U.S. Department of Labor

Employment Standards Administration

Office Of Workers’ Compensation Programs

Division of Energy Employees Occupational Illness Compensation

     

     

Phone:       or      

Fax:          

 

 

Date

 

Representative Name

Address

 

City, State, Zip Code

 

RE:  Claimant Name and Case Number

 

Dear [Representative]:

 

According to our records, you have been designated as the authorized representative in the above case.  As the authorized representative, you have the ability to receive correspondence, submit additional evidence, argue factual or legal issues and exercise appeal rights pertaining to the above claim.  The authorized representative does not have signature authority on behalf of the claimant on Form EN-20.

 

As the authorized representative of [claimant name], any correspondence from the Division of Energy Employees Occupational Illness Compensation (DEEOIC) will be directed to you in this capacity.  If the correspondence indicates a response is warranted or additional information is required, it is expected that you will make the necessary arrangements with [claimant name]. 

 

Representative Fees.  A representative may charge the claimant a fee for costs associated with his/her activities regarding the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).  The claimant is solely responsible for paying any fee or other costs associated with the actions of a representative.  The DEEOIC will not reimburse the claimant, nor is it liable for the amount of any fee and other costs relating to an agreement between a claimant and a representative.

 

Permissible Charges.  Under the regulations implementing 42 U.S.C. § 7385g, a representative is permitted to charge an appropriate fee for services related to a claim before DEEOIC.  The maximum allowable percentage of a payment of lump-sum compensation that can be collected as a fee is as follows:

 

(1)        2% for the filing of an initial claim with DEEOIC, provided that the representative was retained prior to the filing of the initial claim; plus

 

(2)        10% of the difference between the lump-sum payment made to the claimant and the amount proposed in the recommended decision with respect to objections to a recommended decision.

 

Please feel free to contact the District Office, if you have any questions or concerns.  Our telephone number is 000-000-0000 or fax 000-000-0000.

 

Sincerely,

 

Claims Examiner

 

CC:  Claimant