EEOICPA BULLETIN NO. 07-06
Issue Date: February 6, 2007
Effective Date: February 6, 2007
Expiration Date: February 6, 2008
Subject: Educating claimants on impairment and/or wage loss compensation benefits.
Background: Due to the complex nature of the Part E benefit structure and the requirements necessary to qualify for lump sum compensation, selected Resource Centers (RCs) have been tasked to engage in an outreach effort to educate claimants on the requirements for filing for and obtaining impairment and/or wage loss benefits.
References: EEOICPA Procedure Manual E-800, Wage-Loss Determinations; E-900, Impairment Ratings; ECMS User’s Reference Guide for Resource Center Staff.
Purpose: To provide guidance on communicating with claimants who are potentially eligible for impairment and/or wage loss benefits under Part E of the EEOICPA.
Applicability: All DEEOIC and RC staff.
1. To facilitate communication with eligible claimants who are also the covered employee or worker (hereafter referred to as employees) certain DEEOIC RCs will be assigned responsibility for contacting identified employees by telephone to explain the benefit provisions available under Part E. Assignments are as follows:
|Jacksonville DO and FAB||Savannah River RC|
|Cleveland DO and FAB||Portsmouth RC|
|Denver DO and FAB||Espanola RC|
|Seattle DO and FAB||Hanford RC|
2. There are two types of Part E cases that are to be identified and referred to the designated Resource Center (RC) to initiate employee communication:
3. For Part E cases at the Final Adjudication Branch, when a final decision is issued to a living employee with a positive causation determination, a copy is to be prepared and forwarded to the designated RC. This should be done only in situations where there is no indication that a claim has been made for impairment and/or wage loss. Decisions that pertain strictly to survivors of a deceased employee are not to be referred to the RC, but processed in the normal fashion. The Washington, DC FAB will send final decisions that meet these guidelines to the appropriate RC, based on which DO issued the recommended decision on Part E.
4. For any case at the District Office that contains a final decision with a positive finding on causation issued to a living employee and where there has been no claim for impairment and/or wage loss, an initial development letter for impairment and/or wage loss benefits must be completed and sent to the employee with a copy of the letter sent to the assigned RC. An example of an initial development letter for impairment benefits is included as Attachment 1. Examples of the initial development letters for wage loss benefits are included as Attachment 2.
5. Upon receipt of a final decision or a development letter in the RC, the RC should take appropriate action to record its receipt. The RC is responsible for ensuring that an appropriate system for recordkeeping is developed to track referrals, and subsequent actions in accordance with the guidance provided in this bulletin. The RC system records the date the final decision or development letter(s) was received in the RC, the employee’s name, claim number, the date outreach was completed and whether or not the employee intends to pursue impairment and/or wage loss. In addition, the RC will also report on the disposition of all referrals on a weekly basis to the Branch Chief for Outreach and Technical Assistance. This data should be incorporated into the routine weekly RC activity report already generated by the RC manager.
6. The RC staff should carefully review Procedure Manual Chapters E-0800 and E-0900, which explains the eligibility requirements for compensation benefits and the procedures DEEOIC follows for developing impairment and wage loss benefit claims. For each referral, the RC will initiate a telephone call to the employee identified. It will be necessary for the RC to access the Energy Case Management System (ECMS) to obtain contact information for the employee. The purpose of this call is to provide information about the potential impairment and/or wage loss benefits available, respond to questions, and solicit claims.
7. A script (Attachment 3) has been developed for use by the RC staff in explaining impairment and/or wage loss benefits to the employee at a general level. It is important the RC staff adhere to the script. Given the complexity of the benefit structure under Part E, it is likely that the employee will have questions. The RC staff may respond to general follow-up questions; for example, eligibility requirements or program procedures to develop a claim for impairment and/or wage loss benefits. To help the RCs anticipate and answer some of the most common questions regarding impairment and wage loss benefits, DEEOIC has developed a Q & A Sheet (Attachment 4) for use by the RCs.
Claim-specific questions or questions that exceed the RC’s ability to assist the employee must be referred to the assigned DO claims examiner (CE) or FAB hearing representative/claims examiner, per ECMS. No attempt should be made by the RC representative to offer opinion or conjecture as to the likelihood of entitlement. All adjudicatory functions are solely the responsibility of the assigned CE.
8. During the telephone call, if the employee expresses the intention to pursue impairment and/or wage loss benefits or in cases where the RC staff member believes the employee may qualify for these benefits, the RC advises the employee to submit a signed statement or letter to the appropriate DO of their intention to pursue benefits.
9. In cases where the employee expresses the intention to pursue impairment and/or wage loss benefits, the RC must also mail the brochures titled “How Do I Qualify for an Impairment Award” (Attachment 5) and/or “Wage Loss Benefits” (Attachment 6) with an appropriate cover letter to the employee. These brochures were developed to explain these two types of benefits and the requirements that must be met to qualify for benefits.
10. All discussions with the employee about wage loss and/or impairment must be memorialized into the ECMS via the Telephone Management System (TMS) screen in accordance with the instructions contained in the attached ECMS User’s Reference Guide for Resource Center Staff (Attachment 7). In general, each TMS entry should contain a synopsis outline of the discussion; the employee’s question or request, if any; the guidance or solution offered; and a notation as to whether the employee intends to pursue impairment and/or wage loss. The TMS screen is printed and the paper record of the activity is forwarded to the appropriate DO/FAB daily for association with the case file.
11. Designated RCs are responsible to immediately notify via email the DO Point of Contact (POC) and the assigned CE or HR (as denoted in ECMS), on any case needing prioritization, such as a terminally ill employee who wants to claim impairment and/or wage loss. The designated DO POC is the same individual who handles the RC employment verification process. The RC staff member must still submit the printed copy of the telephone contact in TMS to the appropriate DO/FAB for association with the case file. For easier identification, these TMS records must be marked “Priority” on top of the page.
12. The designated RC has seven calendar days from the RC’s receipt of the employee’s final decision or initial development letter(s) to initiate telephonic contact. In cases where the RC is unable to contact the employee within seven calendar days (for example, the employee may be on vacation), the RC must continue to follow up with the employee and document the contact attempts in TMS until contact is successful or a reasonable determination has been made by the RC that further attempts at contact will not be productive. The RC representative may use his or her discretion to determine when to cease further contact attempts with the employee, but as a general rule, after three recorded attempts in as many days has failed to garner employee contact, the RC may cease outreach effort.
13. The RC is to shred the final decision and/or development letter after the employee has been successful contacted or after the RC has ceased outreach effort with the employee.
Disposition: Retain until incorporated into the Federal (EEOICPA) Procedure Manual.
PETER M. TURCIC
Director, Division of Energy Employees
Occupational Illness Compensation
Distribution List No. 1: Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections, and Resource Center Managers.