Energy Employees Compensation: Even with Needed Improvements in Case Processing, Program Structure May Result in Inconsistent Benefit Outcomes
Published: 2004-05-28T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Subtitle D of the Energy Employees Occupational Illness Compensation Program Act of 2000 allows the Department of Energy (Energy) to help its contractors' employees file state workers' compensation claims for illnesses determined by a panel of physicians to be caused by exposure to toxic substances while employed at an Energy facility. Congress mandated that GAO study the effectiveness of the benefit program under Subtitle D. GAO focused on four key areas: (1) the number, status, and characteristics of claims filed with Energy; (2) the extent to which Energy policies and procedures help employees file timely claims for these state benefits; (3) the extent to which there will be a "willing payer" of workers' compensation benefits, that is, an insurer that--by order from or agreement with Energy--will not contest these claims; and (4) a framework that could be used for evaluating possible options for changing the program.
section_title: What GAO Found
paragraphs: During the first 2 1/2 years of the program, ending December 31, 2003, Energy had completely processed about 6 percent of the more than 23,000 cases that had been filed. Energy had begun processing nearly 35 percent of the cases, but processing had not yet begun on nearly 60 percent of the cases. Further, insufficient strategic planning and systems limitations complicate the assessment of Energy's achievement of goals related to case processing, as well as goals related to program objectives, such as the quality of the assistance provided to claimants in filing for state workers' compensation. While Energy got off to a slow start in processing cases, it is now processing enough cases that there is a backlog of cases waiting for review by a physician panel. Energy has taken some steps intended to reduce this backlog, such as reducing the number of physicians needed for some panels. Nonetheless, a shortage of qualified physicians continues to constrain the agency's capacity to decide cases more quickly. Consequently, claimants will likely continue to experience lengthy delays in receiving the determinations they need to file workers' compensation claims. In the meantime, Energy has not kept claimants sufficiently informed about the delays in the processing of their claims as well as what claimants can expect as they proceed with state workers' compensation claims. GAO estimates that more than half of the cases associated with Energy facilities in 9 states that account for more than three-quarters of all Subtitle D cases filed are likely to have a willing payer of benefits. Another quarter of the cases in these 9 states, while not technically having a willing payer, have workers' compensation coverage provided by an insurer that has stated that it will not contest these claims. However, the remaining 20 percent of the cases in these 9 states lack willing payers and are likely to be contested. This has created concerns about program equity in that many of these cases may be less likely to receive compensation. Because of data limitations, these percentages provide an order of magnitude estimate of the extent to which claimants will have willing payers. These estimates could change as better data become available or as circumstances change, such as new contractors taking over at individual facilities. The estimates are not a prediction of actual benefit outcomes for claimants. Various options are available to improve payment outcomes for the cases that receive a positive physician panel determination, but lack willing payers. While not recommending any particular option, GAO provides a framework that includes a range of issues to help the Congress assess options if it chooses to change the current program. One of these issues in particular--the federal cost implications--should be carefully considered in the context of the current and projected federal fiscal environment.

section_title: Letter
paragraphs: For the last several decades, the Department of Energy (Energy) and its  predecessor agencies and contractors have employed thousands of  individuals in secret and dangerous work in the nuclear weapons  production complex. Over the years, employees were exposed to toxic  substances, including radioactive and hazardous materials, and studies  have shown that many of these employees subsequently developed serious  illnesses. The Energy Employees Occupational Illness Compensation  Program Act (EEOICPA) established two programs to help secure  compensation for employees who developed occupational illnesses or for  their survivors. Congressional Committees, as well as individual Members  of Congress, claimants, and advocates have raised concerns regarding  Energy’s processing of claims and the availability of benefits once claims  have been decided.
Enacted as title XXXVI of the Floyd D. Spence National Defense  Authorization Act for Fiscal Year 2001, which was signed into law on  October 30, 2000, this legislation has two major components. Subtitle B  provides eligible workers who were exposed to radiation or other toxic  substances and who subsequently developed illnesses, such as cancer and  lung disease, with a one-time payment of up to $150,000 and covers future  medical expenses related to the illness. The Department of Labor  administers these benefits, payable from a compensation fund established  by the same legislation. Subtitle D allows Energy to help its contractor  employees file state workers’ compensation claims for illnesses  determined by a panel of physicians to be caused by exposure to toxic  substances while employed at an Energy facility. Individuals may apply for  and receive benefits under both programs since benefits are not offset  against each other.
In the conference report for the 2003 appropriations for Energy, the  conferees directed that we study the effectiveness of the benefit program  under Subtitle D of EEOICPA in assisting employees of Energy’s  contractors in obtaining compensation for occupational illnesses. The  Chairman of the Senate Committee on Finance also requested that we  study this issue (see GAO-04-516). We focused our work on four key areas:  (1) the number, status, and characteristics of claims filed with Energy; (2)  the extent to which Energy policies and procedures help employees file  timely claims for state workers’ compensation benefits; (3) the extent to  which there will be a “willing payer” of workers’ compensation benefits;  that is, an insurer that—by order from, or agreement with, Energy—will  not contest these claims; and (4) a framework that could be used for  evaluating possible options for changing the program to the extent that  there may not be willing payers of benefits.
To perform our review, we analyzed data extracted from Energy’s Subtitle  D case management system for applications filed through June 30, 2003,  and again through December 31, 2003. We determined that the data we  used were sufficiently reliable for our purposes by performing electronic  testing for obvious errors in accuracy and completeness, reviewing  available documentation, and interviewing agency officials and  contractors knowledgeable about the data. We also reviewed the  provisions of, and interviewed officials with, the workers’ compensation  programs in 9 states, which accounted for more than three-quarters of  Subtitle D cases filed, and we interviewed the contractors operating the  major facilities in these states. In addition, we conducted site visits to  three Energy facilities in Oak Ridge, Tennessee, the state with facilities  accounting for the largest number of Subtitle D claims. We also  interviewed key program officials and other experts. We conducted our  review from April 2003 through April 2004 in accordance with generally  accepted government auditing standards. For a more complete  explanation of our methodology, see appendix I.
subsections: section_title: Background
paragraphs: Energy oversees a nationwide network of 40 contractor-operated  industrial sites and research laboratories that have historically employed  more than 600,000 workers in the production and testing of nuclear  weapons. In implementing EEOICPA, the President acknowledged that it  had been Energy’s past policy to encourage and assist its contractors in  opposing workers’ claims for state workers’ compensation benefits based  on illnesses said to be caused by exposure to toxic substances at Energy  facilities. Under the new law, workers, or their survivors, could apply for  assistance from Energy in pursuing state workers’ compensation benefits,  and if they received a positive determination from Energy, the agency  would direct its contractors to not contest the workers’ compensation  claims or awards. Energy’s rules to implement the new program became  effective in September 2002, and the agency began to process the  applications it had been accepting since July 2001, when the law took  effect.
