TABLE OF CONTENTS

 

Paragraph and Subject                Page  Date   Trans. No.

 

Chapter 2-0300 Initial Development

 

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

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

2         Resource Center Actions. . . . .  1    01/10    10-07

3         Review by the District Office

       for Potential Development. . .  1    01/10    10-07

  4  Reviewing a New Claim. . . . . .  1    01/10    10-07

  5  Sources of Evidence. . . . . . .  4    01/10    10-07

  6  Advising the Claimant of

       Deficient Evidence . . . . . .  6    01/10    10-07

  7  Requesting Evidence by

 Telephone . . . . . . . . . . .  7    01/10    10-07

  8  Initial Exposure

Development. . . . . . . . . . .  7    01/10    10-07

  9  Former Part D Claims . . . . . .  8    01/10    10-07

 10  Positive DOE Panels. . . . . . .  11   01/10    10-07

 11  Reviewing Part B/E Claims. . . .  12   01/10    10-07

 12  DOE Former Worker Program. . . .  14   01/10    10-07

 13  Terminally Ill Claimants . . . .  17   01/10    10-07

 

Exhibit

 

  1  DOL Letter to DOE Former

  Worker Program . . . . . . . .       01/10    10-07

 


1.   Purpose and Scope.  This chapter explains the procedures to be used by the Claims Examiner (CE) for the review and initial development of a Part B claim, a Part E claim, a Part B/E claim, and for a Part D claim that has been developed by the Department of Energy (DOE), after receipt by the designated District Office (DO) and entry in the Energy Case Management System (ECMS).

 

2.   Resource Center Actions.  Resource Center (RC) staff conduct initial employment verification on most non-Radiation Exposure Compensation Act (RECA) claims filed with the RC and occupational history interviews on all new Part E claims with covered employment and eligible survivors.  The DO conducts initial employment verification only on claims filed directly with the DO.  However, the CE closely reviews all initial development actions taken at the RC and determines what additional and follow-up measures are necessary.

 

3.   Review by the District Office for Potential Development.  Regardless of the type of claim (i.e., B only, E only, B and E, or a Part D claim developed by the DOE), the CE first reviews the claim to determine what development is required to issue a recommended decision.  Key items the CE needs to review to determine whether sufficient evidence exists are listed below.  These three factors are applied differently for each claim type.

 

     a.   Medical Condition(s).

 

b.   Employment History.  Information provided by the RC will assist the CE in determining what additional development is required.

 

c.   Survivorship Eligibility, When Appropriate.  This excludes employee claims and RECA claims for Part B only.

 

4.   Reviewing a New Claim.  The initial review takes place upon the DO’s receipt of the new claim from Mail and Files (see EEOICPA PM 1-0200). The CE reviews the claim as a whole, weighing employment, medical, and survivorship eligibility to properly categorize the claim and determine what development is required.  The information contained in the RC packet assists the CE in planning additional development.

 

When a deficiency in the evidence is identified, the CE must notify the claimant and request evidence needed to resolve the deficiency.  The CE may also assist the claimant with his or her claim by requesting evidence from other sources.

 

a.   Medical Development.  The CE reviews the claimed medical condition(s) on Forms(s) EE-1/2 and the completed Case Create Worksheet to determine whether the claim is applicable under Part B, Part E, or both.  Refer to Chapter 2-0900 covered occupational illnesses under Part B and to Chapter 2-1000 for covered illnesses under Part E.

 

For example, the claimed condition of prostate cancer is applicable under both Part B and Part E but the claimed condition of asbestosis is applicable only under Part E.

 

(1)  The CE must ensure that the condition claimed is covered under Part B, Part E, or both, based upon the claimed employment and the different criteria used to determine covered employment under each Part.

 

(2)  The CE develops the medical condition(s), as needed, in accordance with EEOICPA PM 2-0800, Developing and Weighing Medical Evidence.

 

b.   Employment Development.  At the same time, the CE reviews Form EE-3 and any employment verification request forms or evidence received from the RC to determine whether the claimed employment is applicable under Part B, Part E, or both.

