employees Occupational Illness Compensation Presented by: Rachel Pond, Director www.dol.gov/agencies/owcp/energy 1
What is the EEOICPA? Our mission is to protect the interests of workers who were injured or became ill on the job, or their families, by making timely, appropriate, and accurate decisions on claims and providing prompt payment of benefits to eligible claimants. Provides lump-sum compensation and medical benefits to current and former nuclear weapons workers. Survivors of qualified workers may also be entitled to benefits. 2
Benefits Part B Part E $150,000 Employee & Survivor $2,500 per % Impairment - Employee Annual Wage Loss $10,000-$15,000 - Employee $50,000 RECA Employee & Survivor $125,000 Survivor (+ lump-sum Wage Loss if eligible) $400,000 Lump-sum cap for B & E combined Employee Medical Care for Accepted Conditions 3
Program Eligibility Part B (enacted 2000) Employment Medical Survivors Part E (enacted 2004) 4
Employee Eligibility Employed By DOE Contractors and Subcontractors Part B Yes Part E Yes DOE Federal Employees Yes No AWE Employees (Atomic Weapons Employer) Yes No Beryllium Vendors Yes No RECA Yes Yes 5
Means of Verifying Employment DOE Earnings Records DAR Records Oak Ridge Institute for Science and Education (ORISE) Corporate Verifiers SSA (Social Security Agency) Wage Data Other Sources Affidavits Records/documents created by state/federal agencies Claimant s Personal Records 6
Medical Eligibility Part B (enacted 2000) Part E (enacted 2004) Cancer Chronic Beryllium Disease Chronic Silicosis RECA Section 5 Awardees Any condition related to toxic substances Section 5 of the RECA covers uranium workers employed in the mining, milling or transportation of ore. The U.S. Department of Justice will make a payment of $100,000 to eligible workers or their survivor(s) if it finds them qualified under Section 5 of the RECA. 7
Part B: Special Exposure Cohort (SEC) Worker Group Designation Presumption occupational radiation caused cancer Employment Worked at a particular facility and meet any special conditions (employer or work process) Workday requirement 250 days (aggregate) Specified Cancer 22 cancers named in law 8
Part B: Adding New SEC Classes HHS designates new SEC classes 4 statutory SEC classes; plus As of September 17, 2021, HHS has designated 129 additional SEC classes DOL administers SEC cases No role in designation 9
Part E: Causation & Exposure Exposure to toxic substances Must establish that exposure to a toxic substance is at least as likely as not a significant factor in causing, contributing to, or aggravating the claimed illness. DOL Tools: Occupational History Questionnaire (OHQ) Site Exposure Matrices (SEM) DAR records (from DOE) Former Worker Medical Screening Program (FWP) Other sources: affidavits / facility records 10
Site Exposure Matrices (SEM) A searchable database of facility-specific inventories of toxic substances used during production of atomic weapons Relational search feature to identify potential toxic substances employees encountered during their work Source of reliable data on toxic substances (chemical & biological) linked to a claimed illness or work factor DOL developed and supported this tool to assist examiners and claimants with site specific information in order to promote a positive outcome whenever possible Publicly available for transparency, and to support claimants and their physicians in writing medical opinions on causation 11
Claim Adjudication Process & Timeframes See attached graphic for timeframes File a Claim Claimants have 3 Options to submit a claim Form. Submit Form by mail, electronically or with Resource Center assistance. There are 11 Resource Centers located across the country. Complete Occupational Health Questionnaire (Part E only) The Resource Centers conduct interviews with claimants to collect information pertaining to covered employment and the toxic or radioactive substances the employee may have been exposed to. Provide additional evidence During the review process, the CE may request documentation from the claimant regarding employment, medical, or other necessary evidence Recommended Decisions The District Office issues a recommended decision to the claimant(s), - preliminary decision to accept or deny a case. Final Decision Case referred to the Final Adjudication Branch (FAB) Claimant has the right to appeal in writing or through a hearing. FAB considers all evidence and issues a final decision. (Right to reopen at any time) 12
Role and Function of Medical Health Science Experts Evaluation of case-specific referrals to offer expert written advice to claims staff responsible for decision making Provide professional input a claims examiner can weigh in comparison to other available case evidence Help direct the course of development Respond to claimant questions or input MHSU experts DO NOT decide the outcome of claims Research and analysis of relevant subject matter to support development of program policies and procedure 13
DEEOIC Professional Experts Health Physicist evaluates occupational radiation exposure and application of the dose reconstruction methodology Industrial Hygienist assesses extent, nature and duration of chemical or biological exposure in an occupational setting Toxicologist analyzes data and literature relating to the relationship between toxic substance exposure and disease Registered Nurse provides medical input on the establishment of medical necessity for requested ancillary medical benefits such as home health care and durable medical equipment 14
DEEOIC Medical Consultant Staffing and Organization Medical Health Science Unit (MHSU) employs Two full time health physicists One full time PhD Health Scientist (Toxicologist/Epidemiologist) Available contractor Toxicologists Two full time Certified Industrial Hygienists (CIH) Contractor Certified Industrial Hygienists Four full time Registered Nurses (RN) Contract Medical Consultants 15
Contract Medical Consultant (CMC) A contracted physician who conducts a review of case records to render opinions on medical questions. Medical opinions from a CMC are essential to the resolution of claims due to ambiguous causation, lack of medical evidence, unique exposures or other medical questions. The function of a CMC is to provide clarity to claims situations in the absence of pertinent or relevant medical evidence from other sources that support the claim. A CMC referral may also be necessary for review of impairment or wage loss issues. The claims examiner only refers a case to a CMC in the absence of sufficient medical evidence from a claimant s treating physician. 16
Part E: Employee Impairment % permanent whole person impairment due to covered illness AMA s Guides to the Evaluation of Permanent Impairment, 5th Edition $2,500 awarded for each % of impairment 17
Part E: Employee Wage Loss Decreased capacity to work due to an accepted medical condition Employee Compensation: Any year <50% of pre-disability annual wage = $15,000 compensation Any year > 50% but <75% of pre-disability annual wage = $10,000 compensation 18
Claimant Assistance Resource Centers 11 locations Nationwide 4 District Offices / 5 FAB Offices Cleveland, Denver, Jacksonville, Seattle, and National Office DEEOIC website http://www.dol.gov/owcp/energy/ General program information SEM website Claimant Resources (Forms, Medical Benefits Information) Medical Provider Resources (Enrollment, Bill Processing) 19
Top Accepted Conditions Part E Part B 1. Skin cancer 2. Chronic Obstructive Pulmonary Disease 1. Skin cancer 2. Lung cancer 3. Urinary/Bladder cancer 4. Colorectal cancer Cancer Chronic Beryllium Disease Chronic Silicosis RECA Section 5 Awardees 5. Pancreatic cancer Any condition related to toxic substances 3. Lung cancer 4. Silicosis 5. Hearing loss 20
Statistics Any condition related to toxic substances Cancer Chronic Beryllium Disease Chronic Silicosis RECA Section 5 Awardees 21
DOL & Board Accomplishment Highlights SEM Updates Added health effects data associated with toxic substance exposures (e.g., bladder cancer, breast cancer, leukemia, liver cancer, lymphoma, prostate cancer, etc.) Aliases for Parkinsonism Redesigned Occupational History Questionnaire Improved data collection on employee occupational activities and toxic substance exposures New Presumptive Standards COVID-19 Hearing Loss Ototoxic Substances Asbestos-related diseases Procedural Language Updates Asthma description Six-minute walk test applicability IH exposure characterization 22