Energy’s claims process has several steps. First, claimants file applications  and provide all available medical evidence. Energy then develops the  claims by requesting records of employment, medical treatment, and  exposure to toxic substances from the Energy facilities where the workers  were employed. If Energy determines that the worker was not employed  by one of its facilities or did not have an illness that could be caused by  exposure to toxic substances, the agency finds the claimant ineligible. For  all others, once development is complete, a panel of three physicians  reviews the case and decides whether exposure to a toxic substance  during employment at an Energy facility was at least as likely as not to  have caused, contributed to, or aggravated the claimed medical condition.  The panel physicians are appointed by the National Institute for  Occupational Safety and Health (NIOSH) but paid by Energy for this work.  Claimants receiving positive determinations are advised that they may  wish to file claims for state workers’ compensation benefits. Claimants  found ineligible or receiving negative determinations may appeal to  Energy’s Office of Hearings and Appeals.
Each of the 50 states and the District of Columbia has its own workers’  compensation program to provide benefits to workers who are injured on  the job or contract a work-related illness. Benefits include medical  treatment and cash payments that partially replace lost wages.  Collectively, these state programs paid more than $46 billion in cash and  medical benefits in 2001. In general, employers finance workers’  compensation programs. Depending on state law, employers finance these  programs through one of three methods: (1) they pay insurance premiums  to a private insurance carrier, (2) they contribute to a state workers’  compensation fund, or (3) they set funds aside for this purpose as self- insurance. Although state workers’ compensation laws were enacted in  part as an attempt to avoid litigation over workplace accidents, the  workers’ compensation process is still generally adversarial, with  employers and their insurers tending to contest aspects of claims that they  consider not valid.
State workers’ compensation programs vary as to the level of benefits,  length of payments, and time limits for filing. For example, in 1999, the  maximum weekly benefit for a total disability in New Mexico was less than  $400, while in Iowa it was approximately $950. In addition, in Idaho, the  weekly benefit for total disability would be reduced after 52 weeks, while  in Iowa benefits would continue at the original rate for the duration of the  disability. Further, in Tennessee, a claim must be filed within 1 year of the  beginning of incapacity or death. In contrast, in Kentucky, a claim must be  filed within 3 years of either the last exposure to most substances or the  onset of disease symptoms, but within 20 years of exposure to radiation or  asbestos.
EEOICPA allows Energy, to the extent permitted by law, to direct its  contractors to not contest the workers’ compensation claims filed by  Subtitle D claimant who received a positive determination from a  physician panel. In addition, the statute prohibits the inclusion of the costs  of contesting such claims as allowable costs under its contracts with the  contractors; however, Energy’s regulations allow the costs incurred as the  result of a workers’ compensation award to be reimbursed in the manner  permitted under the contracts. The Subtitle D program does not affect the  normal operation of state workers’ compensation programs other than  limiting the ability of Energy or its contractors to contest certain claims;  Energy does not have authority to expand or contract the scope of any of  these state programs. Thus, actions taken by Energy or its contractors will  not make a worker eligible for compensation under a state workers’  compensation system if the worker is not otherwise eligible.
section_title: Energy Has Processed Few Cases, and Insufficient Strategic Planning and Data Collection Complicate Program Management
paragraphs: As of December 31, 2003, Energy had completely processed about 6  percent of the more than 23,000 cases that had been filed, and the majority  of all cases filed were associated with facilities in 9 states. Energy had  begun processing on nearly 35 percent of cases, but processing had not  begun on nearly 60 percent of the cases. The assessment of Energy’s  achievement of case processing goals is complicated by systems  limitations. Further, these limitations make it difficult to assess  achievement of goals related to program objectives, such as the quality of  the assistance given to claimants in filing for state workers’ compensation.
subsections: section_title: About 6 Percent of Cases Have Been Fully Processed
paragraphs: During the first 2½ years of the program, ending December 31 2003,  Energy had fully processed about 6 percent of the more than 23,000 cases  it received. The majority of these fully processed cases had been found  ineligible because of either a lack of employment at an eligible facility or  an illness related to toxic exposure. Of the cases that had been fully  processed, 150 cases—less than 1 percent of the more than 23,000 cases  filed—had received a final determination from a physician panel. More  than half of these determinations (87 cases) were positive. As of the end of  calendar year 2003, Energy had not yet begun processing nearly 60 percent  of the cases, and an additional 35 percent of cases were in various stages  of processing. As shown in figure 2, the majority of the cases being  processed were in the case development stage, where Energy requests  information from the facility at which the claimant was employed. About   2 percent of the cases in process were ready for physician panel review,  and an additional 3 percent were undergoing panel review.
A majority of all cases were filed early during program implementation,  but new cases continue to be filed. More than half of all cases were filed  within the first year of the program, between July 2001 and June 2002.  However, between July 2002 and December 31, 2003, Energy continued to  receive an average of more than 500 cases per month. Energy officials  report that they continue to receive approximately 100 new cases per  week.
section_title: Energy Facilities in 9 States Account for More than 75 percent of Cases
paragraphs: While cases filed are associated with facilities in 43 states or territories,  the majority of cases are associated with Energy facilities in 9 states, as  shown in figure 3. Facilities in Colorado, Idaho, Iowa, Kentucky,   New Mexico, Ohio, South Carolina, Tennessee, and Washington account  for more than 75 percent of cases received by December 31, 2003. The  largest group of cases is associated with facilities in Tennessee.
Workers filed the majority of cases, and cancer is the most frequently  reported illness. Workers filed more than 60 percent of cases, and  survivors of deceased workers filed about 36 percent of cases. In 2 percent  of the cases, a worker filed a claim that was subsequently taken up by a  survivor. Cancer is the illness reported in nearly 60 percent of the cases.