 

(1)  Under Part B, the applicable facility types include DOE, atomic weapons employers (AWE), beryllium vendors (BV), and RECA mines or mills.  AWE subcontractors are not covered under Part B or Part E.

 

(2)  Under Part E, the only applicable facility type is DOE or a covered RECA Section 5 facility.  Only DOE contractors/ subcontractors are covered; federal DOE employees at such sites are not covered Part E employees.

 

AWE and BV employees are not covered under Part E.  However, if employment is claimed at an AWE or BV during a time in which such facility was designated a DOE facility for remediation, the case file is forwarded to the National Office (NO) for review.  EEOCIPA PM 2-0500 discusses DOE remediation in detail.

 

(3)  The CE looks at the claimed facility types(s) (i.e., DOE, AWE, BV, and covered RECA mines or mills), time period(s), job title(s), and ORISE printouts, if available.  The CE then determines whether the claimed employment is applicable under Part B, Part E, or both, and then develops any employment evidence needed.

 

c.   Eligible Survivor Development.  When Form(s)EE-2 is received, the CE reviews the claim and determines whether all eligible survivors have been accounted for and given the opportunity to apply for survivor benefits.  Also, the CE reviews the claim for sufficient evidence to support the relationship between the survivor and the employee.

 

(1)  Under Part B, the eligible survivors are the surviving spouse, children, parents, grandchildren, or grandparents at the time of payment.

 

(2)  Under Part E, the eligible survivors are the surviving spouse and certain eligible children at the time of the employee’s death (see EEOICPA PM 2-1200).

 

The RCs do not develop for employment or occupational history if it is clear that no eligible survivor exists (which occurs primarily in cases involving adult children under Part E).  The CE must review the evidence of record to confirm the absence of an eligible survivor before issuing a recommended decision based upon RC determination, because the RCs do not perform any adjudication functions.

 

d.   Verifying ECMS Accuracy. After reviewing the claim, the CE reviews the New Claims Review Checklist and ECMS to ensure that the claim was entered correctly in ECMS (see EEOICPA PM 2-2000).

 

5.   Sources of Evidence.  Decisions are based on the written evidence of record.  Evidence may include (but is not limited to) forms, reports, letters, notes, personal statements, and affidavits.  Most of the evidence required under the EEOICPA may be obtained from the following sources:

 

a.   Claimant.  Any claimant filing for benefits under the Act is responsible for submitting the necessary evidence required for the Office of Workers’ Compensation Programs (OWCP) to adjudicate the claim.

 

b.   Department of Energy (DOE).  The DOE, a federal agency, had contractual arrangements with employees, contractors, subcontractors, AWEs and BVs with respect to the United States Atomic Weapons Program.  The Act requires DOE to provide the Department of Labor (DOL) with information relevant to EEOICPA claims.  The DOE conducts medical screening of former DOE facility employees through its Former Worker Program (FWP).  The procedures for obtaining employee-specific FWP records are set forth in Paragraph 12 of this Chapter.

 

c.   Corporate Verifiers.  While it produced atomic weapons, the DOE maintained relationships with a wide variety of external entities such as contractors and subcontractors, BVs and AWEs.  The CE may need to contact these entities to obtain information about a claim for compensation.

 

d.   Oak Ridge Institute for Science and Education (ORISE).  Oak Ridge maintains the ORISE database, which may be accessed via the Internet.  The ORISE database, which contains information for over 400,000 employees from the 1940s until the early 1990s, is an effective source for verifying employment for individual claims.  ORISE is accessible via ECMS, and the initial ORISE search is generally conducted at the RC when a claim is filed.

 

e.   The National Institute for Occupational Safety and Health (NIOSH).  NIOSH is an agency within the Department of Health and Human Services (HHS) that is responsible for estimating the radiation exposure to DOE employees, contractors, subcontractors and AWE employees during the production of atomic weapons.

