TABLE OF CONTENTS
Paragraph and Subject Page Date Trans. No.
Chapter 2-0200 Resource Centers
Table of Contents. . . . . . . . i 01/10 10-07
1 Purpose and Scope. . . . . . . . 1 01/10 10-07
2 Resource Center Functions. . . . 1 01/10 10-07
3 ECMS Usage in the Resource
Centers. . . . . . . . . . . . 4 01/10 10-07
4 Security, Privacy, Conflicts
of Interest. . . . . . . . . . 8 01/10 10-07
5 Employment Verification. . . . . 10 01/10 10-07
6 Occupational History
Development. . . . . . . . . . 17 01/10 10-07
7 Transfer of Cases. . . . . . . . 24 01/10 10-07
8 Part D/E Claim Files . . . . . . 26 01/10 10-07
9 Resource Center File
Retention. . . . . . . . . . . 27 01/10 10-07
10 Wage-Loss and Impairment
Outreach . . . . . . . . . . . 28 01/10 10-07
1 RC Checklist Cover Sheet . . . . 01/10 10-07
2 Occupational History
Interview. . . . . . . . . . . 01/10 10-07
3 Interview Confirmation
Letter. . . . . . . . . . . . 01/10 10-07
4 Impairment Telephone Script. . . 01/10 10-07
5 Wage Loss and Impairment
FAQs. . . . . . . . . . . . . 01/10 10-07
1. Purpose and Scope. This chapter describes the policies and procedures governing the Division of Energy Employees Occupational Illness Compensation (DEEOIC) Resource Centers (RCs).
2. Resource Center Functions. The RCs are situated in key geographic locations throughout the United States to provide assistance and information to the EEOICPA claimant community and other interested parties. The RCs gather substantial information and documentation, but they do not perform adjudicatory functions. The RCs provide claim development support and program outreach as well as initial claim intake.
The District Office (DO) retains all adjudicatory and most additional development functions. The RCs perform only certain initial development and limited follow-up tasks as specifically outlined in these procedures. The RCs are staffed and managed by contractor staff. Each RC has a manager, and each manager reports to the RC Contractor Project Manager, who in turn, reports to the DEEOIC RC Coordinator located at the National Office (NO). The RC Coordinator is responsible for supervising the activities of all RC staff, nationwide.
The RC role as it pertains to initial employment verification and occupational history development includes the following:
a. Claim Intake. Most new Forms EE-1/2 are filed directly with the RC located in the geographical area where the claimant(s) reside. Forms EE-1/2 received directly in the DO undergo employment verification at the DO and such claims are referred to the RC only if the DO determines that an Occupational History Questionnaire (OHQ) is required.
Regardless of place of receipt, the date of filing for a claim is the earliest discernible date stamp or postmark of a claim form or words of claim. Words of claim are any written statements received without a claim form that indicate a claimant’s intention to seek benefits under the EEOICPA.
Whether filing by telephone or in person, RC staff relays information about the program to the claimant. The RC explains the eligibility requirements, asks about conditions that the claimant has developed, and begins the process of gathering information for use in adjudication.
(1) Filing by Telephone. When a claimant files a claim telephonically with RCs but then either refuses or fails to sign an actual claim form, the RCs must proceed as follows:
(a) Two weeks after the call, the RC telephones the claimant, informing him or her that the claim form must be signed to complete the filing process, and then recording the contact in the Telephone Management System (TMS) Energy Case Management System.
(b) Two weeks after that initial follow-up call, the RC sends the claimant a letter telling him or her that the unsigned claim form will be forwarded to the DO assigned to adjudicate the claim, and places a copy of the letter in the case file, but that the DO Claims Examiner (CE) will administratively close the claim because of the lack of a signed claim form.
(c) The RC then prepares a memo to the file documenting the times, dates, and manner of the efforts made to get the form signed, and of the warning that the claim will be closed administratively.
b. Claim Status. Claim status requests regarding initial employment verification or occupational history development fall within the purview of the RC staff, who also field other claim status requests to assist claimants with general questions not requiring DO or Final Adjudication Branch (FAB) involvement.
The RC staff member reviews ECMS status codes and answers claimant inquiries, memorializing such activities into the TMS or Notes screen. If the claim status request is beyond the scope of the RC staff to address, the RC staff member determines the case file location in ECMS and directs the caller to the proper CE or FAB Hearing Representative (HR).
Inquiries received from a claimant or authorized representative seeking claim statuses are referred to the adjudicatory DO CE or the FAB HR as necessary. When referring a claimant or authorized representative to a DO or FAB, the RC provides the claimant/authorized representative with the toll-free number to the DO or FAB. All RC Managers have full read only access to ECMS in order to better assist claimants with inquiries. Any inquiries that cannot be addressed by the RC staff/Manager go to the CE or FAB HR, as appropriate.
c. Program Information. If a potential claimant calls for information and/or guidance and no claim is on file, the RC staff member informs the potential claimant of filing requirements and available benefits. No referral to a DO or FAB is necessary. As no claim exists in the system, a note memorializing the telephone conversation is not entered into ECMS.
Where a current claimant contacts the RC for guidance about the claims process (e.g., confirmation that a claim exists, questions about submitting new evidence or a new claim for benefits), the RC can provide guidance to the claimant as needed without referral to the DO or FAB. A TMS memorializing the telephone conversation is entered into ECMS
Also, RC staff may assist claimants in understanding the information being sought in DO development letters, explain the means by which such information may be obtained, and assist claimants in obtaining evidence. The RCs also assist claimants with medical bills/documentation and enroll/educate medical providers to join and navigate the automated medical bill pay system. A TMS memorializing the telephone conversation is entered into ECMS.
d. Initial Employment Verification. The RCs take initial employment verification steps for all new claims (Part B, E, and B/E) filed with the RC that are not covered under the Radiation Exposure Compensation Act (RECA). The DO conducts initial employment verification on claims filed directly with the DO (see section 5 below).