Diseases affecting the lungs accounted for an additional 15 percent of the  cases. Specifically, chronic beryllium disease and/or beryllium sensitivity  were reported in 7 percent of the cases, 8 percent reported asbestosis, and  less than 1 percent claimed chronic silicosis.
section_title: Insufficient Strategic Planning and Data Collection Limit Energy’s Ability to Determine whether Program Goals Are Being Met
paragraphs: Insufficient strategic planning regarding system design, data collection,  and tracking of outcomes has made it more difficult for Energy officials to  manage some aspects of the program and for those with oversight  responsibilities to determine whether Energy is meeting goals for  processing claims. The data system Energy uses to aid in case  management was developed by contractors without detailed specifications  from Energy. Furthermore, the system was developed before Energy  established its processing goals and did not collect sufficient information  to track Energy’s progress in meeting these goals. While recent changes to  the system have improved Energy’s ability to track certain information,  these changes have resulted in some recent status data being not  completely comparable with older status data. In addition, Energy will be  unable to completely track the timeliness of its processing for  approximately one-third of the cases that were being processed as of  December 2003 because key data are not complete. For example, Energy  established a goal of completing case development within 120 days of case  assignment to a case manager. At least 70 percent of the cases for which  case development was complete were missing dates corresponding to  either the beginning or the end of the case development process—data  that would allow Energy officials to compute the time elapsed during case  development.
Energy has not been sufficiently strategic in identifying and systematically  collecting certain data that are useful for program management. For  instance, Energy does not track the reasons why particular cases were  found ineligible in a format that can be easily analyzed. Systematic  tracking of the reasons for ineligibility would make it possible to quickly  identify cases affected by policy changes. For example, when a facility in  West Virginia was determined to be only a Department of Energy facility  and not also an atomic weapons employer, it was necessary for Energy to  identify which cases had been ruled ineligible because of employment at  the West Virginia facility. While some ineligibility information may be  stored in case narratives, this information is not available in a format that  would allow the agency to quickly identify cases declared ineligible for  similar reasons. Ascertaining the reason for ineligibility would at best  require review of individual case narratives, and indeed, Energy officials  report that it is sometimes necessary to refer back to application forms to  find the reasons. As a result, if additional changes are made that change  eligibility criteria, Energy may have to expend considerable time and  resources determining which cases are affected by the change in policy.
In addition, because it did not adequately plan for the various uses of its  data, Energy lacks some of the data needed to analyze how cases will fare  when they enter the state workers’ compensation systems. Specifically, it  is difficult for Energy to predict whether willing payers of workers’  compensation benefits will exist using case management system data  because the information about the specific employer for whom the  claimant worked is not collected in a format that can be systematically  analyzed. In addition, basic demographic data such as the age of  employees is not necessarily accurate due to insufficient edit controls— for example, error checking that would prevent employees’ dates of birth  from being entered if the date was in the future or recent past. Reliable age  data would allow Energy to estimate the proportion of workers who are  likely to have health insurance such as Medicare.
Insufficient tracking of program outcomes hampers Energy’s ability to  determine how well it is providing assistance to claimants in filing claims  for state workers’ compensation benefits. Energy has not so far  systematically tracked whether claimants subsequently file workers’  compensation claims or the decisions on these claims. However, agency  officials recently indicated that they now plan to develop this capability. In  addition, Energy does not systematically track whether claimants who  receive positive physician panel determinations file workers’  compensation claims, nor whether claims that are filed are approved, or  paid. Furthermore, unless Energy’s Office of Hearings and Appeals grants  an appeal of a negative determination, which is returned to Energy for  further processing, Energy does not track whether a claimant files an  appeal. Lack of information about the number of appeals and their  outcomes may limit Energy’s ability to assess the quality and consistency  of its decision making.
section_title: A Shortage of Qualified Physicians to Issue Determinations Delays Filing of Workers’ Compensation Claims and Claimants May Receive Inadequate Information to Prepare Them to Pursue These Claims
paragraphs: Energy was slow in implementing its initial case processing operation, but  it is now processing enough cases so that there is a backlog of cases  awaiting physician panel review. With panels operating at full capacity, the  small pool of physicians qualified to serve on the panels may ultimately  limit the agency’s ability to produce more timely determinations.  Claimants have experienced lengthy delays in receiving the determinations  they need to file workers’ compensation claims and have received little  information about claims status as well as what they can expect from this  process. Energy has taken some steps intended to reduce the backlog of  cases.
subsections: section_title: Sufficient Cases Have Not Always Been Available for Physician Panel Review, but Energy Has Increased the Pace of Its Case Development Processing
paragraphs: Energy’s case development process has not always produced enough  cases to ensure that the physician panels were functioning at full capacity,  but the agency is now processing enough cases to produce a backlog of  cases waiting for panel review. Energy officials established a goal of  completing the development of 100 cases per week by August 2003 to keep  the panels fully engaged. However, the agency did not achieve this goal  until several months later.
Energy was slow to implement its case development operation. Initially,  agency officials did not have a plan to hire a specific number of employees  for case development, but they expected to secure additional staff as they  were needed. When Energy first began developing cases, in the fall of  2002, the case development process had about 8 case managers. With  modest staffing increases, the program quickly outgrew the office space  used for this function. Though Energy officials acknowledged the need for  more personnel by spring 2003, they delayed hiring until additional space  could be secured in August. By November 2003, Energy had more than  tripled the number of case managers developing cases, and since that  month the agency has continued to process an average of more than   100 cases per week to have them ready for physician panel review.
Energy transferred nearly $10 million in fiscal year 2003 funds into this  program from other Energy accounts. Further, after completing a  comprehensive review of its Subtitle D program, the agency developed a  plan that identifies strategies for further accelerating its case processing.  This plan sets a goal of eliminating the entire case backlog by the end of  calendar year 2006 and depends in part on shifting an additional   $33 million into the program in fiscal year 2004, to quadruple the case- processing operation. With additional resources, Energy plans to complete  the development of all pending cases as quickly as possible and have them  ready for the physician panels. However, this could create a larger backlog  of cases awaiting review by physician panels. Because a majority of the  claims filed so far are from workers whose medical conditions are likely to  change over time, building this backlog could further slow the decision  process by making it necessary to update medical records before panel  review.
section_title: The Ability to Produce More Timely Decisions May Be Limited by the Small Pool of Qualified Physicians and Gaps in Information They Need to Quickly Decide Cases
paragraphs: Even though additional resources have allowed Energy to speed initial  case development, the limited pool of qualified physicians for panels may  limit Energy’s capacity to decide cases more quickly. Under the rules  Energy originally established for this program that required that each case  be reviewed by a panel of 3 physicians and given the 130 physicians  currently available, it could have taken more than 13 years to process all  cases pending as of December 31, without consideration of the hundreds  of new cases the agency is receiving each month. However, in an effort to  make the panel process more efficient, Energy published new rules on  March 24, 2004, that re-defined a physician panel as one or more  physicians appointed to evaluate these cases and changed the timeframes  for completing their review. Under the new rule, a panel composed of a  single physician will initially review each case, and if a positive  determination is issued, no further review is necessary. Negative  determinations made by a single physician panels will require review by  one or more additional single-physician panels. In addition to revising its  rules, the agency began holding a full-time physician panel in Washington,  D.C., in January 2004, staffed by physicians who are willing to serve full- time for a 2- or 3-week period.