 

NIOSH researches site information for covered facilities and sends dose reconstruction reports to EEOICPA DOs.  The DOs use the dose reconstruction reports to determine the probability of causation between a claimed cancer and exposure at a covered facility, based on the criteria established by NIOSH.

 

f.   Medical Sources.  These sources include reports from doctors and hospitals providing examination and/or treatment to covered employees.  By signing Form EE-1 or EE-2, the claimant authorizes OWCP to collect medical documentation pertinent to his or her case.

 

g.   Center for Construction Research and Training.  The Center for Construction Research and Training is a research, development, and training arm of the Building and Construction Trades Department (BCTD) of the AFL-CIO.

 

CPWR has direct access to 15 building and construction trade international unions, signatory contractors, and union health, welfare and pension funds.  CPWR also has access to employment records, union rosters, and dispatch records.

 

CPWR researches and provides employment information for construction and trade worker claims where DOL has been unable to obtain reliable information from other resources (e.g., DOE, corporate verifiers).

 

h.   Site Exposure Matrices (SEM)The SEM database may be accessed via the Internet.  SEM is a source for obtaining evidence of potential exposures to toxic substances at many DOE facilities.

 

i.   Other Sources.  The OWCP may receive evidence from other sources, such as individuals completing employment affidavits, claimant representatives, and other state and federal agencies.

 

6.   Advising the Claimant of Deficient Evidence.  When the CE determines that additional development is required, the claimant must be advised of the deficiency and afforded an opportunity to respond.

 

a.   Initial 30-day Period.  If the CE identifies a deficiency in the evidence that requires development, a letter is prepared which describes the deficiency and additional information necessary to overcome it.  The CE thoroughly reviews the evidence in the file before writing the letter and tailors the letter to the individual case.  Often 30 days will be sufficient time to allow for submission of additional evidence.

 

For example:  If a claimant submits a claim for a non-covered condition and the evidence does not support a covered condition under the EEOICPA, the CE advises the claimant that a covered condition has not been claimed and that he or she is allowed 30 days to claim such a condition and to provide supporting medical evidence.  [If the claimant does not claim a covered condition and does not provide supporting evidence, the CE proceeds with a Recommended Decision for denial.]

 

b.   Final Notice.  If the claimant fails to submit the requested evidence within a 30-day period, in most instances the CE sends a follow-up letter advising the claimant that OWCP has not received the requested evidence and that he or she will be provided with additional time to submit the evidence.

 

For example:  If a covered condition is claimed, but the file is lacking medical documentation, the CE allows a reasonable period of time for submission of the appropriate evidence.  In cases such as this, the CE makes at least two requests for medical documentation.

 

c.   Setting Deadlines.  As the EEOICPA is non-adversarial, the CE uses care when setting deadlines.  The information requested is not always easily obtained because most employees were exposed many years ago.  Thus the CE must be as flexible as possible and advise the claimant that additional time will be granted if the claimant requests a reasonable extension of time. 

 

7.   Requesting Evidence by Telephone.  The CE may also use the telephone to gather evidence.  Person-to-person contact often succeeds in obtaining information, addressing specific concerns, and defusing contentious situations.  Any use of the telephone is to be conducted in a professional and courteous manner.

 

a.   Documenting Phone Calls.  CEs document each call in the Telephone Management System (TMS) in ECMS and place a copy of the automated telephone record in the case file.  It is vital to enter a call summary into the TMS right after the call, while the information is still fresh in the CE’s mind.  For more information on TMS, see EEOICPA PM 0-0400.  

 

8.   Initial Exposure Development.  RC staff conduct occupational history interviews on most new Part E claims filed after August 1, 2005, and on certain Part D/E claims filed before that date.  In conjunction with this step, the CE queries the Site Exposure Matrix (SEM), and prepares the Document Acquisition Request (DAR) and forwards it to the proper DOE Operations Center or corporate verifier requesting exposure information to complement the RC findings.  A DAR is not always necessary; the CE completes a DAR request based upon what medical evidence and exposure documentation is already contained in the case file.   

