CHAPTER 2 – THE EEOICPA

1. Purpose and Scope. This chapter provides an overview of the EEOICPA program and the structure of the DEEOIC. It also addresses the relationships between DEEOIC and OWCP, the various components of the DEEOIC, and training for DEEOIC employees.

2. The EEOICPA. The EEOICPA, as amended, 42 U.S.C. § 7384 et seq., was enacted as Title XXXVI of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001, Public Law 106-398. The Act originally had two parts, Part B and Part D. On October 28, 2004, the President signed into law an amendment that repealed Part D of the EEOICPA and created a new program called Part E.

a. Part B. The purpose of Part B is to provide a lump-sum payment of $150,000 and medical benefits as compensation to covered employees suffering from occupational illnesses incurred as a result of their exposure to radiation, beryllium, or silica while in the performance of duty for the DOE and certain of its vendors, contractors and subcontractors.

The legislation also provides for the payment of compensation to certain survivors of these covered employees, as well as for payment of a smaller lump-sum of $50,000 to individuals or their survivors who were determined to be eligible for compensation under Section 5 of RECA. Compensation for individuals with beryllium sensitivity is limited to medical monitoring and medical benefits.

b. Part E. The purpose of Part E is to provide variable amounts of compensation to DOE contractor employees or to their survivor(s) where it is at least as likely as not that exposure to a toxic substance while employed at a covered facility was a significant factor in aggravating, contributing to or causing the employee’s illness or death. Variable amounts of compensation up to an aggregate total of $250,000 (for the employee and any survivors) are determined based on causation, wage-loss, and impairment.

3. Organization. This paragraph describes the structure and authority of the National, Regional, and District Offices (DOs). OWCP has seven divisions, of which DEEOIC is one. The others are the Division of Federal Employees’ Compensation (DFEC); the Division of Longshore and Harbor Workers' Compensation (DLHWC); the Division of Coal Mine Workers' Compensation (DCMWC); the Regional Directors (6 Regions), the Division of Administration and Operations, and the Division of Financial Administration.

a. Regional Director. OWCP Programs, in each of its six regions, are administered by a Regional Director, who reports to the Director for OWCP.

b. District Director (DD). DEEOIC has four DOs, which are located in Cleveland, Ohio; Denver, Colorado; Jacksonville, Florida; and Seattle, Washington. Each DO is managed by a DD, who reports to the Regional Director. (Exhibit 2-1 contains a jurisdictional map. Exhibit 2-2 contains a list of addresses, telephone numbers, and fax numbers for the DOs.)

4. Responsibilities. This paragraph describes the roles of the various components within the DEEOIC.

a. DOs. Within each DO there are a variety of roles:

(1) Claims Functions. Supervisory Claims Examiners (SCEs) manage units of Senior Claims Examiners (SrCEs) and Claims Examiners (CEs). Staff in these units adjudicate claims, authorize compensation, respond to inquiries from interested parties, and maintain case files.

(2) Fiscal Operations. Fiscal Officers (FOs) are designated for each DO. The primary responsibility of these individuals is to ensure the integrity of the compensation payment process. The FO is also responsible for monitoring financial management records and serves as the DO point of contact for medical billing issues.

(3) Medical Referrals. DEEOIC uses the services of a contractor to assist in obtaining medical opinions on a range of issues including causation, impairment, wage-loss, etc. The contractor is also responsible for the scheduling of second opinion medical examinations. Within each DO, a designated District Medical Scheduler (MS) is responsible for coordinating case referrals with the contractor.

(4) M&F. Contract personnel in this area open, sort and place mail, compile case files, retire case records according to established schedules, image case files and documents, and transfer case files in and out of the DO. The CMR is the central location for incoming mail. The contract staff is responsible for opening mail, prepping the mail for scanning, scanning the mail, and assigning the digital image of the mail to the proper case in the OIS.

(5) Contact and Technical Assistance. Customer Service Representatives are responsible for answering phones, referring calls within the DO and responding to general inquiries. Technical assistants are responsible for providing technical guidance and assistance to DO personnel and maintaining liaison with organizations outside the DO.

b. National Office (NO). The Director of DEEOIC has final authority to manage and administer the program. With the exception of the Final Adjudication Branch (FAB) Chief, who reports directly to the Director, the Deputy Director supervises the DEEOIC Branch Chiefs and serves as the Acting Director in the Director's

absence. Under the immediate jurisdiction of the Director and Deputy Director are the:

(1) Policy Branch. Personnel in the Policy Branch consist of the Policy, Regulations and Procedures Unit (PRPU) and the Medical, Health & Science Unit (MHSU).

(a) The PRPU is responsible for working with the Office of the Director and the SOL in the research, determination and writing of all program policies, regulations and procedures, as well as providing consultative services regarding those policies, regulations and procedures to various DEEOIC staff.

(b) The MHSU conducts and oversees scientific and nursing-related consultative services for DEEOIC staff. This can include industrial hygiene, health physicist, toxicological and nursing-related advice and consulting services. Additionally, these staff provide specific medical and scientific research, reporting and advice in the development of policies, regulations and procedures that involve scientific and/or medical issues.