Energy and NIOSH officials have taken steps to expand the number of  physicians who would qualify to serve on the panels and to recruit more  physicians, including some willing to work full-time. While Energy has  made several requests that NIOSH appoint additional physicians to staff  the panels, such as requesting 500 physicians in June 2003, NIOSH officials  have indicated that the pool of physicians with the appropriate credentials  and experience is limited. The criteria NIOSH originally used to evaluate  qualifications for appointing physicians to these panels included: (1) board  certification in a primary discipline; (2) knowledge of occupational  medicine; (3) minimum of 5 years of relevant clinical practice following  residency; and (4) reputation for good medical judgment, impartiality, and  efficiency. NIOSH recently modified these qualifications, primarily to  reduce the amount of required clinical experience so that physicians with  experience in relevant clinical or public health practice or research,  academic, consulting, or private sector work can now qualify to serve on  the panels. NIOSH has revised its recruiting materials to reflect this  change and to point out that Energy is also interested in physicians willing  to serve on panels full-time. However, a NIOSH official said that he was  uncertain about the effect of the change in qualifications on the number of  available physicians. In addition, the official indicated that only a handful  of physicians would likely be interested in serving full-time on the panels.
Energy officials have also explored additional sources from which NIOSH  might recruit qualified physicians, but they have expressed concerns that  the current statutory cap on the rate of pay for panel physicians may limit  the willingness of physicians from these sources to serve on the panels.  For example, Energy officials have suggested that physicians in the  military services might be used on a part-time basis, but the rate of pay for  their military work exceeds the current cap. Similarly, physicians from the  Public Health Service could serve on temporary full-time details as panel  physicians. To elevate the rate of pay for panel physicians to a level that is  consistent with the rate physicians from these sources normally receive,  Energy officials recently submitted to the Congress a legislative proposal  to eliminate the current cap on the rate of pay and also expand Energy’s  hiring authority.
Panel physicians have also suggested methods to Energy for improving the  efficiency of the panels. For example, some physicians have said that more  complete profiles of the types and locations of specific toxic substances at  each facility would speed their ability to decide cases. While Energy  officials reported that they have completed facility overviews for most of  the major sites, specific site reference data are available for only a few  sites. Energy officials told us that, in their view, the available information  is sufficient for decision making by the panels. However, based on  feedback from the physicians, Energy officials are exploring whether  developing additional site information would be cost beneficial.
section_title: Energy Has Not Sufficiently Informed Claimants about the Status of Their Claims and Subsequent Aspects of the Process
paragraphs: Energy has not always provided claimants with complete and timely  information about what they could achieve in filing under this program.  Energy officials concede that claimants who filed in the early days of the  program may not have been provided enough information to understand  the benefits they were filing for. As a consequence, some claimants who  filed under both Subtitle B and Subtitle D early in the program later  withdrew their claims under Subtitle D because they had intended to file  only for Subtitle B benefits or because they had not understood that they  would still have to file for state workers’ compensation benefits after  receiving a positive determination from a physician panel. After the final  regulations were published in August 2002, Energy officials stated that  claimants had a better understanding of the benefits for which they were  applying.
Energy has not kept claimants sufficiently informed about the status of  their claims under Subtitle D. Until recently, Energy’s policy was to  provide no written communication about claims status between the  acknowledgment letters it sent shortly after receiving applications and the  point at which it began to process claims. Since nearly half of the claims  filed in the first year of the program remained unprocessed as of the  December 31, 2003, these claimants would have received no information  about the status of their claims for more than 1 year. Energy recently  decided to change this policy and provide letters at 6-month intervals to all  claimants with pending claims. Although the first of these standardized  letters sent to claimants in October 2003 did not provide information about  individual claims status, it did inform claimants about a new service on the  program’s redesigned Web site through which claimants can check on the  status of their claim. However, this new capability does not provide  claimants with information about the timeframes during which their  claims are likely to be processed and claimants would need to re-check  the status periodically to determine whether the status of the claim has  changed.
In addition, claimants may not receive sufficient information about what  they are likely to encounter when they file for state workers’  compensation benefits. For example, Energy’s letter to claimants  transmitting a positive determination from a physician panel does not  always provide enough information about how they would go about filing  for state workers’ compensation benefits. A contractor in Tennessee  reported that a worker was directed by Energy’s letter received in  September 2003 to file a claim with the state office in Nashville when  Tennessee’s rules require that the claim be filed with the employer. The  contractor reported the problem to Energy in the same month, but Energy  letters sent to Tennessee claimants in October and December 2003  continued to direct claimants to the state office. Finally, claimants are not  informed as to whether there is likely to be a willing payer of workers’  compensation benefits and what this means for the processing of that  claim. Specifically, advocates for claimants have indicated that claimants  may be unprepared for the adversarial nature of the workers’  compensation process when an insurer or state fund contests the claim.
Energy officials recently indicated that they plan to test initiatives to  improve communication with claimants. Specifically, they plan to conduct  a test at one Resource Center that would provide claimants with additional  information about the workers’ compensation process and advice on how  to proceed after receiving a positive physician panel determination. In  addition, they plan to begin contacting individuals with pending claims this  summer to provide information on the status of their claims.
section_title: While Workers’ Compensation Claims for a Majority of Cases Are Not Likely to Be Contested, Actual Compensation Is Not Certain
paragraphs: Our analysis shows that a majority of cases associated with Energy  facilities in 9 states that account for more than three-quarters of all  Subtitle D cases filed are not likely to be contested. However, the  remaining 20 percent of cases lack willing payers and are likely to be  contested. These percentages provide an order of magnitude estimate of  the extent to which claimants will have willing payers and are not a  prediction of actual benefit outcomes for claimants.
subsections: section_title: A Majority of Cases in 9 States Are Not Likely to Be Contested
paragraphs: The workers’ compensation claims for the majority of cases associated  with major Energy facilities in 9 states are likely to have no challenges to  their claims for state workers’ compensation benefits. Specifically, based  on analysis of workers’ compensation programs and the different types of  workers’ compensation coverage used by the major contractors, it appears  that slightly more than half of the cases will potentially have a willing  payer. In these cases, self-insured contractors will not contest the claims  for benefits as ordered by Energy. Another 25 percent of the cases, while  not technically having a willing payer, have workers’ compensation  coverage provided by an insurer that has stated that it will not contest  these claims and is currently processing several workers’ compensation  claims without contesting them. The remaining 20 percent of cases in the 9  states we analyzed are likely to be contested. Because of data limitations,  these percentages provide an order of magnitude estimate of the extent to  which claimants will have willing payers. The estimates are not a  prediction of actual benefit outcomes for claimants.