 

a.   Occupational History Interview.  Exposure information is partially obtained through the occupational history interview conducted at the RC.  Two separate interview scripts (one for DOE employment, one for RECA) are available, and the findings outlined in these documents assist the CE in clarifying what further exposure development is needed as it relates to causation. 

 

     b.   Review of Evidence.  The CE reviews the claimed employment, exposure documentation, the SEM (see EEOICPA PM 2-0700), and the claimed condition to determine the proper course of development for causation. 

 

     c.   Assignment to RC.  The CE reviews all former Part D cases, new Part E cases filed before August 1, 2005, and claims filed directly with the DO to determine whether an occupational history interview is required. Such evaluations are made on a case-by-case basis by reviewing the evidence in the file as a whole and the exposure evidence in particular.  

 

     (1) If the evidence in the file is insufficient to develop for exposure, the CE assigns an occupational history development task to the RC via memo to the RC manager.

 

     (2) Upon receipt of such assignment, the RC has 14 calendar days to complete the occupational history interview and return the findings to the DO with a cover memorandum outlining all tasks and stating when they were conducted. 

     

9.   Former Part D Claims.  Former Part D claims have been incorporated into the existing Part B EEOICPA files.  DOE may have gathered documents that are relevant to DEEOIC’s current development needs.  The CE must review these claims for medical, employment, and survivorship information (if applicable).

 

The case file may contain copies of records from a Part B claim (e.g., medical records, development letters, Forms EE-5, a NIOSH dose reconstruction report, a recommended decision, a final decision) and/or records that were gathered by the DOE Office of Worker Advocacy (OWA).

 

As noted above, should an occupational history interview be required, the CE assigns the task to the RC.  Any employment development is conducted at the DO; no RC assignment is necessary.  The evidence in these claims may include:

 

a.   Claim Forms.

 

(1)  Form EE-1, EE-2, or EE-3.

 

(2)  Form 350.2, Employee Request for Review by Physician Panel.  This is the primary application form for current or former DOE contract employees under Part D.

 

(3)  Form 350.3, Survivor Request for Review by Physician Panel.  This is the primary application form for a survivor of a former DOE contract employee under Part D.

 

(4)  Form KK-1, KK-2 - OWA1-7/6/01 Request for Review by Medical Panels.  DOE used these forms initially for filing claims by the employee and by the survivor, respectively, and for the claims review by the Medical Panels.  These were internal forms used by OWA only. 

 

Once the Office of Management and Budget (OMB) approved these forms, they became known as Form 350.2, Employee Request for Review by Physician Panel, and Form 350.3, Survivor Request for Review by Physician Panel, respectively.

 

If no DOE/OWA forms are located, the CE reviews the file for any correspondence from the claimant that may contain words of claim.  As with Part B, any correspondence referring to a request for benefits or a request for review by a physician panel will be considered a claim filed under Part E. 

 

b.   Highlight Sheet.  This form provides a chronological description of adjudicative actions, follow-up information, and documented phone calls by the OWA.  This information was entered in OWA’s Case Management System (CMS).

 

c.   Medical Records.  These records include medical narratives, pathology reports, clinical reports, and diagnostic reports.

 

d.   Survivorship Evidence.  This includes marriage certificates, divorce decrees, birth certificates, adoption papers, death certificates, obituaries, and school records.

 

e.   Employment Evidence.  This includes a Document Acquisition Request (DAR), which in turn includes employment records such as job position descriptions, personnel information, security clearance information, employment dates, medical records, accident/incident reports, radiation records, and dosimetry records.

 

f.   Occupational Medical Questionnaire.  This form is in the case file if completed by an RC staff member and/or by an OWA staff nurse based on conversations with claimants.

 

g.   Physician Panel Report.  Some case files may contain this report, which consists of the OWA physician’s discussion, rationale, and conclusion as to whether a toxic substance aggravated, contributed to, or caused the claimed condition(s).  Additional guidance as to the proper evaluation of these reports as they relate to causation is outlined in Paragraph 10 of this Chapter. 

