EEOICPA BULLETIN NO. 09-05
Issue Date: November 26, 2008
___________________________________________________________
Effective Date: November 26, 2008
___________________________________________________________
Expiration Date: November 26, 2009
___________________________________________________________
Subject: Processing Claims for End-Stage Terminally
Ill Claimants
Background: The Division of Energy Employees
Occupational Illness Compensation (DEEOIC) strives to process claims fairly and
expeditiously for all claimants.
However, claimants who are end-stage terminally ill must have priority
processing. It is imperative they have
our compassionate and swift response to all matters regarding their claims. DEEOIC currently has an informal process to
expedite the processing of decisions and payments to claimants in these
situations. These procedures need to be
formalized, and we must be able to track these cases to ensure they are
processed in a timely manner.
Reference: March 8, 2006, Memorandum from Peter M.
Turcic, Director of the DEEOIC, to all DEEOIC Offices regarding “Processing
claims from terminally ill employees.”
Purpose: To formalize the existing practice of
expediting claim and payment processing for end-stage terminally ill claimants
and to provide instructions concerning a new Energy Case Management System
(ECMS) code that has been created to track the progress of claims for these
individuals.
Applicability: All Staff
Actions:
1. District
Office (DO) and Final Adjudication Branch (FAB) Claims Examiners (CE) and Hearing
Representatives (HR) are instructed to watch for indicators of an end-stage
terminally ill claimant any time they are reviewing a case file or preparing a
decision. This information may be evident in a number of ways (e.g. requests
for hospice care, CE review of medical evidence, telephone calls, or letters). Notification may come from resource centers (RCs),
congressional offices, authorized representatives, family members, or medical
providers. Upon receipt of information concerning the end stage of the claimant’s
illness, the District Director (DD) or Assistant District Director (ADD), or
FAB Manager (depending upon where the file is located) must be notified
immediately.
2. The DD/ADD
or FAB Manager must exercise sound judgment in determining if priority handling
is warranted. If medical documents or
other information indicate that the claimant is in the end stage of his/her
illness, or that death is imminent, priority handling is required. If the claimant’s medical status is unclear, a
medical report to substantiate that the claimant is in the end stage of a
disease or illness, must be obtained. Once
this information is available, the DD/ADD or FAB Manager will make a final determination
whether priority handling is required.
3. Having
determined that a claimant in is the end stage of his or her illness, the DD/ADD
or FAB Manager must enter a ‘TL’ –
“Terminal Claimant Designated by the DD/FAB Manager” status code in the Claim Status
History of ECMS. If the case is a B/E
case, the ‘TL’ code must be entered
into both ECMS B and E. The DD or FAB
Manager should prepare a brief memo for the case file explaining the need for
terminal claimant processing (see Attachment 1). The status effective date of the code is equal
to the date of the memo. The memo should be supported by some form of
communication in the case file (e.g. telephone call with corresponding Telephone
Management System (TMS) printout, email, or letter, etc.) explaining the need
for expedited processing. At the time of coding, the file must also be flagged
with a brightly colored sheet of paper that reads, “Terminal Claimant –
Expedite Processing.” This flag should
be stapled to the outside of the file. A
second copy of this “flag” should be spindled in the file (in case the cover
sheet tears off.) The terminal claimant flag
should remain on top of the spindle, even as additional evidence is
received. The only item that can be
placed on top of it is the authorized representative form, which is a partial
sheet, leaving the “Terminal Claimant” sheet still visible.
4. Priority
handling for terminally ill claimants requires that the entire adjudication
process be expedited. Everyone
involved with the case should do everything within their power to make sure the
case progresses as quickly as possible. Whenever the file changes hands, the
person receiving the file should be notified, verbally or in writing, of the
claimant’s terminal status. The supervisor
or DD/ADD should facilitate the expedited adjudication of the claim by
requesting priority processing from any other agencies involved, such as the
Department of Energy (DOE), the Department of Justice (DOJ), and the National
Institute for Occupational Safety and Health (NIOSH).
5. If a
case requires referral to the National Office (NO) for reopening or policy
clarification, the DO or FAB must be sure to identify the claimant as
terminally ill in their memo to the Director.
6. If a terminal
claimant case is accepted and a lump sum payment is to be issued, the DD/ADD or
FAB Manager should determine if the case warrants an immediate (exception
processing) payment, rather than standard payment processing through ECMS. Exception payments are special request
payments that are entered directly into the Treasury Department’s payment
system, at the NO, for same-day or next-day delivery. Exception payments are only to be requested
by the DD/ADD, or FAB Manager, if the claimant’s condition is rapidly
deteriorating and the payment must be transmitted immediately. Upon issuing the final decision, the FAB
should notify the DD that a decision and an EN-20 (Acceptance of Payment) have
been sent to the claimant. The DO should contact the claimant and his family or
authorized representative, and explain why it is imperative they get the
completed EN-20 back as quickly as possible. The CE should explain the advantage
(timeliness) of selecting an electronic funds transfer (EFT) vs. a paper check,
and also explain the need for accurate banking information on the EN-20. It should be emphasized that the DO and/or the
RC will assist in any way possible to expedite the return of the EN-20. This
would include return of the EN-20 by facsimile, if necessary, which is not
permitted for normal payment processing.