As shown in table 1, the contractors for four major facilities in these states  are self-insured, and Energy’s direction to them to not contest claims that  receive a positive physician panel determination will be adhered to. In  such situations where there is a willing payer, the contractor’s action to  pay the compensation consistent with Energy’s order to not contest a  claim could result in a payment that might otherwise have resulted in a  denial of a claim, for reasons such as failure to file a claim within a  specified period of time. Similarly, the informal agreement by the  commercial insurer with the contractors at the two facilities that  constitute 25 percent of the cases to pay the workers compensation claims  will more likely result in payment, despite potential grounds to contest  under state law. However, since this insurer is not bound by Energy’s  orders and it does not have a formal agreement with either Energy or the  contractors to not contest these claims, there is nothing to guarantee that  the insurer will continue to process claims in this manner.
About 20 percent of cases in the 9 states we analyzed are likely to be  contested. Therefore, in some instances, these cases may be less likely to  receive compensation than a comparable case for which there is a willing  payer, unless the claimant is able to overcome challenges to the claim. In  addition, contested cases can take longer to be resolved. For example, one  claimant whose claim is being contested by an insurer was told by her  attorney that because of pretrial motions filed by the opposing attorney, it  would be 2 years before her case was heard on its merits. Specifically, the  cases that lack willing payers involve contractors that (1) have a  commercial insurance policy, (2) use a state fund to pay workers’  compensation claims, or (3) do not have a current contract with Energy. In  each of these situations, Energy maintains that its orders to contractors  would have a limited effect. For instance, an Ohio Bureau of Workers’  Compensation official said that the state would not automatically approve  a case with a positive physician panel determination, but would evaluate  each workers’ compensation case carefully to ensure that it was valid and  thereby protect its state fund. Furthermore, although the contractor in  Colorado with a commercial policy attempted to enter into agreements  with prior contractors and their insurers to not contest claims, the parties  have not yet agreed and several workers’ compensation claims filed with  the state program are currently being contested.
These estimates could change as better data become available or as  circumstances change, such as new contractors taking over at individual  facilities. For example, the contractor currently performing environmental  cleanup at the Paducah Gaseous Diffusion Plant will not re-compete for  this work when its contract ends on September 30, 2004. Energy is  soliciting proposals for a new contract to continue the cleanup work and  has indicated that the new contractors will not be required to take on the  responsibility for the workers’ compensation claims filed by employees of  former contractors. While Energy has proposed that the current clean up  contractor continue to handle the claims of their employees and those of  prior contractors under another of its contracts with the agency, it is  unclear at this point whether the current contractor will be able to arrange  for continuing coverage of these claims without securing workers’  compensation coverage through commercial insurance. Unless the current  contractor can continue to self-insure its workers’ compensation coverage  for these claims, the Paducah cases shown in table 1 would have to be  moved to the category in which contests are likely. As a result of this  single change in contractors, the proportion of cases for which contests  are likely could increase from 20 to 33 percent.
section_title: Multiple Factors Make Compensation Not Certain
paragraphs: In contrast to Subtitle B provisions that provide for a uniform federal  benefit that is not affected by the degree of disability, various factors may  affect whether a Subtitle D claimant is paid under the state workers’  compensation program or how much compensation will be paid. Beyond  the differences in the state programs that may result in varying amounts  and length of payments, these factors include the demonstration of a loss  resulting from the illness and contractors’ uncertainty on how to compute  compensation.
Even with a positive determination from a physician panel and a willing  payer, claimants who cannot demonstrate a loss, such as loss of wages or  unreimbursed medical expenses, may not qualify for compensation. On the  other hand, claimants with positive determinations but not a willing payer  may still qualify for compensation under the state program if they show a  loss and can overcome all challenges to the claim raised by the employer  or the insurer.
Contractors’ uncertainty about how to compute compensation may also  cause variation in whether or how much a claimant will receive in  compensation. While contractors with self-insurance told us that they plan  to comply with Energy’s directives to not contest cases with positive  determinations, some contractors were unclear about how to actually  determine the amount of compensation that a claimant will receive. For  example, one contractor raised a concern that no guidance exists to  inform contractors about whether they can negotiate the degree of  disability, a factor that could affect the amount of the workers’  compensation benefit. Other contractors will likely experience similar  situations, as Energy has not issued written guidance on how to  consistently compute compensation amounts.
While not directly affecting compensation amounts, a related issue  involves how contractors will be reimbursed for claims they pay. Energy  uses several different types of contracts to carry out its mission, such as  operations or cleanup, and these different types of contracts affect how  workers’ compensation claims will be paid. For example, a contractor  responsible for managing and operating an Energy facility was told to pay  the workers’ compensation claims from its current operating budget. The  contractor said that this procedure may compromise its ability to conduct  its primary responsibilities. On the other hand, a contractor cleaning up an  Energy facility under a cost reimbursement contract was told by Energy  officials that its workers’ compensation claims would be reimbursed and,  therefore, paying claims would not affect its ability to perform cleanup of  the site.
section_title: Several Issues Could Be Considered in Evaluating Options for Improving the Likelihood of Willing Payers
paragraphs: Various options are available to improve payment outcomes for the cases  that receive a positive determination from Energy, but lack willing payers  under the current program. If it chooses to change the current program,  Congress would need to examine these options in terms of several issues,  including the source, method, and amount of the federal funding required  to pay benefits; the length of time needed to implement changes; the  criteria for determining who is eligible; and the equitable treatment of  claimants. In particular, the cost implications of these options for the  federal government should be carefully considered in the context of the  current and projected federal fiscal environment.
subsections: section_title: Options for Changing the Current Program
paragraphs: We identified four possible options for improving the likelihood of willing  payers, some of which have been offered in proposed legislation. While  not exhaustive, the options range from adding a federal benefit to the  existing program for cases that lack a willing payer to addressing the  willing payer issue as part of designing a new program that would allow  policymakers to decide issues such as the eligibility criteria and the type  and amount of benefits without being encumbered by existing program  structures. A key difference among the options is the type of benefit that  would be provided.
Option 1—State workers’ compensation with federal back up. This  option would retain state workers’ compensation structure as under the  current Subtitle D program but add a federal benefit for cases that receive  a positive physician panel determination but lack a willing payer of state  workers’ compensation benefits. For example, claims involving employees  of current contractors that self-insure for workers’ compensation coverage  would continue to be processed through the state programs. However,  claims without willing payers such as those involving contractors that use  commercial insurers or state funds likely to contest workers’  compensation claims could be paid a federal benefit that approximates the  amount that would have been received under the relevant state program.
