Harrison & Dublin, oh

Outreach meetings

June 19-20, 2019

Office of the Ombudsman for theEnergy Employees Occupational Illness Compensation Program Act(EEOICPA)

WELCOME

Introductions:

Office of the Ombudsman

Department of Labor’s District Office & Resource Center Staff

National Institute for Occupational Safety and Health (NIOSH)

General Information

Emergency Exits

Restrooms

Cell Phones

Photographs and Videotaping

Slide presentation is available on the Ombudsman web site:

   http://www.dol.gov/eeombd

OUTREACH MEETING AGENDA

Overview of the duties of the Office of the Ombudsman

Overview of EEOICPA Part B

Overview of EEOICPA Part E

Questions and Answers

OFFICE OF THE OMBUDSMAN 

October 2000 – Congress enacted EEOICPA

October 2004 legislation created the Office of the Ombudsman

The Office is independent from the adjudicatory agency with DOL that administers EEOICPA

In 2010, Congress expanded the authority of the Office to include Part B of the EEOICPA

In 2014, the Congress extended the authority of the Office through October 28, 2019

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OFFICE OF THE OMBUDSMAN

Duties:

Provide information on the benefits available under the EEOICPA.

Make recommendations regarding the location of resource centers for the receipt and development of claims.

Submit an annual report to Congress detailing:

The number and types of complaints, grievances and request for assistance received during the year and;

An assessment of the most common difficulties encountered by claimant during the year.

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OMBUDSMAN ASSISTANCE	

We respond to claimants, attorneys, authorized representatives, congressional staff and others

We explain, review and discuss aspects of the EEOICPA claims process

We answer questions and provide other assistance to individuals encountering difficulties with claims pending with DEEOIC

We discuss your concerns, complaints and grievances in our annual report to Congress

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DOL Response to Ombudsman Report

Not later than 180 days after submission of our annual report, the Secretary shall submit to Congress in writing, and post on the public Internet website of the DOL, a response that:

Includes a statement of whether the Secretary agrees or disagrees with the specific issues raised by the Ombudsman in the report;

If the Secretary agrees with Ombudsman on an issue, describes the actions to be taken to correct the issue – and if the Secretary disagrees, describe the reasons the Secretary does not agree.

OMBUDSMAN OUTREACH EFFORTS

Sponsor town hall meetings across the U.S.

Participate in DEEOIC sponsored town hall meetings, traveling resource centers and medical benefits meetings.

Offer opportunities for individuals to speak one-on-one with Ombudsman staff.

Coordinate outreach efforts with the Joint Outreach Task Group

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OMBUDSMAN OFFICE LIMITATIONS

The Office of the Ombudsman cannot:

Rule or make decisions on claims

“Make” DEEOIC reverse or change a decision

Make Congress revise the Act

Take DEEOIC to court

Lobby Congress

Act as an advocate

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EEOICP Overview – Covered Illnesses

  Part B

Chronic Beryllium Disease (CBD)

Beryllium Sensitivity (BeS)

Chronic Silicosis 

Cancers caused by exposure to radiation

 Part E

Any occupational illness where it is “at least as likely as not” that exposure to a toxic substance was a significant factor in  aggravating, contributing to, or causing the illness.

Part B Eligibility – Coverage

Employee Eligibility:		Survivor Eligibility:

DOE Contractors and 		         Eligible Spouse

   Subcontractors			         Children

DOE Employees      		         Parents

Atomic Weapons Employees	         Grandchildren

Beryllium Vendors                            Grandparents

Can include federal employees, 

DOE contractors and subcontractors 

Designated BV who develop CBD

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Part B – Compensation and Benefits

For cancer caused by radiation exposure, chronic beryllium disease and chronic silicosis - $150,000 (lump sum)

Plus medical benefits for the approved conditions

For Beryllium Sensitivity

Only medical monitoring

For approved Section 5 RECA claims - $50,000

Plus medical benefits for the approved condition

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Part B:  Dose Reconstruction

DOL refers Pt. B cancer claims to NIOSH for Dose Reconstruction to determine the level and extent of occupational radiation dose to determine the Probability of Causation (PoC).

PoC is the scientific calculation of likelihood that the radiation exposure caused cancer

The PoC must be 50% or higher for award for compensation.

Part B: Special Exposure Cohort

Claims for cancer do not undergo a dose reconstruction and do not require a determination of the PoC if:

Claimant qualifies for inclusion in a Special Exposure Cohort (SEC) class, and

Has been diagnosed with a “specified” cancer named in the law.