(1) Form EE-3 is the principal source for claimed employment information. However, if a claim is filed without a Form EE-3, the RC does not solicit it from the claimant. Rather, all claim materials are forwarded to the DO, where initial employment verification occurs.
(2) The RC uses DEEOIC tools, including procedures, bulletins, and employment verification updates and is given access to the DEEOIC Shared Drive to view these materials. The RC conducts initial employment verification on claims submitted by DOE contractor/subcontractor, Atomic Weapons Employer (AWE), and Beryllium Vendor (BV) employees for use in the adjudication of claims filed under EEOICPA.
e. Occupational History Questionnaire. RCs conduct occupational history development on all new Part E claims and some previously filed Part D/E claims, as discussed in section 6 below.
3. ECMS Usage in the Resource Centers. ECMS access is granted to the RCs to record claimant interaction and obtain claim status updates. Such interaction is recorded in ECMS Notes or ECMS TMS. RCs cannot input ECMS case status codes. Specific technical guidance regarding ECMS is provided in the ECMS User’s Reference Guide.
Some RC activity occurs prior to case creation in the DO, and ECMS data input is unavailable. RCs make ECMS entries only on created cases. Where the case is not yet created, the RC maintains a written account of all claim-related activity, including the date on which such activity took place. All pre-case create actions at the RC are recorded in the RC memorandum to the DO discussed in section 5 below.
a. ECMS Notes. The ECMS Notes field is used for all face-to-face contact with a claimant on a created case. For example, ECMS notes are used when a claimant appears at the RC to submit evidence or claim forms, to make an inquiry or raise a concern, or to complete the OHQ interview if the interview is done in person.
The RC staff member records the claimant’s visit in the notes field in ECMS, providing a synopsis of the conversation and a description of any evidence or new claim filed during the visit. The Notes entry outlines the interaction with the claimant, including instructions or guidance the RC provides to the claimant. The RC discusses only information on a specific claim with the claimant in question. Once a note is placed in the system, a hard copy is printed and forwarded to the appropriate DO or FAB for association with the case file.
When creating an ECMS notes entry, the RC selects ‘R - RESOURCE CENTER USE ONLY’ entry in the “Note Type” section in the upper left hand box of the screen.
b. TMS. The TMS feature in ECMS allows RC staff members to memorialize telephone conversations and to access telephone messages for calls received in the RC. TMS provides a mechanism to track and maintain telephone contacts on given case files.
RC staff members receive incoming telephone calls, return calls and place calls to claimants and others regarding questions and concerns arising out of the claims process.
(1) RCs receive various kinds of direct calls. Generally, incoming calls are from claimants (or their authorized representatives) seeking claim status or guidance, or from potential claimants seeking program information and guidance regarding the claims process.
(2) A RC staff member returns a telephone call received in the RC within two business days of receipt regardless of the issue at hand. All calls related to claims in ECMS are logged into the TMS and must be returned accordingly.
(3) Outgoing calls are those generated from the RC for a purpose other than returning a telephone call. The DO may request RC assistance in obtaining evidence from a claimant or conducting some additional follow-up on a case file. Many RC outgoing calls are generated in the course of conducting employment verification and occupational history development, and are memorialized in ECMS only on created cases.
c. Calls from Claimants. Each telephone call to or from a claimant must be accurately entered into ECMS in accordance with the specific instructions contained in the ECMS User’s Reference Guide and ECMS PM Chapter. If RC staff members conduct OHQ interviews (see below) by telephone, the OHQ interview must be memorialized in TMS in the same manner as the in-person interview.
The RC staff member handling the telephone call outlines the content of the discussion, the claimant request, if any, the guidance or solution offered, and the outcome of the call or resolution of the issue at hand. Entry of quality data is of the utmost importance, and the RC staff member strives to ensure accuracy and specificity of data input when telephone contact is noted in TMS.
As with ECMS notes, the RC prints a TMS record once completed. The printed TMS record is forwarded to the appropriate DO for association with the case file.
d. ECMS Entries. The RC ECMS user may change ECMS entries placed into the system by RC staff as needed to correct errors, or at the request of the RC manager upon his or her final review of claim file material before it is forwarded to the DO. However, the RC cannot delete ECMS entries, so RC staff and managers must ensure that the data entered into ECMS is of high quality and free of errors prior to saving the entries into the system.
Once an ECMS record is input at the RC level, only NO DEEOIC staff may remove it. No capability to add or alter ECMS claim status codes has been granted to the RCs, and all coding operations related to RC activity on a case (aside from activities related to input in TMS or ECMS Notes) are entered at the DO to correspond with the date of the activity, as noted on the RC memorandum that accompanies case file materials to the DO.
e. ECMS Security. Security measures govern access to the system due to the sensitive nature of the records available in ECMS and other claim file documents (e.g., employment history, payment information, disease history, Social Security Numbers, and addresses).
When a RC staff member is hired, and ECMS access is required for that individual, access must be granted. Conversely, when an RC staff member’s employment is terminated, that person’s ECMS access must be disabled.
(1) To give a new RC staff member ECMS access, the RC manager prepares a memorandum to the RC Contract Project Manager requesting such access and providing all pertinent employee information. The RC Contract Project Manager sends a memorandum to the DEEOIC RC Coordinator at NO, who reviews the request and advises Energy Technical Support of the need to grant access to an incoming RC employee.