Option 2—Federal workers’ compensation model. This option would  move the administration of the Subtitle D benefit from the state programs  entirely to the federal arena, but would retain the workers’ compensation  concept for providing partial replacement of lost wages as well as medical  benefits. For example, claims with positive physician panel determinations  could be evaluated under the eligibility criteria of the Federal Employees  Compensation Act and, if found eligible, could be paid benefits consistent  with the criteria of that program.
Option 3—Expanded Subtitle B program that does not use a  workers’ compensation model. Under this option, the current Subtitle B  program would be expanded to include the other illnesses resulting from  radiation and toxic exposures that are currently considered under the  Subtitle D program. The Subtitle D program would be eliminated as a  separate program and, if found eligible, claimants would receive a lump- sum payment and coverage of future medical expenses related to the  workers’ illnesses, assuming they had not already received benefits under  Subtitle B. The Department of Labor would need to expand its regulations  to specify which illnesses would be covered and the criteria for  establishing eligibility for each of these illnesses. In addition, since the  current programs have differing standards for determining whether the  worker’s illness was related to his employment, it would have to be  decided which standard would be used for the new category of illnesses.
Option 4—New federal program that uses a different type of  benefit structure. This option would address the willing payer issue as  part of developing a new program that involves moving away from the  workers’ compensation and Subtitle B structures and establishing a new  federal benefit administered by a structure that conforms to the type of the  benefit and its eligibility criteria. This option would provide an opportunity  to consider anew the purpose of the Subtitle D provisions. As a starting  point, policymakers could consider different existing models such as the  Radiation Exposure Compensation Act, designed to provide partial  restitution to individuals whose health was put at risk because of their  exposure even when their illnesses do not result in ongoing disability. But,  they could also choose to build an entirely new program that is not based  on any existing model.
section_title: Various Issues Should Be Considered in Deciding Whether Changes Are Needed and Assessing the Options
paragraphs: In deciding whether and how to change the Subtitle D program to ensure a  source of benefit payments for claims that would be found eligible if they  had a willing payer, policymakers will need to consider the trade-offs  involved. Table 2 arrays the relevant issues to provide a framework for  evaluating the range of options in a logical sequence. We have constructed  the sequence of issues in this framework in terms of the purpose and type  of benefit as being the focal point for the evaluation, with consideration of  the other issues flowing from that first decision. For example, decisions  about eligibility criteria would need to consider issues relating to within- state and across-state equity for Subtitle D claimants. The framework  would also provide for decisions on issues such as the method of federal  funding—trust fund or increased appropriations—and the appropriate  federal agency to administer the benefit. For each of the options, the type  of benefit would suggest which agency should be chosen to administer the  benefit and would depend, in part, on an agency’s capacity to administer a  benefit program. In examining these issues, the effects on federal costs  would have to be carefully considered. Ultimately, policymakers will need  to weigh the relative importance of these issues in deciding whether and  how to proceed.
section_title: Purpose and Type of Benefit
paragraphs: In evaluating how the purpose and type of benefit now available under  Subtitle D could be changed, policymakers would first need to focus on  the goals they wish to achieve in providing compensation to this group of  individuals. If the goal is to compensate only those individuals who can  demonstrate lost wages because of their illnesses, a recurring cash benefit  in an amount that relates to former earnings might be in order and a  workers’ compensation option, either a state benefits with a federal back  up or a federal workers’ compensation benefit, would promote this  purpose. If, on the other hand, the goal is to compensate claimants for all  cases in which workers were disabled because of their employment—even  when workers continue to work and have not lost wages–the option to  expand Subtitle B would allow a benefit such as a flat payment amount not  tied to former earnings.
For consideration of a new federal program option, it might be useful to  also consider other federal programs dealing with the consequences of  exposure to radiation as a starting point. For example, the Radiation  Exposure Compensation Act was designed to provide partial restitution to  individuals whose health was put at risk because of their exposure. Similar  to Subtitle B, the act created a federal trust fund, which provides for  payments to individuals who can establish that they have certain diseases  and that they were exposed to radiation at certain locations and at  specified times. However, this payment is not dependent on demonstrating  ongoing disability or actual losses resulting from the disease.
section_title: Eligibility Criteria and Equity of Outcomes
paragraphs: The options could also have different effects with respect to eligibility  criteria and the equity of benefit outcomes for current Subtitle D claimants  based on these criteria. By equity of outcomes, we mean that claimants  with similar illnesses and circumstances receive similar benefit outcomes.  The current program may not provide equity for all Subtitle D claimants  within a state because a claim that has a willing payer could receive a  different outcome than a similar claim that does not have a willing payer,  but at least three of the options could provide within-state equity. With  respect to across-state equity, the current program and the option to  provide a federal back up to the state workers’ compensation programs  would not achieve equity for Subtitle D claimants in different states. In  contrast, the option based on a federal workers’ compensation model as  well as the expanded Subtitle B option would be more successful in  achieving across-state equity.
Regardless of the option, changes made to Subtitle D could also  potentially result in differing treatment of claims decided before and after  the implementation of the change. In addition, changing the program to  remove the assistance in filing workers’ compensation claims may be seen  as depriving a claimant of an existing right. Further, any changes could  also have implications beyond EEOICPA, to the extent that the changes to  Subtitle D could establish precedents for federal compensation to private  sector employees in other industries who were made ill by their  employment.
section_title: Federal Costs
paragraphs: Effects on federal costs would depend on the generosity of the benefit in  the option chosen and the procedures established for processing claims  for benefits. Under the current program, workers’ compensation benefits  that are paid without contest will come from contract dollars that  ultimately come from federal sources—there is no specific federal  appropriation for this purpose. Because all of the options are designed to  improve the likelihood of payment for claimants who meet all other  criteria, it is likely that federal costs would be higher for all options than  under the current program. Specifically, federal costs would increase for  the option to provide a federal back up to the state workers’ compensation  program because it would ensure payment at rates similar to the state  programs for the significant minority of claimants whose claims are likely  to be contested and possibly denied under the state programs. Further, the  federal costs of adopting a federal workers’ compensation option would  be higher than under the first option because all claimants—those who  would have been paid under the state programs as well as those whose  claims would have been contested under the state programs—would be  eligible for a federal benefit similar to the benefit for federal employees. In  general, federal workers’ compensation benefits are more generous than  state benefits because they replace a higher proportion of the worker’s  salary than many states and the federal maximum rate of wage  replacement is higher than all the state maximum rates.
