U.S. DEPARTMENT OF LABOR

Office of Workers’ Compensation Programs

Division of Energy Employees Occupational Illness Compensation

 

 

 

 

 

Date                                                                Employee:

                                                                       

 

Requester name

Address

City, ST  ZipCode

 

Dear Mr./Mrs. Requester:

 

I am writing concerning the alternative filing request you filed under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) to receive a determination as to whether your [employee relationship to survivor] contracted an illness as a result of exposure to toxic substances while working at [facility]

 

The following determination is intended to provide a measure of closure to you and your family, and should serve as recognition of your [employee’s relationship to the claimant]’s extraordinary service and sacrifice on behalf of our country.

  

[Description of the findings]

 

Again, this assessment DOES NOT change your eligibility for benefits or establish causation under the Act, and is not subject to further agency or judicial review. 

 

If you so desire, DOL will undertake full adjudication of the facts of this case.  You will need to complete and submit a form EE-2 (which can be found on DOL’s website at http://www.dol.gov/esa/owcp/energy/regs/compliance/EEOICPForms/ee-2.pdf, the District Offices, or any Resource Center) to begin the adjudication process.   The outcome of a full investigation of the circumstances of the claim may not result in a change of your status as an ineligible survivor, and upon issuance of a final decision in your case, you still may not be entitled to EEOICPA benefits.

 

Sincerely,

 

 

District Director, (City) Office