(2) Upon termination or resignation of an employee, the RC Manager prepares a memorandum to the RC Contract Project Manager. The memorandum provides the former employee’s name, title, employee number, and all other necessary information, including the date of the employee’s termination or resignation. The memorandum requests that the former employee’s access to ECMS be terminated on a specified date (i.e., date of termination or resignation).
(3) The RC Contract Project Manager then prepares a memorandum notifying the DEEOIC RC Coordinator advising of the RC former employee’s scheduled departure. The DEEOIC RC Coordinator advises Energy Technical Support of the need to delete ECMS access to the outgoing RC former employee upon receipt of such notification.
4. Security, Privacy, Conflicts of Interest.
a. RC Staff Member with Interest in a Claim. A RC staff member may be a party to a claim under the EEOICPA or may have a personal or familial interest in the outcome of a claim.
(1) Resource Centers must avoid conflicts of interest in processing claims and should avoid even the appearance of impropriety in their work. Their staffs must work without any bias or influence that would affect their ability to render impartial service to the government in carrying out their duties.
Therefore, Resource Center staff cannot process claims or conduct either employment verifications or occupational histories for immediate family members (defined as spouses, children, siblings, grandparents, parents, or first or second cousins) or for any other individuals with whom they would have so close a relationship as to affect their judgment.
In such cases, the RC notifies the DEEOIC RC Coordinator at NO in writing via e-mail memorandum and refers those cases to the nearest alternate RC. After the conflict review process is completed, the RC manager prepares a memorandum to the alternate RC manager asking that the occupational history development or other task(s) be conducted and forwarded to the next nearest DO that does not have jurisdiction over the RC in question.
The RC assigned this development action has 14 calendar days upon the receipt of the assignment to complete all these activities and to report to the DO.
(2) When a RC staff member has a claim of his or her own, or when the situation meets the definition of a conflict of interest due to a relationship as defined above, the DO case file in question is transferred to the nearest DO for handling.
For instance, a claim involving an RC staff member working at an RC within the jurisdiction of the Denver DO is transferred to the Seattle DO for handling, and vice versa. Claims involving a staff member working at an RC within the jurisdiction of the Cleveland DO are transferred to the Jacksonville DO, and vice versa.
b. Security and Individual Privacy Concerns. When interacting with claimants and other interested parties (e.g., authorized representatives) RC staff must remain aware of individual privacy concerns and maintain compliance with Privacy Act mandates. Except as discussed below, RC staff members may not provide information about an individual claim for benefits, or any other personal information, to anyone other than the identified claimant or his or her authorized representative.
(1) For RC staff to release any information regarding a specific claim or claimant to an alleged authorized representative of that claimant, an authorization form signed by the claimant must be in the case file appointing such individual as the claimant’s authorized representative regarding his or her claim for benefits under the EEOICPA.
A claimant may authorize other third parties to receive claims information, but may not authorize multiple authorized representatives.
(2) Where information is sought that exceeds the RC’s ability to assist the claimant or authorized representative (e.g., specific development questions regarding the relationship between toxic substances and illness), the RC staff refers the matter to the proper DO CE or FAB HR, denoted in ECMS as the primary CE.
c. Multiple Worksites. In all instances involving multiple worksites, the RC closest to the residence of the claimant(s) performs the required development tasks. For instance, if employment is claimed at all three Gaseous Diffusion Plants, and the employee/claimant(s) reside in the Paducah, Kentucky area, the Paducah RC handles all required tasks with assistance from the other RCs as needed.
d. Multiple Claimant Locations. If claimants reside in different states and the claim as a whole can be better served by utilizing more than one RC, a RC will be assigned based upon the geographical locations of the claimants. In such cases the RC forwards documentation to the adjudicatory DO.
5. Employment Verification. Detailed guidance on Employment Verification is found in the PM Chapter covering this subject. Below is an overview of those employment verification tasks with associated resource center tasks.
a. Review of ECMS. When the RC is taking a claim and reviewing it for initial action (employment verification or OHQ), the RC reviews ECMS to determine whether a claim already exists in ECMS. If so, the RC contacts the adjudicatory DO CE for guidance as to whether employment or occupational history development is required. If documentation is present in the existing claim file to either confirm employment or document workplace exposure, the DO advises the RC accordingly and no action is needed by the RC. This is a case-by-case decision made by the DO.
b. Review of Case File. Upon receipt of a new claim, the RC staff member reviews the Forms EE-1/2, EE-3, and EE-4 and the DOE covered facility website to determine the type of facility claimed (e.g., DOE, BV, or AWE). The DOE website lists all major covered facilities, applicable time frames, a description of the site operations, and in certain instances, the names of the major contractors working at those facilities. This review also helps to determine the need for an OHQ, as AWE, BV and DOE (including DOE predecessor agency) federal employment is not covered under Part E and no interview is required.
(1) Claims submitted by AWE employees are excluded from Part E coverage unless their employment occurred during a time when the AWE was undergoing DOE remediation. DOE remediation periods can be ascertained by reviewing the DOE covered facility website, but the RC should seek DO guidance before conducting interviews about such claims.
(2) Claims filed by contractors or subcontractors of DOE or Section 5 RECA workers are always treated as Part E claims for the purposes of conducting an occupational history interview.
d. ORISE. If employment is claimed at a covered facility listed on the DOE website, the RC staff member determines whether employment can be verified through the Oak Ridge Institute for Science and Education (ORISE) database. This database, which is accessed via ECMS, contains employment information for over 400,000 employees who worked at certain facilities from the 1940s to the early 1990s.
Complete usage instructions regarding the ORISE database are discussed in the ECMS release notes dated April 6, 2005, version 22.214.171.124. Since ORISE is part of ECMS, the RC staff member obtains ORISE information by entering an employee’s Social Security Number or name.
