TABLE OF CONTENTS

 

 

Paragraph and Subject                 Page  Date   Trans. No.

 

Chapter 1-0300 Case Creation

                   

      Table of Contents. . . . . . .  i     04/09   09-02 

  1   Purpose and Scope. . . . . . .  1     04/09   09-02

  2   New Cases. . . . . . . . . . .  1     04/09   09-02 

  3   Creating Physical Cases. . . .  4     04/09   09-02

  4   Case Create Worksheet. . . . .  5     04/09   09-02

  5   Creating Cases in Energy Case

        Management System (ECMS) . .  9     04/09   09-02 

  6   Duplicate Cases. . . . . . . .  14    04/09   09-02

  7   Claims Examiner Review . . . .  15    04/09   09-02

  8   Claims for New Medical

        Conditions or New Survivors

        Before a Recommended

        Decision . . . . . . . . . .  17    04/09   09-02 

  9   New Claims Received in the DO

        During Case Review by FAB

        or NO. . . . . . . . . . . .  19    04/09   09-02

 10   Claims for New Medical

        Conditions After a Final

        Decision . . . . . . . . . .  21    04/09   09-02 

 11   Withdrawal of a Claim. . . . .  22    04/09   09-02

 12   Deleting a Claim from ECMS . .  22    04/09   09-02

 

Exhibits

 

  1   Case Create Worksheet. . . . .        04/09   09-02

  2   Letter of Acknowledgement. . .        04/09   09-02

 

1.   Purpose and Scope.  This chapter describes the contents of new cases, the basis for creating them, and the procedures for determining whether a new claim is considered as filed under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Part B, Part E, or both.  Guidance is also provided on the proper handling of additional new claims received during different stages of the claims process. 

 

This chapter also describes the role of the Resource Center (RC), the District Office (DO), and the Secondary Claims Examiner (CE2) Unit in the case creation process.  How to create the physical files and, in general, how to create the electronic records in the Energy Case Management System (ECMS) are also covered in this chapter.  And lastly, the process for handling withdrawn claims, duplicate cases, and the deletion of claims from ECMS is also discussed.

 

2.   New Cases.  A new case usually consists of a Claim for Benefits, Form EE-1 or EE‑2, with the accompanying Form EE‑3, Employment History for a Claim Under the EEOICPA.

 

a.   Written Notice.  A new case is created based on signed written communication from the claimant, claimant’s authorized representative, or a person acting on behalf of the claimant (e.g., a relative, guardian).  Any one of the following documents is considered a request for benefits:

 

(1)  Form EE-1, Employee’s Claim for Benefits;

 

(2)  Form EE-2, Survivor’s Claim for Benefits; or

 

(3)  Any letter or document containing “words of claim” under the EEOICPA.  “Words of claim” simply means that the individual is requesting benefits under the EEOICPA.

 

b.   Resource Center.  Each RC receives new Claims for Benefits, Forms EE‑1 and EE‑2, and provides assistance to claimants in the filing of their claims.  The RC date-stamps the claim forms upon receipt into their office.  In instances when the claimant mails the claim form to the RC, the postmarked envelope is kept and attached to the claim form.

 

(1)  Initial Employment Verification.  As needed, RC staff assist the claimant in completing the Form EE-3, Employment History for a Claim Under the EEOICPA.  For all new non-Radiation Exposure Compensation Act (RECA) claims filed at the RC, the RC staff conduct initial employment verification by using the “Search Orise Data” function under the “Inquiry” option in ECMS, sending a Department of Energy (DOE) Employment Verification Request, Form EE-5, or by sending a request to a corporate verifier, as appropriate. 

 

(2)  Occupational History Development.  RC staff also conduct occupational history development on most claims filed under Part E.  This generally involves conducting an Occupational History Interview.

 

(3)  Time Frames.  Within seven calendar days after receipt of a claim, the RC staff complete all possible initial employment verification and occupational history development. 

 

After taking the actions listed above, the RC then prepares a memorandum to the DO or CE2 Unit outlining their involvement with the claim.  The RC also forwards a checklist to the DO or CE2 Unit, which identifies their completed actions on the claim.  All claim forms, employment verification, occupational history development, and associated documentation are included in the package referred to the DO or CE2 Unit. 

 

c.   New Cases Received Directly in the DO or CE2 Unit.  The DOs and CE2 Units generally receive new claims directly from the RC after they have conducted the initial development steps outlined above.  However, sometimes new claims are received directly in the DO or CE2 Unit from the claimant, authorized representative, or a person acting on behalf of the claimant.  Such cases are immediately created and the employment verification is conducted by the DO or CE2 Unit.  However, the RC conducts Occupational History Questionnaires (OHQs) on those cases, when requested by the DO or CE2 Unit.

