Energy Employees Occupational Illness Compensation Program

May, 2007

Part B

Administration of the EEOICPA

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

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

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 Worker made sick as result of exposure to toxic substance

When eligible:

What benefits are provided under Part E:

Employment – proof of contractor or

Basic Part B Claim Criteria

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. DOL will assist in collection of evidence i.e. employment & exposure records - medical documentation

Burden of Proof

Employment – proof of contractor or
subcontractor employment at a qualifying DOE or RECA facility & exposure to toxic substance

Basic Part E Claim Criteria

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

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

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

Dose reconstruction outcome?  Effect of toxic substance

Cancer Caused by Radiation and Other Toxic Exposure

DOL will evaluate via qualitative medical evidence  Synergistic or additive effect (radiation + exposure from toxin)

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. 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/

Site Exposure Matrices (SEM)


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

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,

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

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

Benefit Process

Offsets
Coordinate with state workers’ compensation to determine possible offset of state award  No offset for payments under Part B

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

W age Loss Calculation
De rm te inina tion 1st Month Wa Loss ge Ave ge Annua Wa 36 Months ra l ge Prior to 1st Wa Loss ge Numbe of Ye rs r a 1st Month Wa Loss to ge SSA Re me Age tire nt

Pa ent ym

$10,000 X Numbe of Ye rs r a Wa Loss 25% - 50% ge Ave ge Annua Wa ra l ge

$15,000 X Numbe of Ye rs r a Wa Loss Gre te 50% Tha ge a r n Ave ge Annua Wa ra l ge

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

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 selfsupport

Survivor – Compensation Categories

Category 1 $125,000

Category 2 $150,000

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


Category 3 $175,000

Computation of WageLoss 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 Review of the Written Record Request for Hearing

Handling Objections
 

Filing Claims
4

District Offices Resource Centers

 11

 Website:

http://www.dol.gov/esa/regs/complia