# Presentation: 018428

## Energy Employees Occupational Illness Compensation Program 

**Energy Employees Occupational ****Illness Compensation Program**** **

**May, 2007**

## 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

## Part B Benefits Overview

_**Who**_**’s 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

**Notes:**
Federal payment direct. 
Mandated funds no annual appropriations
Decision to pay = payment.  EFT or check 

## Part B Benefits Overview, cont’d

_**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

## Part B Benefits Overview, cont’d

_**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.

## Part E Benefits Overview

_**Who**_**’s 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

**Notes:**
Federal payment direct. 
Mandated funds no annual appropriations
Decision to pay = payment.  EFT or check 

## 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

## 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

## 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**

**Notes:**
Automatic vs. causation finding

## 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 **

## 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)

**Notes:**
If cancer can be attributed solely to toxic exposure, the claimed condition under Part E can be processed without waiting for NIOSH to complete the dose reconstruction.  

## Causation – Toxic ExposuresWhat 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/

**Notes:**
DOL wants to speed the process and these are the resources to accomplish this...

## Radiation Exposure CompensationAct (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**

## 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

## 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**

## 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/

## 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**

## 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**

## Impairment Award

**Determination of % permanent impairment due to covered illness**
**Standard Applied – AMA’s 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**

## 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

## 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

## Slide 22

## 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

## 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**

## Survivor Claims 

**Eligible Survivors – *****(at time of employee’s 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**

**Notes:**
Under the age of 23 years and full time student continuously enrolled in an educational institution  since age 18.

## 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**

## 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

## 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

## Filing Claims

**4 District Offices**
**11 Resource Centers**
**Website:****  **_[http://www.dol.gov/esa/regs/compliance/owcp/eeoicp/main.htm](http://www.dol.gov/esa/regs/compliance/owcp/eeoicp/main.htm)_