 

Claim forms received directly from the RC or from the claimant are date-stamped upon receipt in the DO or CE2 Unit and the postmarked envelope from the claimant is kept and attached to the claim form.    

 

(1)  New Cases Received Directly in the National Office (NO).  There are instances when claimants submit their claims to the NO instead of the RC, DO, or the CE2 Unit.  When this occurs, the claim form(s) and any attached documentation are date-stamped by the NO and forwarded to the appropriate DO or CE2 Unit for case create (as discussed in this chapter) and processing, in accordance with jurisdiction (See EEOICPA PM 0-0100).  The DO or CE2 Unit also date-stamps the forms upon receipt into their office from NO.    

 

d.   Electronic Applications.  A claimant or third party has the option of accessing and completing a claim form electronically on the Department of Labor Website at www.dol.gov/owcp/energy/regs/compliance/claimsforms.htm  When a claim form is submitted electronically, it is automatically sent via e-mail to the DEEOIC Form Mailbox at DEEOIC-FormsReceipt@dol.gov.  A claimant or third party, who has questions or technical problems, requests assistance via the DEEOIC Assistance Mailbox at DEEOIC-FormsAssistance@dol.gov.  The Branch of Outreach and Technical Assistance (BOTA) manages and responds to all e‑mails submitted to both mailboxes on a daily basis.

 

(1)  When claim forms are received in the DEEOIC Form Mailbox, BOTA reviews them to determine the DO or CE2 Unit to assign the claim to for processing in accordance with jurisdiction (See EEOICPA PM 0-0100).  Once this has been determined, a BOTA staff member forwards the electronic file via e-mail to the persons designated in the DO or CE2 Unit as the Point of Contact (POC) and backup.

 

(a)  When the POC receives the e-mail, he or she prints the e-mail and the attached claim form(s) and takes them immediately to the mailroom to be processed and created, according to the procedures outlined in this chapter.

 

(b)  The e-mail from BOTA is treated as a postmarked envelope and filed down, along with the claim form(s), on the spindle in the case file.

 

(c)  If the POC is out of the office, the designated backup processes the claim form(s).

 

3.   Creating Physical Cases.  Case files are constructed from letter-size (8 1/2" x 11"), half-cut Kraft folders.  Each of the four terminal digits of the file number (i.e., the last four digits of the employee’s Social Security Number (SSN)) appears on a brightly-colored background label and is affixed to the outside edge of the folder.  The employee’s name and the file number are written either on the bottom right hand portion or sideways along the right side on the front of the folder.

 

a.   Forms.  New cases normally contain the following forms which are filed down, starting from the bottom, on a spindle:

 

(1)         Forms EE-1, EE-2, and/or document containing “words or claim” is filed down on the bottom of the spindle;

 

(2)  Form EE-3 is filed on top of the Forms EE-1, EE-2, and/or document containing “words or claim”; and

 

(3)  If a claim form (Forms EE-1/EE-2/document containing “words of claim”) for benefits already exists, the new claim form is placed directly after (i.e., on top of) the existing claim form(s).

 

b.   Documents.  Medical reports, letters, and other documents are filed down in chronological order on the spindle (or on several spindles, if needed due to size).  The date of a document is the date it was received (date-stamped) in the DEEOIC Office.

 

From the bottom to the top, the oldest documents are on the bottom and the newly received documents are on the top.  However, documents that still require action (e.g., the payment certification form) are not placed on the spindle until the action is completed.  Instead, they are clipped to the front of the case folder or inside on the left hand side of the file jacket.

 

c.   Voluminous Records.  When a great number of documents are received from a single source (e.g., hospital records, prior Part D records, or records from a Document Acquisition Request), they are placed on a separate spindle, as long as the records are clearly identified as belonging to a single identifiable source (See also EEOICPA PM 1-0400).

 

4.   Case Create Worksheet.  Once the Mail and File (M&F) staff construct a physical file for the new case (See paragraph 3 above), but before the Case Create Clerk (CCC) creates the new case in ECMS, a DEEOIC employee with experience in claims processing (hereafter referred to as “designated employee”), as designated by the District Director (DD) or the CE2 Unit Supervisory CE, reviews the claim to determine whether it is entered in ECMS as a Part B claim, a Part E claim, or both. 

 

The designated employee reviews the available claim information about the medical condition(s) and employment claimed.  Once the designated employee makes a determination as to the ECMS system(s) the claim is to be created in, he or she completes the Case Create Worksheet (See Exhibit 1), prints and signs his or her name (“Reviewer”), dates the worksheet, attaches it to the front of the folder, and forwards the case to the CCC for case creation.

