Resource Center Outreach Effort

Impairment and Wage Loss

Frequently Asked Questions

Impairment

 

  1. What is an impairment award?

 

An impairment award is monetary compensation for the permanent loss of function of a body part or organ, due to an illness covered under the EEOICPA.

 

  1. Who is eligible for impairment benefits?

 

Employees who have received positive causation determinations under Part E of the EEOICPA.

 

  1. What proof do I need for DOL to establish impairment?

 

In general, impairment is a decreased function in a body part(s) or organ(s) established by medical evidence.  Impairment ratings are based on the evaluation of specific medical tests (i.e. pulmonary function tests, liver function tests, etc.) that can be done by any qualified physician.  In other words, medical evaluations necessary to evaluate the degree of loss of function of body parts that are affected by the covered condition. 

 

  1. What is considered when determining percentage of impairment?

 

DOL considers the following:

·         Loss of function (whole person) as a result of a covered illness

·         Standards applied from the American Medical Association’s (AMA’s) Guides to Evaluation of Permanent Impairment, Fifth Edition

·         Whether the condition has reached maximum medical improvement (MMI), i.e. well stabilized and unlikely to improve with treatment.  DOL will award impairment ratings for chronic conditions without the need for those claimants to wait for a recovery that is unlikely to occur.

 

  1. How is impairment compensation calculated?

 

Each one percent of impairment=$2500

Example:  3% impairment rating = $7500 award

 

  1. How do I apply for impairment benefits?

 

You apply for benefits by providing a written, signed statement to DOL that you wish to claim impairment benefits.  No particular form is needed. 

 

  1. How does DOL determine impairment?

 

DOL determines impairment ratings based upon a physician’s evaluation.  The evaluation can be performed by a physician of the claimant’s choice.  DOL can arrange for a qualified physician to review the claimant’s medical records and make an impairment evaluation.  The claimant will not be sent to a physician for this review.  The physician will use the information provided by the claimant’s physician to determine the degree of impairment.  DOL can also seek an additional evaluation when necessary. 

 

8.  What requirements are necessary for a physician to be qualified?

 

The physician must hold a valid medical license and Board certification/eligibility in the appropriate field of expertise (i.e. toxicology, pulmonary, occupational medicine, etc.) to perform an evaluation. 

 

The physician must also show that he/she meets at least one of the following criteria:

 

·         certified by the American Board of Independent Medical Examiners (ABIME) and/or American Academy of Disability Evaluating Physicians (AADEP)

·         possesses knowledge and experience in using the AMA’s Guides  to conduct impairment ratings.

 

Wage Loss

 

9.  What are wage loss benefits?

 

Covered employees may receive compensation for wage loss if the loss was caused by a covered illness.  Wage loss compensation is payable for years of wage loss prior to regular Social Security Administration (SSA) retirement age (usually 65 years).  The wage loss can be total or partial.

 

10.  Who is eligible for wage loss benefits?

 

Claimants who have received positive causation determinations under Part E of the EEOICPA, and experienced wage loss prior to Social Security Administration regular retirement age as a result of the covered illness.

 

11.  What type of proof will I be required to submit to prove my wage loss?

 

In addition to medical evidence, various types of documentation may be submitted to establish earnings, such as: 

 

12.  What type of medical evidence is needed to support loss of wages?

 

·         Medical reports showing an inability to work

·         Physician’s office notes

·         Return-to-work slips

·         Physician’s signed statement explaining a relationship between covered illness and period(s) of wage loss

·         District medical consultant’s evaluation report

 

13.  How is wage loss compensation computed?

 

Covered employees may be eligible to receive compensation for wage loss for each qualifying year (prior to normal SSA retirement age) in which their earnings fell a specific percentage below their average annual earnings (AAW) for the 36-month period before they suffered a wage loss (not including periods of unemployment) as a result of the covered illness:

 

 

 

 

14.  What is considered when determining wage loss?

 

DOL considers the following:

·         When initial wage loss began

·         Dates of wage loss claimed

·         Number of years of wage loss prior to SSA retirement age

·         AAW amount prior to the first wage loss

 

15.  How do I apply for wage loss benefits?

 

If you have never claimed wage loss benefits, a written and signed statement that you wish to claim wage loss benefits is enough to establish a claim.  The statement should be sent to the District Office that handles your claim.  If you have already made an initial wage loss claim,  Form EE-10 is used to claim  additional calendar years of wage loss..

 

16.  How often can I apply for additional wage loss?

 

Additional wage loss claims can be filed on a yearly basis.

 

 17.  I am currently receiving SSA disability benefits due to a problem unrelated to my DOE work.  How will you determine if I have a wage loss due to my accepted illness?

 

Medical evidence that wage loss is related to a covered illness must be submitted in order for wage-loss benefits to be afforded.  Wage loss due to an unrelated condition that is not approved under Part E is not compensable. 

 

18.  Will employees whose onset of illness occurs after retirement be eligible for compensation based on wage loss?

 

They can be if they were unable to work due to the illness and the inability to work began prior to regular SS retirement age. 

 

19.  Are wage loss benefits available to survivors of covered employees?

 

Yes, in addition to the basic $125,000 survivor benefit, a survivor may receive additional compensation in increments of $25,000 based on the employee’s years of qualifying lost wages.  For example, if there are no qualifying lost wages, the survivor receives $125,000.  If the employee had qualifying wage loss for a period of time of at least 10 years but less than 20 years, the survivor will receive an additional $25,000, for a total of $150,000.  If the employee had at least 20 years of qualifying wage loss, the survivor will receive an additional $50,000 for a total of $175,000.

 

 20.   If an employee dies before retirement age, do those years qualify in determining additional    survivor benefits?

 

DOL will presume that the deceased employee (in a Part E claim only) experienced qualifying wage loss for each calendar year after the calendar year of his or her death up to and including the calendar year when he or she would have reached his or her normal retirement age under the Social Security Act (SSA).