 

h.   Former Worker Program (FWP) Documents.  As discussed in greater detail in Paragraph 12 of this Chapter, DOE medically screens former DOE facility workers.  The resulting studies document claimed illnesses and exposure.  The CE may encounter DOE FWP documentation in the case file.  The CE reviews DOE FWP findings together with all other evidence in file when evaluating for causation.

 

i.   Authorized Representative Release Form.  The claimant may have designated a representative to act on his or her behalf in the adjudication process with DOE.  The CE contacts the claimant to determine whether this designation is still valid (see EEOICPA PM 2-0400).

 

j.   Duplicate Records.  The CE may find duplicate copies of records in the Part D case file.  The CE maintains the integrity of the Part D case file by keeping it in the order that it was received in the district office.  The CE does not remove any duplicate copies of individual records unless it is obvious that there is an exact duplicate photocopy of the entire case record in the file.  In this instance the CE shreds the duplicate photocopy.

 

10.  Positive DOE Panels.

 

a.   Official Positive DOE Panels.  If a positive DOE physician panel finding is present in a Part D case file and the DOE approval letter is signed by a DOE official, the physician panel finding is considered an official positive determination from DOE. Generally, such claims are in posture for acceptance of causation under Part E, but further development of survivorship and potential coordination and offset issues may be required of the CE before issuing a recommended decision:

 

(1)  Eligible Survivor.  In survivor claims the CE needs to determine whether the claimant is an eligible survivor under Part E and whether the accepted covered illness aggravated, caused, or contributed to the covered Part E employee’s death (see EEOICPA PM 2-1200).

 

(2)  State Workers’ Compensation Benefits/Tort Offset. Also, the CE needs to determine whether the claimant received any compensation from a state workers’ compensation plan (see EEOICPA PM 3-0400 and 3-0500).

 

b.   Unofficial Positive DOE Panels.  If a positive DOE panel finding is present in the case file, but no accompanying approval letter signed by a DOE official is present, the case is not in posture for possible acceptance.  In such a case, the physician panel report has not been sent to the claimant and the CE does not consider it an official positive determination from DOE.  Therefore, the CE reviews the claim to determine if further development is needed concerning survivorship, medical, employment or exposure issues, as with any other claim.  

 

11.  Reviewing Part B/E Claims.  A claim accepted under Part B is also accepted for causation under Part E for the accepted Part B covered occupational illness, if all other appropriate criteria under Part E are met.

 

Unlike a Part E claim with an accepted Part B claim, a claim that has been accepted under Part E is not automatically accepted under Part B.

 

In developing these cases, the CE needs to be alert to the differences in medical, employment, and survivorship requirements between Part B and E claims (including RECA claims), since these differences can result in the need for additional development and/or non-approval of the claim under Part E, even though it has been approved under Part B.

 

a.   Medical Differences Between Part B and E Claims.  Covered illnesses under Part E include all the covered occupational illnesses under Part B (i.e., beryllium sensitivity, chronic beryllium disease, chronic silicosis, and cancer) plus additional covered illnesses (e.g., asbestosis).

 

However, the covered occupational illnesses under Part B do not include all the covered illnesses under Part E (for example, asbestosis, peripheral neuropathy, and anemia).

 

b.   Employment Differences in Facility Sites Between Part B and E Claims.  Covered employment under Part B includes all covered employment under Part E (i.e., DOE contractor/ subcontractor, RECA).

 

However, covered employment under Part E does not include all covered employment under Part B.  Part E covers employment at a DOE or RECA Section 5 facility.  It also covers employment at AWE and beryllium vendor facilities only during a period when they were designated as DOE facilities or during DOE remediation periods.  Part E does not cover employment for beryllium vendors or AWE facilities outside of the time they were considered DOE facilities.

 

c.   Survivorship Differences Between Part B and E Claims. These issues are addressed in the Survivorship Chapter of the PM.

 

d.   RECA Differences Between Part B and E Claims.

 

(1)  An eligible survivor who is the child of the covered employee under RECA and under Part B is not an eligible survivor under Part E unless he or she meets the definition of “covered child.”

