NIOSH Referral Letter to Claimant

Dear [Insert Claimant Name]:

We have received the necessary medical and employment information submitted in support of your claim for compensation under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).

The next step in the adjudication of your claim is the dose reconstruction process. The National Institute for Occupational Safety and Health (NIOSH), an agency within the Department of Health and Human Services, administers this portion of the process. In order for NIOSH to proceed with the dose reconstruction, they must have access to your complete case record. Therefore, a copy of your case file is being referred to them.

Based on our review of your claim, we will report the following information to NIOSH:

Medical

  • Cancer diagnosis type (nomenclature), [Insert Diagnosis Code(s)] and date of diagnosis

Employment

  • Employer name, facility, and dates of employment (list each individually)

If you [or the “the employee” when writing to a survivor] had any other primary cancers, in addition to what is listed above, it is important that you send written medical records documenting an explicit diagnosis of any additional primary cancers, the type of cancer, and the date of its first diagnosis. Also, with regard to employment, if you [or “the employee” if writing to a survivor] had other covered employment, either before or after the dates shown above, or employment at another Department of Energy covered facility, please send us any evidence you have that supports this additional employment. Any such medical or employment evidence should be sent to your claims examiner at the mailing address provided below.

Once NIOSH receives your case record, they will send you a letter advising that they have received your information. The letter will contain information on dose reconstruction and what to expect from NIOSH in regard to your claim. NIOSH has informed us that the process of dose reconstruction can be time consuming because it relies on information that must be collected from a number of sources. NIOSH’s first priority is to ensure the collected information is valid and that the assumptions used to estimate doses are fair, consistent, and well-grounded in the best available science.

Once NIOSH completes the dose reconstruction, they will send us the results, and we will apply a formula, using the NIOSH data, to determine whether your [or the employee’s] claimed cancer is at least as likely as not (a 50% or greater probability) related to the covered employment. We will then notify you, in writing, regarding the status of your claim.

If you have specific questions regarding the status of the dose reconstruction, you may contact the NIOSH office by calling their toll-free number at 1-877-222-7570. Any other questions regarding your claim should be addressed to your claims examiner at the mailing address below.

Sincerely,

Claims Examiner

{Insert Central Mailroom Address}