Resource Center staff determines whether appropriate data may be found in ORISE by checking the Employment Pathways Overview Document (EPOD). If the facility description includes the statement, “ORISE – yes,” then RC staff first develops employment by accessing ORISE. If ORISE information is unavailable or inconclusive, additional development is pursued as outlined below.
In either case, the RC staff member prints the results found in ORISE as part of the evidence of file. If employment is listed at a facility not on the ORISE list, ORISE is not consulted for verification.
(1) If the ORISE matches claimed employment within six months, no additional development is required. The RC prints out the ORISE database query result, prepares a memorandum stating the date the ORISE action was taken, and forwards all available materials to the DO with an RC checklist (Exhibit 1).
If an OHQ is required on a Part E claim, the RC attempts to complete the OHQ to be forwarded with the RC checklist. The findings and associated memoranda are subject to CE review and can potentially serve as a basis for verifying and accepting claimed employment under the EEOICPA.
(2) If the claimed employment cannot be confirmed through ORISE, or is only partially confirmed, the RC prints the ORISE record and determines if other sources of employment verification are available as outlined through the Employment Pathways Overview Document as described in Chapter 2-0500.
e. The EE-5 Process/DOE POC. Employment under the EEOICPA is also verified using the EE-5 process. The EE-5 process is applicable to employment claimed at DOE facilities, including contractor and subcontractor employment, as well as Beryllium Vendor and Atomic Weapons Employer employees. The RC refers the EE-5 package according to instructions in the PM.
For those instances in which employment is claimed for which there is no applicable DOE operations office, the following steps are to be taken:
(1) Employment for which EPOD indicates that a corporate verifier is able to confirm employment. For those instances in which a corporate verifier has employment information, resource center staff prepares the appropriate correspondence to a corporate verifier. EPOD identifies the information needed by each specific corporate verifier in order for them to confirm employment. EPOD also contains the name and address for corporate verifier contact persons from whom verification should be requested.
(2) If EPOD does not provide any pathway for employment verification at a claimed facility, the RC center staff informs the claimant that DOE does not possess employment records for the facility claimed and no other knowledgeable source exists to verify employment. In writing or by telephone, the RC advises the claimant to submit further evidence in support of his or her claimed employment directly to the DO. If the claimant is the employee or a clearly eligible survivor, the RC also asks the claimant to sign Form SSA-581 so that the DO may request SSA records. The RC does not forward Form SSA-581 to SSA, but sends it to the DO with the employment verification packet. The RC does not mail this form to a claimant.
(4) The RC prepares a memorandum documenting the dates on which employment verification actions were taken for each claimant. The memorandum is forwarded to the DO within seven days of receipt of Form EE-1/2. The memorandum is accompanied by the Resource Center Claim Checklist (Exhibit 1) listing all materials enclosed and further actions required.
(5) Each adjudicatory DO District Director (DD) designates primary and alternate RC employment verification Points of Contact (POCs) and provides the RC with their names and contact information. The DD must immediately inform the RC if a POC is replaced.
(a) Duties. The DO employment verification POC serves as the primary contact for all responses regarding initial employment verification requests made by the RCs. The POC reviews all employment verification responses, consults ECMS to determine the CE handling the claim in question, and forwards all employment responses to the handling CE within one business day of receipt of the response in the DO.
(b) E-Mail Contact. Each POC has access to e-mail for use in verifying employment. The POC’s e-mail address is copied on all e-mail requests for verification (where such request is the desired method of inquiry) and the e-mail from the RC provides the POC’s name and contact information and requests that the employment verification response be forwarded to the attention of the POC.
(6) The RC prepares the claim package with the accompanying memorandum and checklist outlining the actions taken and forwards all documents to the adjudicatory DO. The RC includes a copy of the DOE Verification of Employment Memorandum, which serves to acknowledge that DOE has no employment information to provide.
(a) Later submissions to the DO do not require a formal memorandum, but should be accompanied by the Resource Center Claim Checklist. Any activity the RC took that needs to be captured by the DO in ECMS can be outlined either on the Checklist or on a separate sheet of paper.
(b) The RC manager verifies the contents of the referral package and signs the checklist. The RC manager is responsible for validating that the information in the referral package(s) reflects the RC actions taken and accurately reports the dates of all activities conducted.
(c) The DO sometimes grants extensions of time in the face of extenuating circumstances. When RC staff conduct large outreach events and take new claims, they cannot begin employment verification actions until they return to the RC. In this instance the RC may ask the DO for an extension of time. The RC manager e-mails the DO Employment Verification POC with all claim file information requesting an extension of time and outlining the reason behind the request.
f. SSA-581 and Other Evidence. The following evidence, while not exhaustive, may assist in evaluating the validity of a period of claimed employment. RC staff should use judgment to determine which of the listed items staff should request from claimants.
(1) Time and attendance forms; W-2 forms and other tax statements; wage and earnings statements; check stubs; correspondence from the employer addressed to the employee; notices of promotion, reassignment, layoff, etc; ID cards; minutes from employment related meetings; punch cards; sign in and out logs; security clearance applications; union records; letters and certificates of achievement or participation in a certain event.
(2) Also, Forms EE-4 (Employment Affidavit) from coworkers and others with firsthand knowledge may be acceptable to establish employment in conjunction with other evidence. The RC may assist the claimant in preparing Form EE-4, but only contacts employment verifiers as identified therein. The RC does not contact coworkers or other individuals or gather employment or other evidence on behalf of the claimant.