 

(2)  An employee who does not meet the employment and other requirements under RECA section 5 (and therefore under Part B) may be eligible under Part E.

 

(3)  An employee who does not meet the medical criteria for covered conditions under RECA section 5 (and therefore under Part B) may still be eligible under Part E (i.e., all cancers, asbestosis, etc.)

 

e.   Requirements for New Part E Claim Filing.  If a former Part D claim exists, a claimant does not need to file a new claim under Part E.  If there is a Part B acceptance on record, a claimant does not need to file a new claim for benefits under Part E.  However, if a Part B denial is on record, or a Part B claim is pending a decision, the claimant must file a new claim form seeking benefits under Part E. 

 

12.  DOE Former Worker Program (FWP).  The FWP began in 1996 and is designed to evaluate the effects of DOE's past operations on the health of workers employed at DOE facilities.  The program documents medical conditions and workplace exposures that may help the CE develop and adjudicate claims.  Additional information about the FWP is available at http://www.eh.doe.gov/health/.

 

In some instances, FWP records will appear in the Part D case file.  If no records exist there, or a new Part E, B/E claim is filed, the CE requests FWP documents during initial development.

 

The CE reviews FWP records in light of the evidence in the file as a whole when evaluating a claim.  EEOICPA PM 2-0700 explains how the CE uses FWP records in assessing causation.

 

     a.   Medical Component.  FWP records contain valuable information about medical conditions and can help the CE develop for a covered illness.

 

(1)  The FWP is a screening program and does not provide a final diagnosis for the medical conditions detected.  If the screening tests identify a potential disease, the employee is referred to his or her treating physician for further medical workup and diagnosis.

 

          (2)  Results of medical tests conducted by the FWP (e.g., pulmonary function tests, beryllium lymphocyte proliferation tests, blood tests, X-rays with B reader interpretations, etc.) are valid when interpreted by certified medical professionals.  Therefore, the CE may use such test results in evaluating records for a covered illness, provided a physician’s interpretation of the test result is present.

 

b.   Exposure Component.  FWP medical screening is conducted to evaluate former DOE workers for adverse health outcomes related to occupational exposures to substances such as beryllium, asbestos, silica, welding fumes, lead, cadmium, chromium, and solvents.  Therefore, these records contain valuable exposure information.  The CE reviews FWP screening records along with the evidence in the file as a whole when evaluating claimed exposure.

Also, the FWP asks the former DOE employee to undergo a Work History Interview, which examines workplace exposure at DOE facilities.  The CE uses the results of the interview when assessing work history and exposure.

c.   Existence of FWP Records.  The CE must review the case file/claim forms to determine whether FWP records exist.

 

     (1) Part D Cases.  As indicated, some former Part D cases will contain FWP records.  The CE searches the case file for cover memos or medical records provided by the FWP.  The CE should also refer to DOE Form 350.2, Employee Request for Review by Physician Panel, question 11, or Form 350.3, Survivor Request, question 11, to determine if the employee participated in the FWP.  If records are not present, but there is some indication that they may exist, the CE obtains them as outlined below.

 

     (2) New B/E Claims.  With regard to new claims, the CE must review Form EE-3 and/or section 5(B) of the DOL Occupational History Interview (see EEOCIPA PM 2-0200) to determine if the employee participated in a FWP screening program at the claimed work site. If so, the CE prepares a request package to be sent to the appropriate FWP.

 

     d.   Obtaining FWP Records.  Where no records exist in a former Part D case, or a new Part E claim is filed, the CE requests the records from the appropriate FWP Point of Contact (POC).  The complete POC list is available for viewing on the shared drive by accessing the Part E folder, Former Worker Program subfolder.  If the records are unavailable at a POC, the POC cannot be determined, or a new Form EE-3 is required (see below), the CE requests assistance from the claimant.

 

(1)  POC Request.  After determining that FWP records must be requested, the CE reviews the POC list to identify the appropriate POC.  The CE prepares a package and a cover letter to the POC (Exhibit 1). The package includes a letter to the FWP, a cover memo, Form EE-1 or EE-2, and the new Form EE-3.

