EEOICPA Benefits Offset Worksheet
(For internal DEEOIC use only)
Covered Employee:
Claimant:
Claim Number:
1. Gross Settlement/Final Judgment Amount.......$__________________
2. Was Line 1 split between multiple parties?.................Y / N
a. If yes, go to either Step 3 or Step 4
b. If no, and Line 1 was paid to the employee or
another person with no independent cause of action,
deduct amounts for any other causes of action or for
medical treatment prior to date EEOICPA claim was
from Line 1 (see Instruction 2). Enter balance here
and go to Step 5.............................$__________________
3. Allocation Between Parties Provided by Judge or Jury:
a. To Employee for Covered Illness (do not
include payments for medical treatment prior
to date EEOICPA claim was filed).............$__________________
b. To Employee for Other Damages (if any)..$__________________
c. To Other Party(s) (list separately).....$__________________
To Other Party..........................$__________________
To Other Party..........................$__________________
4. CE Allocation Between Parties (all other cases):
a. Standard allocation for payment split between
living employee and other parties is 75% of
Line 1, after deducting amounts for any other
causes of action or for medical treatment prior
to date EEOICPA claim was filed. Enter result
here and go to Step 4c..................$__________________
b. Standard allocation for payment to deceased
employee with other parties is 50% of Line 1,
after deducting amounts for any other causes
of action or for medical treatment prior to
date EEOICPA claim was filed. Enter result
here and go to Step 4c..................$__________________
c. Good cause shown for different allocation?............Y / N
d. Different allocation for covered illness of
employee................................$__________________
5. Amounts Paid to Attorney/Firm for:
a. Costs of Suit (see Instruction 3).......$__________________
Divide costs by gross settlement to determine
costs percentage (Line 5a/Line 1)...................._____%
b. Multiply Line 2b, 3a, 4a, 4b or 4d (one only)
by the costs percentage. Enter here....$__________________
c. Attorney Fees...........................$__________________
Divide attorney fees by gross settlement to
determine attorney fees percentage (Line 5c/Line 1).._____%
d. Multiply Line 2b, 3a, 4a, 4b or 4d (one only)
by the LESSER of attorney fees percentage
or 40%. Enter here.....................$__________________
6. Net Amount of Payment for Covered Illness to be Offset:
a. Subtract Line 5b from Line 2b, 3a, 4a, 4b or
4d, as appropriate. Enter balance here......$__________________
b. Subtract Line 5d from Line 6a to arrive at amount
to be offset. Enter result here.............$__________________
7. Claimant’s Entitlement to EEOICPA Benefits:
a. Amount of unpaid lump-sum payment.......$__________________
b. If Line 7a is larger than Line 6b, subtract
Line 6b from Line 7a and enter balance due to
claimant here................................$__________________
c. If Line 7a is smaller than Line 6b, subtract
Line 7a from Line 6b and enter amount of surplus
to be recovered from medical benefits here...$__________________
* * * * * * * * * * *
INSTRUCTIONS FOR COMPLETING THE WORKSHEET
1. Putting a Value on a Settlement or Judgment. EEOICPA benefits
are not reduced if benefits awarded by the Department of Justice under section 5 of the RECA were reduced by the full amount of the payment received by the uranium worker or the survivor(s). However, if the
amount of the payment received exceeded the $100,000 that can be
awarded under section 5 of the RECA, any EEOICPA benefits payable
must be reduced to account for the amount of the payment that was
in excess of $100,000. This amount is entered directly on Line 6b,
and only Step 7 of the Worksheet needs to be completed.
A payment can include both an initial cash payment and some future payments. The “value” of future payments is the present value of
the future payments, not the sum of all the future payments (which
would always be more than the present value of the future payments).
If the future payments are made through an annuity, the CE may accept
the purchase price of the annuity as the present value of the future payments.
Do not attempt to put a dollar value on any future payment that is contingent upon an event that has not yet taken place, such as the diagnosis of an additional medical condition. This particular type
of future payment cannot be valued and is not to be included in the
amount listed on Line 1 of the Worksheet.
Whenever a covered illness is aggravated by medical malpractice, any payment on a final judgment or settlement relating to the malpractice
is an amount that must be reported to OWCP and included in the amount listed on Line 1. If the malpractice payment is only a reimbursement
for medical treatment provided prior to the date the covered employee filed a claim for EEOICPA benefits, deduct the malpractice payment at
Line 2b, 3a, 4a or 4b of the Worksheet. In all other situations, the
CE must refer the case to the National Office.
2. Allocating a Joint Recovery Between Multiple Parties. A payment
on a final judgment or settlement is a joint recovery only if it was
paid to multiple parties. Joint recoveries are “allocated” or split
up between multiple parties at either Step 3 or 4 of the Worksheet.