Part E – Employee/Survivor Eligibility

Employee Eligibility		Survivor Eligibility

DOE Contractors		Spouse

DOE Subcontractors		Child – who at the time of 

RECA Section 5                      the employee’s death was:

    Uranium miners, millers,       		Under age 18 or

    and ore transporters                         Under age 23 and a

                                                            	continuous full time 							student, or

                                                              Any age if medically 						incapable of self 							support	                                                    

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Part E – Covered Illness

Any illness (or death) where it is “at least as likely as not” that exposure to a toxic substance(s) at a covered DOE or Section 5 RECA facility, during a covered time period, was a significant factor in aggravating, contributing to, or causing the employee’s illness (or death)

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Part E – Burden of Proof

Evidence Required:

Medical evidence to establish a covered illness. Proof of a medical diagnosis is needed.

Evidence of exposure to a toxic substance while employed at a covered DOE site 

Evidence of an established scientific link associated to a specific toxic substance(s) significant enough to have caused, contributed to or aggravated the claimed diagnosed illness (or death).

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Part E - Benefits

Employee Compensation & Benefits – Approved Part E claims

Medical benefits for the covered illness(es) including home health care benefits.

Impairment compensation for permanent impairment for the accepted covered illness(es); must be claimed.

Wage loss compensation based on the years of lost wages due to the accepted covered condition until your normal Social Security retirement age; must be claimed.

There is a cap of $250,000 on Part E compensation. However, no monetary cap on medical benefits.

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Part E – Survivor Benefits

Survivor Benefits – Approved Part E claims

Lump sum compensation of $125,000 (plus wage loss if applicable)

Wage Loss – Survivors may also be eligible for additional compensation for wage loss if:

The employee accrued between 10 and 19 years of wage loss due to the approved condition (an additional $25,000)

The employee accrued 20 years or more of wage loss due to the approved condition (an additional $50,000)

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Practical Information

DOL may have your claim reviewed by a specialist (CMC, IH, Toxicologist, etc.) & you should be provided a copy of the report with your Recommended Decision.

You can request a copy of any specialist report from your claims examiner at any time, even before your decision.  Your request must be in writing.

You can request a copy of your case file from your claims examiner.  Your request must be in writing.

Practical Information

File a new claim for all new illnesses as they arise

Claim can be reopened at any time

Make sure you have reported any/all potentially covered employment to the DOL

Review your Occupational History Interview for completeness and accuracy

Practical Information

If claim accepted for medical benefits, you can:

Find enrolled providers online by clicking on Provider Search at: https://owcpmed.dol.gov/portal/providersearch/displaySearchForm.do

If your accepted covered illness or treatment for the illness causes new illness or injury – you can file a claim for consequential illness/injury.  File a claim for new illnesses as they arise.

You must notify DOL in writing of change in health care provider.

**Nelson, Malcolm - OMBUDSMAN (NM-O) -**DOL has significantly revised its website.  I believe that the new address for this search is https://owcpmed.dol.gov/portal/providersearch/displaySearchForm.do .  Moreover, it is more difficult to now access Provider Search - you have to link to Claimant/Authorized Representatives and then to Medical Bill Portal.  Not sure if there is a short cut.

Submitting Document to the DOL

Mail to the central mailroom in London, KY

Fax to your claims examiner in local district office or FAB office

Take to the local Resource Center and have them send to DOL

Upload to Energy Document Portal –

https://eclaimant.dol-esa.gov

Ombudsman Contact Information 

U.S. Department of Labor

Office of the Ombudsman

200 Constitution Ave. NW. – Room N2454

Washington, DC  20210

Toll Free: 1-877-662-8363

Fax:  202-693-5899

Email: ombudsman@dol.gov

Website: www.dol.gov/eeombd

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DEEOIC Contact Information

Cleveland District Office

    1001 Lakeside Avenue, Suite 350

    Cleveland, OH  44114

    Toll Free:  888-859-7211

Portsmouth Resource Center

    1200 Gay Street

    Portsmouth, OH  45662

    Toll Free:  (866)363-6993

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Online Resources

DEEOIC -  http://www.dol.gov/owcp/energy/

DOL (DEEOIC) Federal EEOICPA Procedure Manual

https://www.dol.gov/owcp/energy/regs/compliance/PolicyandProcedures/ConsolidatedProcedureManual.htm

Federal (EEOICPA) Regulations - http://www.dol.gov/owcp/energy/regs/compliance/law/FinalRuleInRegister.pdf

https://www.dol.gov/owcp/energy/regs/compliance/seminfo.htm

Questions?

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