For either of the two options mentioned earlier, a decision to offset the  Subtitle D benefits against the Subtitle B benefit could lessen the effect of  the increased costs, given reports by Energy officials that more than   90 percent of Subtitle D claimants have also filed for Subtitle B benefits.  However, the degree of this effect is difficult to determine because many  of the claimants who have filed under both programs may be denied  Subtitle B benefits. The key distinction would be whether workers who  sustained certain types of illnesses based on their Energy employment  should be compensated under both programs as opposed to recourse  under only one or the other. If they were able to seek compensation from  only one program, the claimant’s ability to elect one or the other based on  individual needs should be considered.
The effects on federal cost of an expanded Subtitle B option or a new  federal program option are more difficult to assess. In many cases, the  Subtitle B benefit of up to $150,000 could exceed the cost of the lifetime  benefit for some claimants under either of the workers’ compensation  options, resulting in higher federal costs. However, the extent of these  higher costs could be mitigated by the fact that many of the claimants who  would have filed for both benefits in the current system would be eligible  for only one cash benefit regardless of the number or type of illnesses. The  degree of cost or savings would be difficult to assess without additional  information on the specific claims outcomes in the current Subtitle B  program. The effects on federal costs for the new federal program option  would depend on the type and generosity of the benefit selected.
section_title: Conclusions
paragraphs: More than 3 years after the passage of EEOICPA, few claimants have  received state workers’ compensation benefits as a result of assistance  provided by Energy. While Energy has eliminated the bottleneck in its  claims process that it encountered early in program implementation—the  initial development of cases—in doing so it has created a growing backlog  of cases awaiting review by a physician panel. In the absence of changes  that would expedite this review, many claimants will likely wait years to  receive the determination they need to pursue a state workers’  compensation claim. In the interim, their medical conditions may worsen,  and claimants may even die before they receive consideration by a state  program. While Energy has taken some steps designed to reduce the  backlog of cases for the physician panels, it is too early to assess whether  these initiatives will be sufficient to resolve this growing backlog.
Whether they ultimately receive positive or negative determinations,  claimants deserve complete and timely information about what they could  achieve in filing under this program, what the claims process entails, the  status of their claims, and what they are likely to encounter when they file  for state workers’ compensation benefits. Without complete information,  claimants are unable to weigh the benefits and risks of pursuing the  process to its conclusion. Indeed, given that the majority of claimants have  also filed for benefits under Subtitle B and many may have already  received decisions on those claims, some claimants may not be aware that  they still have a Subtitle D claim pending. Further, given the limited  communication from Energy since their claims were filed, some claimants  may be unaware that resources are being expended developing their  claims. Finally, because Energy does not currently communicate to  claimants what they are likely to encounter when they file for state  benefits, claimants may be unprepared for what may be a difficult and  protracted pursuit of state benefits.
Energy may be hindered in its ability to improve its claims process and  evaluate the quality of the assistance it is providing to claimants in this  program using the data it currently collects. Energy may also be  unprepared to provide the analysis needed to inform policymakers as they  consider whether changes to the program are needed because it does not  systematically track the outcomes of cases that are appealed or the  outcomes of claims that are filed with state workers’ compensation  programs. Finally, Energy will be limited in its ability to provide complete  and accurate information to claimants regarding the status and outcomes  of their claims without good data.
Even if all claimants were to receive timely physician panel determinations  stating that the workers’ illnesses had likely been caused by their  employment with Energy, some may never receive state workers’  compensation benefits. The lack of a willing payer may delay the receipt of  benefits for some claimants as insurers and state fund officials challenge  various issues aspects of the claim. For other claimants, the challenges  raised in the absence of willing payers may ultimately result in denial of  benefits based on issues such as not filing the claim within the time limits  set by the state program—issues that would not be contested by willing  payers. This disparity in potential outcomes for Subtitle D claimants may  warrant the consideration of changes to the current program to ensure  that eligible claims are paid without undue delay and that there is a willing  payer for all claimants who would otherwise be eligible.
section_title: Recommendations for Executive Action
paragraphs: To improve Energy’s effectiveness in assisting Subtitle D claimants in  obtaining compensation for occupational illnesses, we recommend that  the Secretary of Energy:  in order to reduce the backlog of cases waiting for review by a physician  panel, take additional steps to expedite the processing of claims though its  physician panels and focus its efforts on initiatives designed to allow the  panels to function more efficiently. For example, Energy should pursue  the completion of site reference data to provide physicians with more  complete information about the type and degree of toxic exposures that  may have occurred at each Energy facility. in order to provide claimants with more complete information, expand and  expedite its plans to enhance communications with claimants. These plans  should focus on providing more complete information describing the  assistance Energy will provide to claimants, the timeframes for claims  processing, the status of claims, and the process that claimants will  encounter when they file claims for state workers’ compensation benefits. in order to facilitate program management and oversight, develop cost- effective methods for improving the quality of the data in its case  management system and increasing its capabilities to aggregate these data  to address program issues. In addition, Energy should develop and  implement plans to track the outcomes of cases that progress through the  state workers’ compensation systems and use this information to evaluate  the quality of the assistance it provides to claimants in the Subtitle D  program. Such data could also be used by policy makers to assess the  extent to which this program is achieving its goals and purposes. in order to reduce disparities in potential outcomes between claimants  with and without willing payers, consider developing a legislative proposal  for modifying the EEOICPA statute to address the willing payer issue.  When assessing different options, several issues such as those discussed in  this report should be considered, including the purpose and type of  benefit, eligibility criteria and equity of benefit outcomes, and effects on  federal costs.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to Energy for comment. In commenting  on the draft report, Energy indicated that the agency had already  incorporated several of our recommendations and will aggressively tackle  the remainder. However, Energy did not specifically comment on each  recommendation.  In addition, the comments highlighted several initiatives  either planned or underway that are designed to improve the Subtitle D  program. Several of these initiatives address issues raised in our report for  which we recommended changes. In particular, Energy agreed with our  findings regarding problems with communications with Subtitle D  claimants and outlined the steps the agency has planned to correct these  problems. Further, Energy agreed with our finding that there was not a  system in place to track the outcomes of workers’ compensation claims  filed with the state programs and indicated that the agency has recently  initiated such a system, as we recommended. Finally, the comments  provide more recent information about the agency’s progress in  processing Subtitle D claims and reiterate the agency’s plan for eliminating  the backlog of claims by 2006. Energy’s comments are provided in  appendix II. Energy also provided technical comments, which we have  incorporated as appropriate.