 

a.   Part B Medical Condition.  If a claim identifies a Part B medical condition, the Part B medical condition is specified on the worksheet for entry in both ECMS B and ECMS E.

 

b.   Part E Medical Condition.  If a claim identifies a Part E covered illness only, the condition is specified for entry in ECMS E only. 

 

c.   Consideration of Employment.  In addition to considering the claimed medical condition(s), the designated employee considers the claimed employment when determining whether the case is created in ECMS B, ECMS E, or both. 

 

(1)  For claims filed at the RC, the RC verifies employment through the Oak Ridge Institute for Science and Education (ORISE) in ECMS (as described in paragraph 2 above) or clarifies the nature of the claimed employment.  Any attached employment verification documents and/or medical evidence, in conjunction with the claim forms, are reviewed by the designated employee to determine whether the claim belongs in ECMS B, ECMS E, or both.

 

(2)  If a claim identifies employment as a federal employee at a DOE facility and a Part B medical condition, the Part B medical condition is specified on the worksheet for entry in ECMS B only, because a DOE federal employee is not a covered DOE contractor employee under Part E.

 

(3)  If a claim identifies employment at an Atomic Weapons Employer (AWE) or a Beryllium (BE) Vendor and a Part B medical condition, the Part B medical condition is specified on the worksheet for entry in ECMS B only, because employment at an AWE or BE Vendor is not covered employment under Part E.  The exception to this is if it is indicated that the employee worked at an AWE or BE Vendor that was designated as a DOE facility for remediation

 

(a)  If appropriate, the assigned CE or CE2 of the case (not the designated employee) conducts additional employment development to determine if the latter situation holds true.  If the latter does hold true, the assigned CE or CE2 prepares a memorandum and forwards it, along with the case file, to his or her Supervisory CE for signature requesting from the Chief of Operations that the claim be created in ECMS E.  Once approved, the assigned CE or CE2 forwards the case file and signed memorandum to the CCC for case creation in ECMS E.

 

(4)  If a claim identifies a Part E medical condition and employment at an AWE or a BE Vendor with no indication of the site being designated as a DOE facility for remediation, the Part E medical condition is specified on the worksheet for entry in ECMS B only, because to establish covered employment under Part E, the employee had to have been a DOE contractor employee.

 

Example 1If only Part B medical conditions are checked on the claim form (e.g., Chronic Beryllium Disease, Beryllium Sensitivity, Chronic Silicosis, or Cancer) and DOE contractor employment is claimed, the designated employee checks Box 1a of the worksheet for data entry into both ECMS B and ECMS E.  

 

Example 2:  Some AWE and BE Vendor facilities are designated as DOE facilities during periods of remediation.  If the claimant from Example 1 instead claims employment with an AWE or BE Vendor during a period of remediation or identifies the AWE or BE Vendor as a DOE facility on the Form EE-3, the designated employee checks Box 1a of the worksheet for data entry into both ECMS Part B and Part E.  Additional development by the assigned CE or CE2 is required to establish covered employment under Part E.

 

Example 3:  To establish covered employment under Part E, the employee had to have been a DOE contractor employee.  If the claimant from Example 1 claims only employment as a DOE federal employee, the designated employee checks Box 2 of the worksheet for data entry into ECMS B only.

 

Example 4:  If a non-Part B medical condition (e.g., asbestosis) and DOE contractor employment are claimed, the designated employee checks Box 3 of the worksheet for data entry into ECMS E only.

 

Example 5:  To establish covered employment under Part E, the employee had to have been a DOE contractor employee.  If the claimant claims diabetes (a non-Part B medical condition) and employment with an AWE or BE Vendor during a period in which remediation did not occur or does not identify the AWE or BE Vendor as a DOE facility on the Form EE-3, the designated employee checks Box 2 of the worksheet for data entry into ECMS B only.

 

Example 6:  If an employee claims prostate cancer and DOE contractor employment, the designated employee checks Box 1a of the worksheet for data entry into both ECMS B and ECMS E.  If the same employee claims both prostate cancer and asbestosis, the designated employee checks Box 1b of the worksheet for data entry into both ECMS B and ECMS E.  In the space provided, the prostate cancer is identified as a Part B and Part E condition, while asbestosis is identified as a Part E condition only.

 

Example 7:  If a claimant identifies chronic silicosis on the Form EE-2, the designated employee checks Box 1a of the worksheet for data entry into both ECMS B and ECMS E, if and only if the claimant claims employment in underground tunnels in Nevada or Amchitka Island, Alaska.  If the claimant indicates another location, the designated employee checks Box 3 of the worksheet for data entry into ECMS E only.

 

Example 8:  For all new RECA 5 claims, the designated employee checks Box 1a of the worksheet, and the medical conditions are entered in both ECMS B and ECMS E. 

