EEOICPA BULLETIN NO.  09-05

 

Issue Date: November 26, 2008

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Effective Date: November 26, 2008

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Expiration Date: November 26, 2009

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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



Attachment 1

Attachment 2

 

 

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 Centers