 

The CE should state in the memo that an EEOICPA claim has been received for the named DOE employee, the employee participated in the specified FWP, and DOL is requesting a copy of all FWP records. The memo and package are faxed or mailed to the designated POC.

 

(2)  New Form EE-3.  FWPs will accept only a new Form EE-3 as a release.  If the case file contains an old Form EE-3, the CE writes to the claimant asking the claimant to complete and sign a new Form EE-3.  Once the new form is received, the CE prepares the request package as outlined above.

 

          (3) No FWP Records.  When the CE cannot locate FWP records, the CE contacts the claimant in writing to determine if the employee participated in a FWP at the claimed work site.  The CE includes a new Form EE-3 with the letter and instructs the claimant to complete, sign and return the new Form EE-3 to the DO only if the employee participated in the FWP.

     e.   Building Trades National Medical Screening Program Database.  This database contains work history and medical test results for certain employees who worked at Amchitka Island, Savannah River, Oak Ridge, and Hanford and who filed Part D claims with DOE from 2000-2004.

(1)  The CE views medical data and work histories contained in the database by accessing the Shared Drive, Part E folder, Former Worker Program subfolder. The “read me” file in the FWP subfolder contains detailed instructions for navigating the database and retrieving information.

     (2)  The CE searches the database for medical information and prints the results. The medical results generated from the database do not contain a physician’s signature.

(a)  A letter from the Building Trades FWP Medical Director, Dr. Laura Welch, describing the information obtained in the database search and attesting to its validity is located on the Shared Drive, Part E folder, FWP subfolder.

(b)  The CE prints Dr. Welch’s letter and attaches it to the search results.  The CE places these documents into the case file and weighs the information with the evidence on file as a whole.

13.  Terminally Ill Claimants.  OWCP strives to process claims fairly and expeditiously for all claimants.  However, claimants who are end-stage terminally ill must have priority processing.  These claims should be handled swiftly and compassionately.

a.   Claims Actions.  DO and FAB CEs and hearing representatives (HRs) are instructed to watch for indicators of an end-stage terminally ill claimant any time they are reviewing a case file or preparing a decision.  Indicators of end-stage terminally ill claimants include requests for hospice care, medical evidence stating that the claimant is at the end-stage of an illness, or telephone calls or letters from RCs, congressional offices, authorized representatives, family members, or medical providers regarding the claimant’s illness.  Upon receipt of information concerning the end-stage of the claimant’s illness, the District Director (DD) or Assistant District Director (ADD) or FAB Manager (depending on where the file is located) must be notified immediately.

The DD/ADD or FAB Manager must use sound judgment in determining if priority handling is warranted.  If medical documents or other information indicate that the claimant is in the end-stage of his/her illness, or that death is imminent, priority handling of the case is required.  If the claimant’s medical status is unclear, a medical report that establishes that the claimant is in the end-stage of a disease or illness must be obtained.  Once this information is obtained, the DD/ADD of FAB Manager will determine whether priority handling is warranted.

Once it is determined that a claimant is in the end-stage of his/her illness, the DD/ADD or FAB Manager must enter the appropriate status code in ECMS and prepare the case file in accordance with EEOICPA PM 2-2000.

Priority handling for terminally ill claimants requires that the entire adjudication process be expedited.  Whenever the file changes hands, the person receiving the file should be notified, verbally or in writing, of the claimant’s terminal status.  The supervisor or DD/ADD should facilitate the expedited adjudication of the claim by requesting priority processing from any other agencies involved, such as the DOE, Department of Justice (DOJ), and NIOSH.

If a case requires referral to the NO for reopening or policy clarification, the DO or FAB must identify the claimant as terminally ill in the memo to the Director.  Procedures for expediting payment processes for terminally ill claimants can be found in the EEOICPA PM 3-0600.

 

Exhibit 1: DOL Letter to DOE Former Worker Program