(3) If the claimant is a walk-in employee or a clearly eligible survivor, the RC asks the claimant to sign Form SSA-581 so that the DO may request SSA records for use as a tool in additional employment development. The RC does not forward Form SSA-581 to SSA, but sends it to the DO with the employment verification packet. The RC does not mail this form to a claimant.
g. SEC/Newly Designated SEC. The Secretary of the Department of Health and Human Services (HHS) has approved additional designations to the SEC class, and other designations are anticipated in the future. Many new SEC designations are/will be employment-specific and date-specific. HHS defines SEC inclusion specifically in many instances, and it will be necessary to identify a person’s job title, years of employment, place of employment, and other facts based upon the specific language defining the SEC.
Therefore, it is necessary to gather employment-specific information when verifying employment at these sites. The Policy Branch issues Bulletins outlining specific guidance for handling newly-designated SECs. The Policy Branch Chief ensures that the RCs receive all Bulletins related to SEC class inclusion.
Since Form EE-5 does not contain a section to list employment-specific information, the RCs use the cover letter to DOE for this purpose. In the DOE cover letter the RC requests specific duty station information to assist the DO when rendering determinations as to SEC class inclusion. The request is tailored to meet the exact definition of SEC employment as set out by HHS and defined in Bulletins issued by the Policy Branch.
6. Occupational History Development. In addition to initial employment verification, the RCs conduct initial occupational history development on Part E cases only regarding claims involving covered Part E employees and their eligible survivors. This is done in part by completion of the OHQ (Exhibit 2). There are two OHQs, one for RECA and one for non-RECA claims.
Whenever possible, this step occurs during claim intake at the RC, with the results forwarded to the DO within the seven day period in which the initial employment verification task is conducted. The RC may conduct the OHQ prior to receipt of the claim filing, but the OHQ is not to be sent to the DO until a signed claim form is received.
If no signed claim form is received, the RC returns the OHQ to the claimant with instructions to return to the RC with a signed claim form.
a. Time Frames. If the OHQ cannot be completed within the initial seven day period, the RC sends the claims package to the DO immediately upon completion of employment verification (within seven days of receipt of claim forms), and then conducts the occupational history development.
(1) The RC has a total of 14 calendar days from the date of receipt of the claim or receipt of the assignment from the DO to conclude the occupational history development steps.
(2) If all actions cannot be completed within that time frame, the RC advises the DO CE via e-mail of the reason for the delay and outlines a reasonable timeframe in which to finalize all necessary actions.
(3) If an additional seven calendar days elapse after the 14 calendar day due date, the RC telephones or e-mails the DO CE requesting a time extension and providing an action plan.
(4) As soon as the occupational history task is complete, and assuming that a signed claim form has been received, all documentation is immediately forwarded to the DO with a memo or Claim Checklist noting the date on which the interview(s) was conducted. The RC maintains a copy of all case file materials until the occupational history development process is complete.
(5) If the RC cannot conduct the OHQ within 30 days of receipt of assignment and/or filing of the claim, the RC suspends all activities and reports to the DO. No further action is taken. The DO CE sends a letter to the claimant requesting a response once all materials are received in the DO. Depending upon the claimant‘s response, the CE can assign the OHQ task to the RC.
b. Occupational History Development Not Conducted. Under the following circumstances, no OHQ development occurs:
(1) If beryllium illness or chronic silicosis is the only condition claimed, unless otherwise directed by the DO. In addition, no occupational history development is conducted where only ineligible survivors are claiming benefits. For a complete discussion of eligible survivors under Part E, see EEOICPA PM 2-1200.
In such instances, the claim file material is immediately forwarded to the DO upon completion of the employment verification portion, the DO reviews for necessity of further occupational history development, and assigns development tasks to the RC as needed.
(2) If benefits are approved under Part B, or a positive DOE physician panel finding exists that DOE accepted under the Part D program and the employee is a DOE contractor or subcontractor (not a federal employee) then the employee is also covered under Part E for those approved diagnosis. In all cases, the RC consults ECMS for the status of the Part B claim for acceptance and queries the DO for guidance if a question arises as to whether or not an occupational history development action is required.
(3) If the Department of Justice (DOJ) has accepted a RECA Section 5 claim, no occupational history development is necessary, unless the claim was filed by a survivor. All other RECA claims generally require independent adjudication and require an OHQ. Cancer claims submitted by Section 4 RECA claimants who do not wish to file with DOJ require an OHQ. See Chapter 2-1100 for details.
d. Occupational History Questionnaire and Interview. The main function of the RC staff member in his or her occupational history development role is to conduct the OHQ interview. In cases with multiple survivors, all claimants are interviewed, unless one or more claimants have been designated to represent all of the claimants with regard to the interview process.
(1) Sometimes one claimant will know more about possible worksite exposure, or be more comfortable with a formal interview process, than the others. In such instances, a simple signed statement by the other claimants designating a certain claimant to be interviewed in his or her stead will suffice.
(2) Such a signed statement is not a designation of an authorized representative, and is only used in the interview process. Where an authorized representative has been appointed on a claim file with multiple claimants, there is no need to designate a claimant to participate in the questionnaire process. Authorized representatives may determine how the questionnaire process will be conducted.
(3) Much of the information gathered through occupational history development is sensitive in nature and is subject to Privacy Act mandates. Accordingly, the information developed may not be disclosed to any individual unless he or she is an authorized representative of the claimant or an authorized DEEOIC representative (see EEOICPA PM 2-0400).
e. Timeliness Goals. An interview must be scheduled and completed within the timeframes stated in this document, and all reworks and follow-up interviews must be conducted within seven days of receipt in the RC as noted above.
To properly conduct the interview, the RC staff must understand the work performed by DOE employees. Knowledge of the types of hazardous materials potentially present at DOE sites, the covered illness resulting from claimed exposures, the standard length of exposure for the illness to occur, and the medical diagnosis required to verify the illness is also necessary.