 

5.    Creating Cases in Energy Case Management System (ECMS).  The CCC creates new cases and adds them to the automated system. Any claim submitted by way of Forms EE-1, EE-2, or written document containing “words of claim” is created in ECMS.  The CCC reviews the claim forms (EE‑1/2 and EE‑3) and the Case Create Worksheet prior to case creation in ECMS.

 

a.   Social Security Number (SSN).  The database record for each case normally contains the employee’s SSN as the file number.  If the employee’s nine digit SSN is not listed on the claim form, a nine digit dummy SSN is used.  Therefore, new cases are created and numbered in ECMS by using the employee’s nine digit SSN or a nine digit dummy SSN, as appropriate.

 

(1)  Creating Dummy SSN.  The computer system assigns a dummy SSN when the claimant does not supply a SSN (the first three characters will be "000").  The CCC tabs through the SSN field and enters the claimant’s last name, first name, and middle initial.  The computer prompts "OK to create case file number."  When the CCC enters "yes," the computer system then generates a dummy SSN.

 

b.   When the Case Does Not Exist In ECMS.  If the employee’s SSN does not already exist in ECMS B or ECMS E (i.e., a new case that does not exist in ECMS at all) then the case is created by using the “Add Case” function under the “Function” option in ECMS and numbered using the employee’s nine digit SSN or a nine digit dummy SSN.

 

c.   When the Case Already Exists in ECMS.  If the employee’s SSN already exists in ECMS B only, a new claim is added to ECMS E through the “Open Case” function under the “File” option.  Conversely, if the employee’s SSN already exists in ECMS E only, a new claim is added to ECMS B through the “Open Case” function under the “File” option. 

 

The “Add Case” function under the “Function” option in ECMS is not used for this purpose.  

 

d.   Shared Data.  For the most part, ECMS B and ECMS E function the same way and allow for independent data entry into either system.  Most information on the first ECMS screen (“Case Update” screen) is shared between ECMS B and ECMS E.  Except for the “Claims” section at the bottom of the screen, information in the “Case Update” screen automatically transfers between the two systems without having to enter duplicate data into ECMS B and ECMS E.

 

The CCC enters information into the following shared fields/sections in ECMS:

 

(1)         CE

(2)         CE Assign Dt

(3)         Dist Office

(4)         Location

(5)         Location Assign Dt

(6)         Employee Name and Address

(7)         Employee Census Information

(8)         Employee Dependents

(9)         Employment Classifications

(10)    Work Sites

 

Phone messages and call-ups are also shared between ECMS B and ECMS E, but are not entered during case creation.

 

e.   ECMS Entry.  For case creation, the following ECMS data entry rules apply:

 

(1)  Worksite information is shared between ECMS B and ECMS E and can be viewed from either system.  The CCC enters the worksite information in the “Case Update” screen in either ECMS B or ECMS E.  In each line item of the “Work Site” section, the first column (“Pt Source”) indicates “B” or “E”.  If a “B” is shown, the employment information was entered in ECMS B and is automatically shared with ECMS E.  Conversely, if an “E” is shown, the employment information was entered in ECMS E and is automatically shared with ECMS B.

 

Since the employment is developed simultaneously for the Part B and Part E portions of the claim, the point of entry is from either system.  However, if a DEEOIC employee wants to update employment information, it is only done in the ECMS Part identified in the “Pt Source” column;

 

(a)  For Part B only cases, all worksite information (claimed/verified/non-verified) is entered directly into ECMS B.  If the worksite is not specifically identified in the ECMS “Worksite Desc Search” table field, the information is listed in the “Note” field.

 

(i)  The only exception is for RECA claims, where worksite data does not need to be entered into ECMS B.  The reason for this is that the worksite data is adjudicated by the Department of Justice, as determined under RECA section 5.

 

(b)  For Part E only cases, including RECA cases, all worksite information (claimed/verified/non-verified) is entered directly into ECMS E.  If the worksite is not specifically identified in the ECMS “Worksite Desc Search” table field, the information is listed in the “Note” field.  If multiple mines/mills are listed in the Form EE-3, they are entered in the “Note” field.

 

(2)  The file date is the earliest of either the postmark date on the envelope, the facsimile date on the transmittance (fax), or the received date stamp date from any RC or DEEOIC Office on the signed claim form or document containing “words of claim” (but not earlier than July 31, 2001 for Part B and not earlier than October 30, 2000 for Part E).  The postmarked envelope is kept with the claim form and filed down on the spindle in the case file.  The CCC enters the earliest discernable date as the claim’s file date in the “Filed Dt” field, under the “Claim Information” section, in the “Claim Update” screen of the applicable ECMS system(s); 

 

(a)  For a claim form transmitted electronically (e-mail), the file date is the date the claimant electronically sent the claim form to the DEEOIC-Form Receipt Mailbox (i.e, the date on the sent line of the claimant’s e-mail).  This is the same date that the e-mail is received in the DEEOIC-Form Receipt Mailbox.

