Sample Cover Letter

 

Dear Claimant Name:

 

Enclosed is the Notice of Recommended Decision of the Jacksonville District Office concerning your claim for compensation under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). The district office recommends acceptance of your claim for skin cancer under both Part B and Part E of the EEOICPA, and recommends that you be awarded medical benefits, in addition to lump sum compensation in the amount of $150,000.00. The district office recommends that your Part B and Part E claims for fibromyalgia be denied. Finally, your claim for chronic obstructive pulmonary disease (COPD) is being deferred pending further development. Please note that this is only a RECOMMENDATION; this is not a Final Decision.  We caution against making financial commitments based on the anticipated receipt of an award.  The Recommended Decision has been forwarded to the Final Adjudication Branch (FAB) for their review and issuance of the Final Decision.

 

Please read the Notice of Recommended Decision and Claimant Rights carefully, as it recommends an acceptance of some benefits and denial of others.  You have several choices.  Consider your options carefully as your choice will affect your ability to raise objections, as well as the steps the FAB takes in issuing a Final Decision. 

 

(Insert this paragraph when the decision was made using a DMC report) In arriving at this decision, the district office received the opinion of a District Medical Consultant (DMC) who reviewed all the medical records contained in your file and provided an opinion on your case.  If you would like to review the DMC’s report, please send a letter to the FAB at the address listed above asking for a copy.  Your request should include your full name, file number, date of request, signature, that you are requesting the “DMC Report,” and the address to which you want us to send the records

 

State Workers’ Compensation:  If you receive or have received any benefit (with the exception of medical benefits or vocational rehabilitation) from a state workers’ compensation program for any of the same conditions being recommended for acceptance in this decision under Part E, you must notify the FAB immediately.  This includes any benefits received after the issuance of this Recommended Decision (remove this paragraph if the decision is a denial or Part B decision).

 

Tort Actions: If anyone receives or has received any form of benefit (money, medical benefits, etc.) based on a lawsuit claiming that the employee was harmed from the same type of exposure (e.g. asbestos, radiation, beryllium, or any other toxic substance) upon which the EEOICPA claim is being recommended for acceptance in this decision, the FAB must be notified immediately.  This includes any benefits received after the issuance of this Recommended Decision (remove this paragraph if the decision is a denial).

 

Should you have any questions concerning the recommendation, you may call the FAB, toll free, at: (FAB Office telephone number)

 

Sincerely,

 

 

 

Claims Examiner