The RC staff must also possess sufficient knowledge of the EEOICPA, the DOE and RECA sites, and hazardous materials to record sufficient, valid data in occupational history questionnaires as well as ECMS and TMS notes.
f. Proper Use of OHQ. DEEOIC developed the DOE and RECA occupational history questionnaires for use by the RC staff, who must properly use them to obtain the information DEEOIC requires to evaluate a claim for causation. This chapter deals solely with the DOE OHQ; for further guidance regarding the RECA OHQ, see EEOICPA PM 2-1100.
The interview may be conducted in person or by telephone. On created cases, all telephonic activity regarding occupational history development is captured in the ECMS TMS screen, while all in-person activity is placed in the ECMS Notes screen. All required ECMS coding is input at the DO once the occupational history development task is complete and all documentation is returned to the DO.
g. Use of Script. When conducting interviews, the RC adheres to the script prepared by the DEEOIC. It is of the utmost importance that all interviews follow the prepared script, but flexibility is allowed for follow-up questions that logically flow out of the results of the interview.
If the interviewee has little or incomplete knowledge about a particular subject, the RC notes such deficiencies so that the DO is aware that information-gathering efforts were made.
Each interview takes approximately two to three hours to complete. It is possible that multiple claimants will require an interview for one case file.
(1) Overall, the RC interviewer is responsible for the proper conduct of the interview and for producing a complete, comprehensive questionnaire, including correct grammar and spelling.
(2) The RC makes certain to comply with specific requests for information from the CE. For instance, if the CE wants specific exposure information regarding solvents (e.g., benzene exposure) the RC follows up with a line of questioning to satisfy the CE’s request.
(3) Once the interview is completed, the RC staff member gives the claimant the interview confirmation letter (Exhibit 3) verifying that the interview took place, and its date. A copy is sent with the OHQ for inclusion in the case file.
(4) All information is saved to the OHQ exactly as presented by the interviewee without alteration, duplication, or summarization by the RC interviewer, and the original paper version of the OHQ and a saved copy on a CD is forwarded to the appropriate DO within two days of completion.
(5) The RC interviewer in no way interprets the information presented by the interviewee. The OHQ is a stand-alone document and only the CE may interpret its meaning when using it as a development tool.
h. No RC Action Required. Neither initial employment verification nor occupational history development is undertaken where there is no eligible survivor under the statute. Where it is obvious that no eligible survivor exists (especially in the case of adult children under Part E) no additional RC action takes place.
(1) Since occupational history development is conducted exclusively on Part E claims, no action is necessary where Part E employment is not claimed or confirmed. If employment is claimed or confirmed at an AWE, a BV, or the employee is a DOE (or predecessor agency) federal employee, no occupational history interview is conducted.
(2) AWE contractors/subcontractors are not afforded coverage under the EEOICPA, and such claimed employment does not require occupational history development by the RC.
(3) The RC does not conduct initial employment verification on claims submitted by RECA claimants. However, occupational history development is necessary on most RECA claims and should be attempted upon receipt of Form EE-1/2 in the RC.
Since the DO must begin employment verification with the DOJ, all RECA claim forms are sent to the DO on the date of receipt in the RC for case create at the DO. Since the RECA claim forms are not held for seven calendar days, as in most other cases, whenever possible the RC attempts to conclude the occupational history development on the date of receipt of the RECA claim forms prior to shipment to the DO.
Where occupational history development cannot be completed at the RC on RECA claims upon the date of filing, the RC copies the RECA claim form documents and maintains a file at the RC while conducting occupational history development actions. In such instances the RC has 14 calendar days from the date the claim is received in the RC to conclude the occupational history development actions.
The RC prepares a list of all materials being submitted on a transmittal sheet outlining the material being sent, separated by the claim number. All such documentation is associated with the proper case file upon receipt in the DO.
i. Materials Destroyed. Once all employment verification and occupational history development actions are finalized and the CE confirms by telephone or e-mail that the DO does not require further assistance, the RC destroys its file copy.
j. Follow-Up or Reworks of Complete OHQs. Upon review of a completed OHQ, the DO may determine that additional information is required or identify an error that requires remedy.
(1) Follow-up interviews are conducted when the DO identifies additional issues through further development of the claim for causation that require RC assistance. The CE makes follow-up assignments directly to the RC manager with an accompanying memo outlining instructions as to the required additional development needed.
(2) Reworks arise when an error is found in the final product from the RC. Interview reworks are conducted only where the CE identifies a deficiency (i.e., incomplete or inaccurate data). Reworks must be approved by a CE and are forwarded to the RC manager by the DO DD with a memorandum outlining specific instructions as to the deficiency found and the required remedy.
(3) The RC must complete all follow-up and rework assignments from the DO within seven calendar days of receipt in the RC.
7. Transfer of Cases. Once all possible initial employment verification/occupational history development actions are complete, the RC sends all claim forms, associated documents, and the RC checklist to the DO with a memorandum outlining RC activities to that point.
Upon receipt of the initial submission, the case is created as set out in EEOICPA PM 1-0300. Once the case is created and the claim assigned to a CE, the CE reviews all claim file materials and employment verification/occupational history development materials for ECMS coding.
a. Codes. The CE inputs coding in ECMS to correspond with the date on which the action occurred at the RC.
b. CE Review. The CE reviews the initial submission to determine whether additional tasks are necessary at the RC level. As noted above, the DO may return any part of the package if a deficiency is identified or an additional interview is deemed necessary.