 

(3)  The received date is the date in which any DEEOIC Office (DO, CE2 Unit, Final Adjudication Branch (FAB), or NO) receives a claim form or document containing “words of claim,” as identified by the DEEOIC Office’s received date stamp date.  The CCC enters the earliest discernable date as the claim’s received date in the “Rcvd Dt” field, under the “Claim Information” section, in the “Claim Update” screen of the applicable ECMS system(s);

 

(a)  When a claim is received electronically, the date on the sent line of the claimant’s e-mail is the received date.  The DEEOIC Office does not use the date in which the POC received the e-mail from BOTA.  The file date and received date of the electronically submitted claim form are the same.

 

(4)  The signature date is the date in which the claimant, claimant’s authorized representative, or a person acting on behalf of the claimant (e.g., a relative, guardian) signs the Forms EE-1, EE-2, or document containing “words of claim.”  The CCC enters this date as the claim’s signature date in the Signature Dt” field, under the “Claim Information” section, in the “Claim Update” screen of the applicable ECMS system(s);

 

(5)  The medical conditions are entered under the “Medical Conditions” section in the “Claim Update” screen of the applicable ECMS system(s), as identified in the completed Case Create Worksheet; and

 

(6)  The CCC also enters data under the “Other Claim Factors” and the “SECs” sections (both containing drop down menus) in the “Claim Update” screen of the applicable ECMS system(s), as identified on the Form EE-1 or EE-2.  In addition, the CCC enters data under the “Payees” section in the “Payee Update” screen of the applicable ECMS system(s), as identified on the Form EE-1 or EE-2.

 

f.   Multiple Claimants.  There are cases which contain multiple claimants, where one claimant files for a medical condition that is approved under Parts B and E (e.g., stomach cancer) and the other claimant files for a medical condition that is approved under Part E (e.g., asbestosis).  As long as eligibility has been established and there is an approved condition, a new claim is created in the other ECMS system for each eligible claimant, as appropriate, even when the claimant did not file a claim under that Part.  As long as there is an open (active) claim for that claimant, there is no need to request an additional claim for the approved condition, which was already claimed by another claimant in that same case.

 

g.   Case Create Worksheet.  Once the case is created in ECMS, the CCC prints and signs his or her name (“Case Creator”) and dates the worksheet, and then attaches it to the front of the case jacket.

 

h.   After Case Creation.  When a batch of cases has been created, the CCC notates on the front of each case file jacket the location for it to be sent within the DEEOIC Office and also enters the appropriate assigned CE and the Case Location Code under the “Case Information” section in the “Case Update” screen of ECMS (See EEOICPA PM 1-0400 and 1-0500 Exhibit 2).  The CCC then forwards the cases to a Workers’ Compensation Assistant/Customer Service Representative to send an acknowledgement letter to the claimant (See Exhibit 2).

 

6.   Duplicate Cases.  The automated system checks for duplicate cases.  Sometimes, duplicate cases are created when an incorrect SSN is used.  If this happens, the DD, ADD, Chief of Operations, or the CE2 Unit Supervisory CE is responsible for ensuring that both case files are merged appropriately and that all the ECMS coding in the case record to be deleted is entered in the correct case record prior to deletion.  The DD, ADD, Chief of Operations, or the CE2 Unit Supervisory CE must obtain authorization from NO to delete the duplicate case record from ECMS.  The DD, ADD, Chief of Operations, or the CE2 Unit Supervisory CE prepares a memorandum to the Branch Chief of the Automated Data Processing Systems and the Branch Chief of Policy, requesting the authority to merge/resolve the two cases in ECMS and that the payment records for compensation and medical bills be reconciled. 

 

When there is a duplicate case, the case deleted is usually the one with the most recent “Rcvd Dt” in ECMS.  However, if all compensation and bill payments were made in the later case, then the earlier case is deleted.  All the documents from both case files are retained to show the date of first filing and the adjudicatory actions taken thereafter.  The following steps are taken after the duplicate record is deleted from the automated system:

 

a.   Notation on Case Jacket.  The M&F Clerk writes "Duplicate of 000-00-0000" (the file number of the other case) on the outside of the duplicate case file jacket;

 

b.   Forms.  In the upper right corner, the M&F Clerk re-numbers all documents with the file number of the case that is retained.  These documents are then combined with the retained case file; and

 

c.   Advising the Claimant.  The assigned CE or CE2 advises the claimant by letter that the duplicate case was created in error and that only the file number of the retained case is to be used.  However, if the claimant was never notified of the duplicate number, there is no need to send the letter.