7. Upon
receipt of the properly completed EN-20, and if an exception processing payment
is warranted, the DO fiscal officer will send an email to the National Office Fiscal
Officer (NOFO) advising that a payment request is being forwarded for immediate
processing. This email notification simply serves as notice of an incoming
payment request, and need only contain the anticipated amount of the payment,
the claimant’s last name, and last 4 digits of the claim number. The email notification must be followed by a
fax to the NOFO, with the necessary payment documents listed in item #10 below.
The NOFO will not initiate any action until the actual payment documents have
been received by fax at the NO.
8. When entering exception processing payments in
ECMS, the DO Payee Change Assistant will enter the “AOP received date,” and the
“EFT Account Information” on the “Payee” screen. However, the CE will not
create a payment on the “Compensation” screen.
In the event the DO begins the payment approval process on the
“Compensation” screen, and subsequently determines that a manual payment is
required, the payment approvals must be deleted from the “Compensation” screen.
9. Once the
DO has notified the NOFO of a pending exception payment request, the DO will
begin preparing the Exception Processing Payment Transaction Form (EPPTF). For
EFT transactions, the fiscal officer must contact the financial institution and
verify the EFT information on the EN-20, the same as with a normal ECMS payment
(i.e. account name and number, account type, bank name, etc.) Additionally, the fiscal officer must inquire
of the bank whether the routing number on the EN-20 can accept a same-day wire
transfer (Fed Wire) or whether the payment must be sent as an ACH (overnight)
payment? When completing the EPPTF (available
to staff on the DEEOIC shared drive), the PTF must specify the type of
payment transaction being requested (i.e. same-day or overnight payment). If the bank routing number can accept either
type of electronic payment, the default preference should be “Fed Wire” on the
PTF. (If a Fed Wire payment is desired, the FO can also obtain confirmation of
the bank routing number at: www.fedwiredirectory.frb.org).
The
EPPTF is routed through the CE, senior CE/supervisor, DO fiscal officer, and
the DD. Each will review the payment information on the form for accuracy; will
check the information against the payee screen in ECMS; and will complete all
other separate and compulsory creation, certification, verification, and
authorization duties (respectively), in an expedited manner. If all information
is correct, they will print and sign their names, and date the form. If there is an error, the form is rejected by
checking the “Transaction Cancelled” box and indicating the reason for the
cancellation. The information is
immediately corrected, and the process starts over. The last two signatures are
left blank on the EPPTF, at the DO. No
compensation payment is created in ECMS.
10. The DO
fiscal officer will send, via fax to the NOFO, a copy of the claimant’s
completed EN-20, a copy of the phone message verifying the account information
for electronic payments, and a completed EPPTF.
After completing the fax transmission, the DO fiscal officer must notify
the NOFO by telephone, that a “terminal payment request” has been transmitted,
and must obtain confirmation that the payment request has been received for immediate
processing. If the NOFO is
unavailable, the fiscal officer should contact the designated back-up person,
or the Unit Chief for Policy.
11. The NOFO
will review all of the faxed information and take the appropriate steps to process
an exception payment through the Treasury Department’s Secure Payment System
(SPS). Upon completion of the exception
payment process, the NOFO will notify the DD/ADD and DO fiscal officer that the
payment has been certified with the Treasury Department. Fed Wire transfers are typically delivered to
the recipient bank within one to two hours of certification. ACH transfers are
completed overnight, for delivery the next day.
The DO should advise the claimant and/or family members when to expect
the payment.
12. Upon completion
of the exception payment, the NOFO will send the DD a copy of the EN-20 that
was faxed to the NOFO; the EPPTF containing the final two signatures entered at
the NO, and printed verification of the completed transaction from the SPS
system. These documents should be sent to the DD via FedEx. Verification of
payment documents is now the responsibility of the DD/ADD, and the case file is
no longer being sent to the National Office.
Upon receipt of the exception processing documents from the NOFO, the
DD/ADD will verify that these documents match the original payment documents in
the case file. Once verified, the DD/ADD will prepare a memorandum for the case
file stating verification of the fiscal documents (original and facsimile
copies of the EN-20 and PTF) has been completed and the documents are in order.
13.
The NOFO
retains copies of the payment documents in a secure, locked location at the NO.
Disposition:
Retain until incorporated in the Federal (EEOICPA) Procedure Manual.
RACHEL P. LEITON
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