The CE uses the information obtained during the occupational development as a tool for establishing causation (based upon employment and the claimed covered illness) in the adjudication process. Also, the CE proceeds to develop the claim.
c. Receipt of Materials in the RC After Initial Seven Day Memo. Any such materials are sent to the DO with the occupational history development package if they cannot be included with the seven day memo submission. All other materials received at the RC after all development is concluded (including printouts of TMS and ECMS Notes records) are submitted without a memo or checklist.
d. Receipt of Material in the DO Prior to Case Create. In some cases the DO receives documentation from the RC prior to receipt/filing of a claim form. The DO maintains all such information in a dummy folder and retains it until the claim form is received. When the case is created, RC actions are coded to correspond with the day upon which they actually occurred, regardless of claim filing date. ECMS coding must reflect the true date a RC action was taken.
8. Part D/E Claim Files. In the past, Part D/E claims potentially required occupational history development at the RCs. The CE evaluates the older Part D/E claims on a case-by-case basis to determine whether a referral to the RC is needed.
a. Exposure Evidence. The CE examines the case file for the existence of DAR records, other DOE exposure records, and other employment records that might provide exposure evidence and eliminate the need for an OHQ.
Also, the CE consults the Site Exposure Matrices (SEM) in conjunction with the case file material to determine the need for further development by the RC. The CE must make the OHQ assignment to the RC unless he or she can establish the plausibility of exposure to a toxic substance by other means [e.g., the SEM, Document Acquisition Request (DAR) records, other employment evidence indicative of exposure].
(1) If the CE determines that an OHQ is required due to a lack of other exposure and employment evidence, an assignment to the RC is made. The RC has 14 calendar days from the date of receipt of the assignment from the DO to complete the occupational history development tasks outlined by the CE.
(2) The CE prepares a memorandum to the RC requesting that the OHQ be completed. The CE lists any specific information (e.g., toxic exposure, employment) that needs development. Any relevant case file material (e.g., claim forms, employment and exposure records) is attached for RC review. The CE includes precise instructions as to the information being sought. The Senior CE or Supervisor reviews the memorandum and approves the assignment before it is sent to the RC.
Upon receipt in the RC, the assignment is logged into ECMS Notes. Date of receipt in the RC is the first day of the 14 calendar day period.
(3) Once the CE identifies the need for an OHQ and tasks the RC with an assignment to conduct the interview, the DO sends a letter to the claimant. The letter advises the claimant that the interview is conducted on behalf of DOL, that it is different from any other prior interview the claimant may have given, and that it is intended to provide the claimant with a thorough and timely adjudication of his or her claim.
(4) The CE also “closes out” the OHQ assignment (or follow-up or rework) in this manner if the RC attempted to complete the OHQ, but was unsuccessful because the claimant could not be reached or refused to complete it. The status effective date in this situation is the date of the RC memo to the DO explaining why the OHQ could not be completed.
9. Resource Center File Retention. Depending upon the circumstances and the need for additional follow-up regarding a task described in this chapter, RCs retain or destroy file materials as necessary.
a. Office of Worker Advocacy (OWA) Files. There is no need to retain materials related to old OWA claim files. The RCs may destroy any OWA materials on hand.
b. Part D Files without Employment Verification (EV) or OHQ Information. This material is disseminated from the DOs as necessary based upon DO review and identified assignments to the RC. Any such material on hand at the RC can be destroyed unless it is being used in the process of a DO assignment. Once completion of the assignment is confirmed via the method outlined below, all materials are to be destroyed.
c. New Incoming Cases. Where only EV is conducted, the RC destroys case file material upon completion of the EV task and DO confirmation of receipt of all documents. Case file materials regarding Part E claims that require an OHQ are retained either until the OHQ process is complete and the DO confirms receipt of the transmitted materials, or in cases where the OHQ cannot be conducted, as described above.
d. DO Transmittal. Upon receipt of the EV/OHQ and/or all other pertinent documentation required of the RC, the DO checks off each item listed on the transmittal and then faxes the transmittal to the appropriate RC instructing it to destroy its case file materials. Upon receipt of the DO transmittal, all such materials are destroyed. The transmittal may be sent by the DD or any individual designated by the DD for such purpose.
e. Receipt of Documents in the NO or FAB. If NO or FAB receives a Resource Center transmittal containing information for association to a case file at NO or FAB, the Policy Analyst/Hearing Representative/CE (or designee at the discretion of management) confirms receipt via fax to the appropriate RC, instructs the RC to destroy their copy of the transmitted material, and associates the materials to the case file. The faxed instruction sheet is also placed in the case file for record keeping purposes.
If NO or FAB receives a transmittal from a Resource Center, but the case file is no longer at NO or FAB, the Policy Analyst/Hearing Representative/CE (or designee at the discretion of management) immediately forwards the materials and transmittal sheet to the appropriate DO. When the DO receives the transmittal, the DO follows the instructions above.
10. Wage-Loss and Impairment Outreach. Due to the complex nature of the Part E benefit structure and the requirements necessary to qualify for lump-sum compensation, selected Resource Centers (RCs) have been tasked to engage in an outreach effort to educate claimants on the requirements of filing for and obtaining impairment and/or wage-loss benefits.
a. Outreach. To facilitate communication with eligible claimants who are also the covered employee or worker (hereafter referred to as employees) certain DEEOIC RCs are assigned responsibility for contacting identified employees by telephone to explain the benefit provisions available under Part E. Assignments are as follows:
Jacksonville DO and FAB
Savannah River RC
Cleveland DO and FAB
Denver DO and FAB
Seattle DO and FAB
b. RC Referral. There are two types of Part E cases that are to be identified and referred to the designated Resource Center (RC) to initiate employee communication:
1. Cases at the Final Adjudication Branch where a positive Final Decision has been issued to a living employee and there has not been a prior claim for impairment and/or wage-loss.