 

7.   Claims Examiner Review.  Upon receipt of a new case, but prior to initial development and adjudication, the assigned CE or CE2 reviews the claim forms, any attached employment and/or medical evidence assembled at the RC, the employment verification and occupational history development conducted by the RC, the Case Create Worksheet, and ECMS to ensure the claim was entered in the correct ECMS system(s) and that the claim information was entered correctly.  After this review is complete, the assigned CE or CE2 attaches the Case Create Worksheet to the inside cover on the left side of the case jacket, and files down all associated claim file documents on the spindle in chronological order in the case file.

 

a.   Claim Entry into ECMS.  The assigned CE or CE2 must ensure that the claim is entered in the correct ECMS system(s).  If a claim is created in the wrong ECMS system, certain steps are followed to delete the incorrect entry (See paragraph 12 below).  If a claim was not created in one of the ECMS systems but needs to be, the assigned CE or CE2 returns the claim to the CCC for case creation (See paragraph 5 above). 

 

b.   Verification of Claimant/Employee Information.  The assigned CE or CE2 confirms that the claimant/employee information is correct in ECMS.  The assigned CE or CE2 checks the last name, first name, and middle initial of the employee/claimant in ECMS for accuracy.  The full middle name does not appear in ECMS unless the claim form is signed with the complete middle name.  The assigned CE or CE2 checks the gender, date of birth, and date of death (when applicable) in ECMS for accuracy.  The address and phone number of the claimant/employee are also checked for accuracy.

 

c.   Medical Conditions.  The assigned CE or CE2 must ensure that the medical conditions are entered in the correct ECMS system(s).  If a medical condition is incorrectly entered, or not entered at all, the assigned CE or CE2 updates the medical information in the correct ECMS system(s). 

 

d.   Initial Handling Conducted by the RC.  The assigned CE or CE2 reviews the employment verification and occupational history development materials provided by the RC.  The assigned CE or CE2 enters the claim status codes under the “Claim Status History” section in the “Claim Update” screen of ECMS, for each claimant, as appropriate, to reflect the actions taken by the RC.

 

(1)  The assigned CE or CE2 enters the “OR – ORISE Employment Evidence Received”, "ES – Employment Verification Sent to DOE”, and/or "CS – Request for Corporate Verification" claim status code(s), as appropriate.  The “Claim Status Dt” is the date in which the action was taken by the RC, as identified in their memorandum to the DO or CE2 Unit.

 

If the assigned CE or CE2 enters an “ES,” he or she also enters the appropriate reason code from the drop-down menu.  The drop down reason code indicates the specific DOE Operations Center the Form EE-5 was sent to (e.g., “AL5 – Albuquerque Operations Office (EE-5)”). 

 

(2)  If the employee’s OHQ has been completed, the assigned CE or CE2 enters the "DO – Development-Other" claim status code and selects the reason code "OH - Occupational History."  The “Claim Status Dt” for the “DO/OH” code is the date the occupational history interview was completed, as reported in the RC memorandum to the DO or CE2 Unit.

 

(a)  If a deficiency is identified or an additional interview is deemed necessary, the DO or CE2 Unit returns part of the package back to the RC.  The assigned CE or CE2 does not enter the “DO/OH” code in ECMS because the OHQ is not yet complete.  Instead, the assigned CE or CE2 enters the “RC – Resource Center” code and the drop down reason code “RK - Rework” or ”FW - Follow‑up”, respectively, as appropriate.  The “Claim Status Dt” is the date of the memorandum from the DO or CE2 Unit to the RC outlining the rework or follow-up task, as appropriate.

 

(b)  Upon return from the RC, the assigned CE or CE2 enters the “DO/OH” code in ECMS to correspond with the date on which the rework or follow-up occupational history development action occurred, as reported in another RC memorandum to the DO or CE2 Unit.

 

(3)  If the claim requires additional follow up action by the RC or development by the assigned CE or CE2, the assigned CE or CE2 enters a call up in ECMS notes, as a reminder.  The assigned CE or CE2 reviews the initial submission (and all subsequent submissions from the RC) and assigns additional tasks to the RC as necessary.

 

e.   Missing Information.  If a claim form or document with “words of claim” is missing vital information (e.g., a diagnosed condition, RECA information), the assigned CE or CE2 requests the omitted information from the claimant.  The assigned CE or CE2 lists the information that is required and explains the reason the request is being made.

