TABLE OF CONTENTS

 

 

Paragraph and Subject                Page  Date   Trans. No.

 

Chapter 2-0100 Introduction

 

     Table of Contents. . . . . . .    i    01/10     10-07

  1  Purpose and Scope. . . . . . .    1    01/10     10-07

  2  Structure of Part 2. . . . . .    1    01/10     10-07

  3  Responsibilities of

       Claims Examiners . . . . . .    2    01/10     10-07

  4  Reference Materials for

       Claims Examiners . . . . . .    2    01/10     10-07


 

1.   Purpose and Scope.  Part 2 outlines the policies, guidelines and procedures for developing, adjudicating and managing claims under the EEOICPA.

 

This chapter describes the structure of EEOICPA PM Part 2 and the responsibilities of the Claims Examiner (CE) in administering the EEOICPA.  The reference materials listed at the end of this chapter are available to staff in each District Office (DO), Final Adjudication Branch (FAB) and National Office.

 

2.   Structure of Part 2

 

a.   General Topics.  The chapters in this section address intake of information at Resource Centers (2-0200) and initial development by CEs (2-0300).  PM 2-0400 addresses services provided by representatives. 

 

b.   Employment and Exposure.  The chapters in this section address the aspects of employment that must be established for coverage under the EEOICPA.  They include covered employment (2-0500), Special Exposure Cohort status (2-0600), and toxic substance exposure (2-0700). 

 

c.   Eligibility.  The first three chapters in this section address the medical aspects of entitlement.  They include a chapter on developing and weighing medical evidence (2-0800), a chapter describing the criteria for cancer and radiation claims (2-0900), and a chapter describing the criteria for non-cancerous conditions (2-1000).

 

The last two chapters in this group address entitlement under the Radiation Exposure Compensation Act (RECA) (2-1100) and requirements for establishing survivorship (2-1200).

 

d.   Entitlement.  These chapters address ratings for permanent impairment (2-1300), computing compensation payments for wage-loss (2-1400), and consequential injuries (2-1500). 

 

e.   Decisions and Hearings.   This section provides guidance on writing recommended decisions (2-1600), and is followed by two chapters about the work of the FAB.  The first (2-1700) addresses the procedures used by FAB, while the second (2-1800) focuses on the decisions FAB issues.  The final chapter in this group (2-1900) discusses reopening claims.

 

f.   Codes.  The last two chapters in Part 2 address coding under the Energy Case Management System (ECMS).  PM 2-2000 describes the codes used in overall case processing, while PM 2-2100 describes the codes used to track decisions made within the Program.

 

3.   Responsibilities of Claims Examiners.  The CE develops and adjudicates claims, provides courteous and timely responses to requests for information, initiates compensation payments and monitors assigned caseloads. 

 

a.   Processing Claims.  The CE is expected to exercise keen judgment, derived from experience, background, and acquired knowledge, tempered with compassion and common sense.  This involves the ability to assess evidence, identify pertinent issues, and make well-rationalized judgments.  Each case stands on its own merits and must be impartially judged based on the facts established in the case file.  The decision cannot be based on conjecture, speculation, or unwarranted presumption.

 

4.   Reference Materials for Claims Examiners.  Each DO has resources containing the following items including, but not limited to: 

 

a.   Energy Employees Occupational Illness Compensation Program Act (EEOICPA) of 2000, as amended, 42 U.S.C. § 7384 et seq.

 

b.   20 CFR Parts 1 and 30 (Regulations) – Claims for Compensation Under the Energy Employees Occupational Illness Compensation Program Act, issued December 29, 2006.

 

c.   Executive Order 13179, signed December 29, 2006.

 

d.   EEOICPA Procedure Manual.

 

e.   EEOICPA Bulletins, Circulars, Transmittals, and Program Memoranda.  The Policy Branch issues these documents.

 

f.   Dorland's Illustrated Medical Dictionary, W.B. Saunders Co.

 

g.   Guides to the Evaluation of Permanent Impairment, 5th Edition, American Medical Association.

 

h.   Current edition of The Merck Manual, Merck & Co.

 

i.   Current directory of the American Medical Association for each state within the DO's jurisdiction.

 

j.   Current ICD-9 coding manual.

 

k.   NIOSH regulations on dose reconstruction and probability of causation (42 CFR Parts 81 and 82, Guidelines for Determining the Probability of Causation and Methods for Radiation Dose Reconstruction Under the Employees Occupational Illness Compensation Program Act of 2000; Final Rules).

 

l.   The most recent DO accountability review report.

 

m.   Road map or atlas covering the DO’s geographical jurisdiction.

 

n.   The Federal Register publications listing covered facilities.

 

     o.   Resource Center procedure manual.

 

p.   User’s Guide for the Interactive RadioEpidemiological Program (NIOSH-IREP).

 

q.   Directory of Department of Energy records, contacts, and description of Department of Energy facilities.

 

     r.   Shared Drive maintained by the National Office.