2. Cases at the District Office where a positive Final Decision has been issued to a living employee and initial development is underway for impairment and/or wage-loss.
c. Referral from FAB. For Part E cases at the Final Adjudication Branch, when a final decision is issued to a living employee with a positive causation determination, a copy is to be prepared and forwarded to the designated RC. This should be done only in situations where there is no indication that a claim has been made for impairment and/or wage-loss. Decisions that pertain strictly to survivors of a deceased employee are not to be referred to the RC, but processed in the normal fashion. The Washington, DC FAB sends final decisions that meet these guidelines to the appropriate RC, based on which DO issued the recommended decision on Part E.
d. Development. For any case at the DO that contains a final decision with a positive finding on causation issued to a living employee and where there has been no claim for impairment and/or wage-loss, an initial development letter for impairment and/or wage-loss benefits is completed and sent to the employee with a copy of the letter sent to the assigned RC. An example of an initial development letter for impairment benefits is included in EEOICPA PM 2-1300. Examples of the initial development letters for wage loss benefits are included in EEOICPA PM 2-1400.
e. Records. Upon receipt of a final decision or a development letter in the RC, the RC should take appropriate action to record its receipt. The RC is responsible for ensuring that an appropriate system for recordkeeping is developed to track referrals, and subsequent actions in accordance with the guidance provided here. The RC uses a spreadsheet to record the date the final decision or development letter(s) was received in the RC, the employee’s name, claim number, the date outreach was completed and whether or not the employee intends to pursue impairment and/or wage-loss. In addition, the RC will also report on the disposition of all referrals on a weekly basis to the DEEOIC RC Coordinator. This data should be incorporated into the routine weekly RC activity report already generated by the RC manager.
f. Contacting the Claimant. The RC staff should carefully review Procedure Manual Chapters 2-1300 and 2-1400, which explain the eligibility requirements for compensation benefits and the procedures DEEOIC follows for developing impairment and wage-loss benefit claims. For each referral, the RC initiates a telephone call to the employee identified. It is necessary for the RC to access ECMS to obtain contact information for the employee. The purpose of this call is to provide information about the potential impairment and/or wage-loss benefits available, respond to questions, and solicit claims.
A script (Exhibit 4) has been developed for use by the RC staff in explaining impairment and/or wage-loss benefits to the employee at a general level. It is important the RC staff adhere to the script. Given the complexity of the benefit structure under Part E, it is likely that the employee will have questions. The RC staff may respond to general follow-up questions; for example, eligibility requirements or program procedures to develop a claim for impairment and/or wage-loss benefits. To help the RCs anticipate and answer some of the most common questions regarding impairment and wage-loss benefits, DEEOIC has developed a Q & A Sheet (Exhibit 5) for use by the RCs.
Claim-specific questions or questions that exceed the RC’s ability to assist the employee must be referred to the assigned CE or FAB hearing representative/claims examiner, per ECMS. No attempt should be made by the RC representative to offer opinion or conjecture as to the likelihood of entitlement. All adjudicatory functions are solely the responsibility of the assigned CE.
g. Statement from the Claimant. During the telephone call, if the employee expresses the intention to pursue impairment and/or wage-loss benefits or in cases where the RC staff member believes the employee may qualify for these benefits, the RC advises the employee to submit a signed statement or letter to the appropriate DO stating his or her intention to pursue benefits.
h. Claimant Information. In cases where the employee expresses the intention to pursue impairment and/or wage- loss benefits, the RC must also mail the brochures titled “How Do I Qualify for an Impairment Award” (available on the DEEOIC website at http://www.dol.gov/esa/owcp/energy/regs/compliance/brochure/ESA_how_do_I_qualify.pdf) and/or “Wage-Loss Benefits” (available at the DEEOIC website at http://www.dol.gov/esa/owcp/energy/regs/compliance/brochure/ESA_wage_loss.pdf) with an appropriate cover letter to the employee. These brochures were developed to explain these two types of benefits and the requirements that must be met to qualify for benefits.
i. TMS. All discussions with the employee about wage-loss and/or impairment is memorialized into the ECMS via the TMS screen. In general, each TMS entry contains a synopsis outline of the discussion; the employee’s question or request, if any; the guidance or solution offered; and a notation as to whether the employee intends to pursue impairment and/or wage-loss. The TMS screen is printed and the paper record of the activity is forwarded to the appropriate DO/FAB daily for association with the case file.
j. Special Instructions for Terminal Claimants. Designated RCs are responsible for immediately notifying via email the DO POC and the assigned CE or FAB HR (as denoted in ECMS), on any case needing prioritization, such as a terminally ill employee who wants to claim impairment and/or wage-loss. The designated DO POC is the same individual who handles the RC employment verification process. The RC staff member still submits the printed copy of the telephone contact in TMS to the appropriate DO/FAB for association with the case file. For easier identification, these TMS records must be marked “Priority” on top of the page.
k. Follow Up with the Claimant. The designated RC has seven calendar days from the RC’s receipt of the employee’s final decision or initial development letter(s) to initiate telephone contact. In cases where the RC is unable to contact the employee within seven calendar days, the RC continues to follow up with the employee and documents the contact attempts in TMS until contact is successful or the RC makes a reasonable determination that further attempts will not be productive. The RC representative may use his or her discretion to determine when to cease further contact attempts with the employee, but as a general rule, after three recorded attempts in as many days has failed to garner employee contact, the RC may cease outreach effort.
l. Disposing of the Decision. The RC is to shred the final decision and/or development letter after the employee has been successfully contacted or after the RC has ceased outreach effort with the employee.