 

8.   Claims for New Medical Conditions or New Survivors Before a Recommended Decision.  When a claimant submits a claim form for an additional covered occupational illness under Part B or a covered illness under Part E prior to the issuance of a Recommended Decision, the new filed claim is recorded in ECMS by updating the “Medical Conditions” section in the “Claim Update” screen.  When an additional survivor submits a claim for survivor benefits under Parts B and/or E prior to the issuance of a Recommended Decision, the new filed claim is created in ECMS and reviewed, as discussed in paragraphs 4, 5, and 7 above.

 

a.   Medical Evidence Only.  If the claimant submits medical evidence for an unclaimed condition (i.e., medical evidence indicating the presence of a covered occupational illness or covered illness) without a claim form or document with “words of claim” for the covered condition, then the DO or CE2 Unit contacts the claimant by telephone to explain the situation and sends a letter (with an attached claim form) asking the claimant to submit a new claim form. 

 

(1)  The DO or CE2 Unit only requests a new claim form and develops the evidence further, if it is apparent that eligibility is likely. 

 

(2)  The letter addresses the receipt of the new evidence and explains the need for a Form EE-1 or EE-2 to establish a new claim.  A claim form is not requested, however, when it is unlikely that the new medical evidence establishes a covered medical condition (e.g., evidence of a recurrence of a previously reported cancer or evidence of a noise-induced hearing loss). 

 

b.   Medical Evidence and “Words of Claim”.  A new claim form is not required if the claimant provides medical evidence of a new condition along with a signed written statement that he or she wants the medical condition to be considered (or other “words of claim”).  The assigned CE or CE2 develops and adjudicates the new claimed condition accordingly.

 

c.   Survivorship Evidence Only.  If a new survivor submits survivorship evidence (e.g., birth certificate, marriage certificate, school records) without a claim form, then the DO or CE2 Unit contacts the claimant by telephone to explain the situation and sends a letter (with an attached claim form) asking the claimant to submit a claim form.

 

(1)  The DO or CE2 Unit only requests a claim form and develops the evidence further if it is apparent that eligibility is likely. 

 

(2)  The letter addresses the receipt of the new evidence and explains the need for a Form EE-2 to establish a new claim. 

 

9.   New Claims Received in the DO During Case Review by FAB or NOThere are instances when an already created case file is under review with FAB (e.g., a review of the Recommended Decision) or NO (e.g., Reopening Request, policy question), and a claimant files a new medical condition or a new survivor files a claim.  The DO date-stamps the claim form(s) and any attached documentation upon receipt into their office.

 

a.   Case Review by FAB.  Sometimes instead of the claim form(s) being sent to the FAB (or CE2 Unit), it is inadvertently sent to the DO who issued the Recommended Decision.  In order to promote efficiency, the DO’s M&F Clerk sends an e-mail, with an attached scanned/imaged copy of the claim form(s) and any received documents, to the designated CE2 in the appropriate local FAB or to the NO CE2 Unit Supervisory CE, if the case is at the NO FAB. 

 

The request advises the CE2 that the attached new claim is being forwarded for case creation and appropriate development.  In the body (not the subject line) of the e-mail, the M&F Clerk lists the employee’s name, the claimant’s name (if different from the employee’s name), file number, the assigned FAB Representative, and the received date of the new claim.  The DD, FAB Branch Chief, and Chief of Operations are also included in a carbon copy of the e-mail.  This is followed up with the DO mailing (or hand delivering if located in the same building) the original claim form(s) and attached documents to the CE2.

 

(1)  Once the CE2 receives the e-mail from the M&F Clerk, the CE2 prints the attachments, date-stamps the documents, and advises the assigned FAB Representative to assign the case to him or her in ECMS. 

 

(2)  The FAB Representative assigns the case to the appropriate CE2 through the “Open Case” function under the “File” option in ECMS.  The FAB Representative then selects the appropriate CE2 in the drop down menu of the “CE2” field under the “FAB Co-located Development” section in the “Case Update” screen of ECMS.  Once the FAB Representative selects the appropriate CE2, he or she tabs over to the “CE Assign Dt” field, which automatically populates with the current date and time (this field can be manually inputted if needed). 

 

In addition, the FAB Representative keys the case file to the appropriate CE2 by entering the appropriate ECMS Case Location Code in the “Location” field (See EEOICPA PM 1-0500 Exhibit 2), tabs over to the “Location Assign Dt” field, which automatically populates with the current date and time (this field can be manually inputted if needed), and then clicks on the “Save” button.  The FAB Representative then advises the CE2 that the case has been assigned to him or her in ECMS. 

 

Both the FAB Representative and the CE2 are able to make entries into ECMS without having to transfer the case back and forth in the system.