If multiple parties brought a lawsuit or sought a settlement, but
only one party received a payment, fill in the appropriate amount
on Line 2b of the Worksheet IF THE PARTY WHO RECEIVED THE PAYMENT
WAS THE EMPLOYEE OR ANOTHER PERSON WITH NO INDEPENDENT CAUSE OF
ACTION.
If someone other than these two specific parties received the
entire payment and the employee was alive at the time it was
paid, no offset is required and the Worksheet does not need
to be completed.
If a judge or jury specifies how to allocate a joint recovery
between the parties, use that allocation to fill in the
appropriate blanks in Step 3. In all other situations
involving a joint recovery, the CE automatically allocates
25% of the payment to the other parties for their loss of
consortium and enters the remaining 75% on Line 4a of the
Worksheet as the amount that the living covered employee
received for his or her covered illness. If the claimant
wants to allocate more than 25% of the joint recovery to
the other parties, he or she must submit evidence and legal
argument to the CE showing that a higher percentage is
appropriate. This evidence MUST show that:
A. State law in the relevant state provides a cause of
Action for loss of consortium for the family member to whom
the recovery is attributed, and
B. A cause of action for loss of consortium was asserted
by that family member, either in the same action or in separate
actions.
If an employee incurred an occupational illness that was covered
by EEOICPA and died before receiving a payment out of a joint
settlement or judgment, the CE automatically allocates 50% of
the amount listed on Line 1 to the other parties for their causes
of action and enters the remaining 50% on Line 4b of the Worksheet
as the amount that the deceased employee’s estate received for his
or her covered illness. If the claimant wants to allocate more
than 50% to the other parties, he or she must submit evidence
and legal argument to the CE showing that a higher percentage
is proper. This evidence MUST show that:
A. State law in the relevant state provides a cause of action
for loss of consortium or wrongful death for the family member
to whom the recovery is attributed, and
B. A cause of action for loss of consortium or wrongful death
was asserted by that family member, either in the same action
or in separate actions.
To make these required showings in either situation described
above, the claimant can submit a copy of the complaint filed
on behalf of the spouse and/or children, and citations to
appropriate state case law or statutes. If the CE determines
that the evidence and argument support allocating a higher
percentage to the other parties, thereby resulting in a lower
allocation to the employee, the lower allocation to the employee
should be entered on Line 4d.
3. Deductions for Costs of Suit and Attorney Fees. Costs that
may be listed on Line 5a of the Worksheet are reasonable
out-of-pocket costs and expenses involved in bringing a
lawsuit, but do not include fees paid to co-counsel or
normal office expenses like secretary or paralegal services
or in-house record copying costs. Before the CE may approve
the deduction of any costs, the costs MUST be itemized so
the nature of each individual cost may be evaluated by the
CE to ensure that it is allowable. Costs that are allowable
include filing fees, travel expenses, record copy services,
witness fees, court reporter costs for transcripts of hearings
and depositions, postage, and long distance telephone calls.
Once the allowable costs have been calculated and listed on Line
5a, the CE must divide these costs by the amount of the gross
recovery listed on Line 1 of the Worksheet to determine the
percentage of the gross recovery that is represented by the
allowable costs. Once this percentage has been calculated,
the CE must multiply it by the amount listed on Line 2b (if the
only party paid was the employee or another person without an
independent cause of action), or the amount listed on Line 3a,
4a, 4b or 4d (if multiple parties were paid) to calculate the
costs to be deducted from the recovery. This last figure is
the amount to be entered on Line 5b.
Attorney fees submitted for consideration should be entered on
Line 5c of the Worksheet. Using the same basic calculation
method used for costs, the CE should divide Line 5c by Line 1
to determine the percentage of the gross recovery that is
represented by the attorney fees. Enter this percentage in
the space provided after Line 5c. In general, any fee that
exceeds 40% of the figure listed on Line 1 will be considered unreasonable. To determine the amount of allowable attorney
fees to be deducted, the CE must multiply the amount listed
on Line 2b (if the only party paid was the employee or another
person without a cause of action of their own), or the amount
listed on Line 3a, 4a, 4b or 4d (if multiple parties were paid),
by the LOWER of the attorney fees percentage that was entered in
the space after Line 5c, or 40%, and enter the resulting amount
on Line 5d. If the attorney fee percentage exceeds 40%, the
CE should inform the claimant of this and allow an opportunity
to establish that an attorney fee in excess of 40% is reasonable.
The circumstances which should be taken into account in determining
the reasonableness of both attorney fees and costs of suit for
the purpose of offsetting EEOICPA benefits include, among other
things, prevailing local fees, cases of similar complexity and
the amount of the gross settlement or final judgment at issue. Determinations of the CE in these areas are made for the sole
purpose of administering § 7385 of the EEOICPA and do not have
any effect on a fee agreement between an attorney and client
or any other matter not involving the application of the Act.