Copies of this report are being sent to the Secretary of Energy, appropriate  congressional committees, and other interested parties. The report will  also be made available at no charge on GAO’s Web site at  http://www.gao.gov. If you have any questions about this report, please  contact me at (202) 512-7215. Other contacts and staff acknowledgments  are listed in appendix III.
section_title: Appendix I: Scope and Methodology
paragraphs: To determine the number of cases filed under Subtitle D, the status of  these cases and characteristics of claimants, we used administrative data  from Energy’s Case Management System (CMS). Energy does not publish  standardized data extracts from this system, so we requested that Energy  query the system to provide customized extracts for our analysis. The first  extract contained data on the status and characteristics of cases filed  between July 2001 and June 30, 2003. The second extract was obtained as  an update and contained data related to cases filed between July 2001 and  December 31, 2003.
Because multiple claims can be associated with a single case, Energy’s  system contains data at two levels—the case level and the claim level. For  example, if both the widow and child of a deceased Energy employee file  claims, both claims will be associated with a single case, which is linked to  the Energy employee. At the case level, the system contains information  about the Energy employee, such as date of birth and date of death (if  applicable), the facilities at which the employee worked, and their dates of  employment and the status of the case as it moves through the  development process in preparation for physician panel review. At the  claim level, CMS contains information related to the individual claimants,  such as the date the claim was signed and the claimant’s relationship to  the Energy employee.
The extracts provided by Energy contain case-level data, for the most part.  Data elements that are collected at the claim level were reported at the  case level in our files. For example, the system includes a claim signature  date for each claim. In our case-level file, Energy provided the earliest  signature date, so that we would know when the first claim was signed.  Illness data are also collected at the claim level. In our case-level file,  Energy provided all the illnesses claimed by all claimants. We then  aggregated the illness data to determine which illnesses were claimed on  each case.
We interviewed key Energy officials and contractors and reviewed  available system documentation, such as design specifications and system  update documents. Once the first data extract was received from Energy,  we tested the data set to determine that it was sufficiently reliable for our  purposes. Specifically, we performed electronic testing to identify missing  data or logical inconsistencies and reviewed determination letters for  cases that had physician panel determinations. We then computed  descriptive statistics, including frequencies and cross-tabulations, to  determine the number and status of cases received as of June 30, 2003.
When we received the second data extract, containing data through the  end of calendar year 2003, we matched it to the first one to determine how  many additional cases had been received between July 1, 2003, and  December 31, 2003, and to determine if any cases were missing. We  determined that some cases (less than 2 percent) that had been in the first  extract were missing from the second file. We consulted with Energy  contractors and determined that one case had been accidentally omitted  from the query results and that the remaining cases had been dropped  from CMS because they were duplicate cases or had been determined to  be non-Subtitle D cases. This is possible because the Resource Centers use  the CMS system to document incoming cases for both Subtitle B and  Subtitle D. Energy contractors provided a replacement file that included  the case that had been inadvertently dropped. They also reported that  there were still a small number of duplicate cases identified in CMS, and  hence in our data extract, but that Energy had not yet decided which cases  to retain. Since Energy officials had not yet decided which case records to  retain and which to delete at the time of our extract, we decided to leave  the cases identified as duplicates in our analysis file.
We reviewed available system documentation, performed electronic  testing and reviewed determination letters for cases that had physician  panel determinations to determine that the data contained in the second  extract was sufficiently reliable for our purposes. During our electronic  testing, we discovered a discrepancy between the December 31, 2003,  status information included in our file and the December 31, 2003, status  information reported by Energy on its Web site. On further discussion with  Energy officials and contractors, we determined that when running the  query, Energy contractors had calculated the December 31, 2003, status  information using the wrong field in the database. Energy contractors gave  us a third data file containing the correct status information that we then  appended to the analysis file. We then computed additional descriptive  statistics, including frequencies and cross-tabulations to determine the  number and status of cases received as of December 31, 2003.
To determine the extent to which Energy policies and procedures help  employees file timely claims for state workers’ compensation benefits, we  reviewed Energy’s regulations, policies, procedures, and communications  with claimants. In addition, we interviewed key Energy officials and  contractors at Energy facilities. We also interviewed panel physicians and  contractors responsible for case development. In addition, we interviewed  advocates, claimants, and officials at the National Institute for  Occupational Safety and Health. Finally, we conducted site visits to three  Energy facilities in Oak Ridge, Tennessee—the state accounting for the  largest number of Subtitle D cases.
To estimate the number of claims for which there will not be willing  payers of workers’ compensation benefits, we reviewed the provisions of  workers’ compensation programs in the 9 states that account for more  than three-quarters of the cases filed. The 9 states are: Colorado, Idaho,  Iowa, Kentucky, New Mexico, Ohio, South Carolina, Tennessee, and  Washington. The results of our analysis cannot necessarily be applied to  the remaining 25 percent of the cases filed nationwide. Because of data  limitations, we assumed that: (1) all cases filed would receive a positive  determination by a physician panel; (2) all workers lost wages because of  the illness and were not previously compensated for this loss; and (3) in all  cases, the primary contractor rather than a subcontractor at the Energy  facility employed the worker. While we believe that the first two  assumptions would not affect the proportions shown in each category, the  third assumption could result in an underestimate of the proportion of  cases lacking willing payers to the extent that some workers may have  been employed by subcontractors that used commercial insurers or state  funds for workers’ compensation coverage. Some subcontractors use  these methods of workers’ compensation coverage because they may not  employ enough workers to qualify for self-insurance under some state  workers’ compensation programs. We also interviewed Energy officials,  key state workers’ compensation program officials, workers’  compensation experts, private insurers, and the contractors operating the  major facilities in each of the states to determine the method of workers’  compensation coverage these facilities used.
Finally, we took several steps to identify possible options for changing the  program in the event that there may not be willing payers of benefits. We  reviewed existing laws, regulations, and programs; analyzed pending  legislation; and considered characteristics of existing federal and state  workers’ compensation programs. We also identified the issues that would  be relevant for policy makers to consider in implementing these options.
section_title: Appendix II: Comments from the Department of Energy
section_title: Appendix III: GAO Contacts and Staff Acknowledgments
subsections: section_title: GAO Contacts
section_title: Staff Acknowledgments
paragraphs: In addition to the above contacts, Melinda L. Cordero, Mary Nugent, and  Rosemary Torres Lerma made significant contributions to this report.  Also, Luann Moy and Elsie Picyk assisted in the study design and analysis;  Margaret Armen provided legal support; and Amy E. Buck assisted with  the message and report development.