 

(3)  For a new claimed medical condition, the CE2 enters the medical condition in the appropriate ECMS system(s), as discussed in paragraphs 4 and 5 above.

 

(4)  For a claim filed by a new survivor, the designated employee within the CE2 Unit completes the Case Create Worksheet (as described in paragraph 4 above) and forwards it, along with the claim form and any attached documentation, to the CCC to create the case in ECMS (See paragraph 5 above).

 

(5)  Once the CCC creates the case in ECMS, the claim documentation is returned to the CE2 who then reviews that information, in addition to the evidence in the case file, and develops the claim as appropriate.

 

(6)  Prior to the FAB transferring a case out of their office that the CE2 is assigned to in ECMS, the FAB Representative or the M&F Clerk clicks on the “Unassign CE2” button in the “Case Update” screen.

 

b.   Case Review by NO. When the DO receives a new claim on a case that is under review by the NO (e.g., Reopening Request, policy question), the M&F Clerk must advise the DD who in turn contacts the Unit Chief for Policies, Regulations and Procedures in NO to determine how to effectively handle the incoming claim.  This is determined on a case by case basis.

 

10.  Claims for New Medical Conditions After a Final Decision.  A claim form is required when a Final Decision has been issued and a claimant submits evidence of a new occupational illness under Part B or a covered illness under Part E.  A claimed medical condition is new only if it was not previously addressed in a Final Decision.  A new claim form is not needed for consequential conditions.  However, a signed written request to claim a consequential condition is required.  

 

a.   ECMS Entry.  The newly filed claim is recorded by the assigned CE or CE2 with the entry of the claim status code “RD- Reopened - Development Resumed” under the “Claim Status History” section in the “Claim Update” screen of ECMS B, ECMS E, or both, as appropriate.  The received date stamp, facsimile transmittance date (fax), or postmark date (whichever is the earliest discernable date) is entered as the “Claim Status Dt” in ECMS. 

 

b.   No Claim Form Received.  If the claimant only submits medical evidence for a new condition (e.g., medical evidence indicating the presence of an occupational illness or covered illness), then the DO or CE2 Unit sends a letter requesting that the claimant submit a new claim form.  Before the letter is sent, the assigned CE or CE2 initiates a phone call with the claimant to explain the situation and determine the claimant’s intention to pursue a new claim.  

 

(1)  The DO or CE2 Unit requests a new claim form and develops the evidence further, only if it appears that coverage is likely. 

 

(2)  The letter addresses the receipt of the new evidence and explains the need for a Form EE-1 or EE-2 to establish the new claim.  If it is unlikely, however, that the new medical evidence establishes a new covered medical condition, a claim form is not requested. 

 

c.   Words of Claim.  If a claimant submits a new claim form for a new condition or a signed written statement that he or she wants the medical condition to be considered (or other “words of claim”), the assigned CE or CE2 develops and adjudicates the new claim, regardless of whether or not it is likely that the condition is covered under the EEOICPA.

 

11.  Withdrawal of a Claim.  A claimant is able to withdraw his or her claim for benefits for any claimed condition(s), including wage loss or impairment, prior to the issuance of a Final Decision for the requested benefit(s).  All requests to withdraw a claim for benefits must be in writing, signed by either the claimant or his or her authorized representative, and specific in reference to what part(s) of the claim is to be withdrawn.  The assigned CE or CE2 codes the withdrawal request appropriately under the “Claim Status History” section in the “Claim Update” screen of ECMS system(s), with the “Claim Status Dt” being the earliest discernable received date of the withdrawal request letter.

 

12.  Deleting a Claim from ECMS.  If the assigned CE or CE2 determines that a claim (for deleting a case, follow the instructions in paragraph 6) was created in the wrong ECMS system or needs to be added to an ECMS system, the claim is returned to case create.  The assigned CE or CE2 writes a memo, in which his or her Supervisory CE reviews and signs, advising the Chief of Operations to delete or add a claim in a specific ECMS system. 

 

If a claim is added to an ECMS system, the memo provides the name of the claimant, the file number, the file date, the applicable ECMS system, and refers to the claim form for any additional information for the CCC to enter into ECMS. 

 

If a claim needs to be deleted in ECMS, the memo provides the name of the claimant, the file number, and the applicable ECMS system. 

 

The CCC initials and dates the memo once the claim has been deleted or added to an ECMS system.  The memo is filed down on the spindle in chronological order within the case file and returned to the assigned CE or CE2.

 

Example:  If a claim is for Part E only (e.g., asbestosis), but was entered in ECMS B and E, the B claim needs to be deleted.  The CCC deletes the claim information, not case information, in the incorrect version of ECMS.

 

Exhibit 1: Case Create Worksheet

Exhibit 2: Letter of Acknowledgement