(2) Branch of Outreach and Technical Assistance (BOTA). Personnel in the BOTA are responsible for technical assistance and outreach activities, including developing informational materials and maintaining the Web page. In particular, BOTA staff:

(a) Develop and conduct training for DEEOIC staff;

(b) Manage the program’s priority correspondence activity, including FOIA requests; preparing responses for the Secretary of Labor; Office of Congressional and Intergovernmental Affairs; OWCP Director, and the Director of the DEEOIC;

(c) Facilitate development of comprehensive outreach plans; including local outreach by Resource Centers (RC); monitor and approve outreach expenses, conduct and arrange outreach events, and vest as the POC on the Joint Outreach Task Force Group (JOTG). The JOTG is comprised of representatives from the DOE, the DOE Former Worker Program (FWP), the NIOSH, and the DOL and NIOSH offices of the Ombudsman. These agencies work together to conduct joint outreach to current and former workers of the DOE workforce; and

(d) Promote and maintain cooperative relations with individuals and groups having EEOICPA interests through technical assistance and public relations activities.

(3) Branch of Automated Data Processing Systems (BAS). Members of this Branch provide data processing and payment systems support services for the DEEOIC. In particular, the Branch is responsible for:

(a) Developing and maintaining activities related to ECS and OIS;

(b) Providing statistical reports and data; and

(c) Providing overall computer services.

(4) Management Unit. Members of this unit support the efficient operations of the DEEOIC by providing the following functions:

(a) Oversee DEEOIC budget and ensure that budget limitations are not exceeded;

(b) Monitor and manage personnel and procurement actions; and

(c) Provide administrative support to the Director and the Deputy Director.

(5) Branch of Medical Benefits Adjudication and Bill Processing (BMBABP). Personnel in this branch are responsible for medical bill processing, adjudication of all medical benefits that require pre-approval (like home health care related activities) for claimants who have accepted conditions, and program integrity.

(a) The Medical Bill Processing Unit (MBPU) oversees the medical bill processing systems, transactions and coding necessary to assure prompt and accurate payment for approved medical benefits, and works with OWCP and the Central Bill Processing contractor to develop and implement appropriate bill payment codes, procedures and resolutions to issues which arise.

(b) The Program Integrity Team provides analysis, investigations, audit and reporting regarding whether payments made to claimants or providers were accurate and appropriate, and align with necessary treatments for approved conditions. When potential billing inaccuracies or discrepancies are identified, they will work to provide training and/or implement bill adjustments, as appropriate and necessary.

(c) The Medical Benefits Adjudication Unit (MBAU) provides medical benefits adjudication and decisions regarding requests for medical care or equipment that requires preauthorization.

c. FAB. Personnel in this Branch are responsible for issuing all FDs under the EEOICPA, except for decisions on overpayments. The FAB also processes all objections by holding oral hearings or reviewing the written record. FAB representatives issue FDs that affirm, remand, or reverse RDs issued by the DEEOIC DOs.

A FAB Office is located in Washington, D.C., and a FAB unit is co-located with, but independent from, each of the four DOs. The manager of each FAB DO reports to the FAB Chief. (Exhibit 2-2 contains a list of addresses, telephone numbers, and fax numbers for the FAB units.)

(1) A separation must exist between the DOs and FAB to maintain impartiality in case adjudication functions. The designated CE assigned to a case handles all necessary development on outstanding claim elements not related to the RD currently in front of the FAB for review, and may issue a RD whenever the case record contains enough evidence on file to support a RD on any of the outstanding claim elements. While the CE may concurrently work on a case assigned to FAB, the CE may not engage in any case adjudication activity relating to a claim under evaluation by FAB. Moreover, FAB may not seek CE assistance with regard to its evaluation or development of a claim under consideration for finalization.

5. Training. This paragraph describes the information new employees need and addresses

the kinds of training OWCP provides to its employees.

a. Orientation. Orientation is provided to all new employees of the DO, FAB and NO. This orientation includes the following topics:

(1) Organization of the DO, the Regional Office, the FAB, the NO, and OWCP, as appropriate;

(2) Mission and objectives of the DEEOIC;

(3) General description of duties;

(4) Staffing pattern, chain of command;

(5) Floor plan/physical layout of office, unit locations, emergency procedures, office security, etc.;

(6) Mail handling, paper and case flow;

(7) Working hours, breaks, lunch hour, sick and annual leave arrangements, flextime, telephone use, overtime authorization, etc.;

(8) Introduction to staff;

(9) Reference materials; and

(10) Role of partner agencies, e.g. NIOSH, DOE, DOJ, RCs, etc.

b. Courses. Three formal training courses have been developed for the DEEIOC staff. These include:

(1) All Staff Members Orientation. This is a course designed by each DO, FAB, and the NO to explain the basic concepts of the EEOICPA.

(2) CE Course. CEs, Senior CEs, Supervisors, and FAB Representatives take this course.

It is delivered in a classroom or through self-instructional format. A resource person is available to respond to questions if the self-instructional format is used.

The course, which requires about two weeks to complete, is designed to explain the claims adjudication process and to develop case management skills.

(3) Secondary Training. Additional training is provided to all claims personnel to address developing needs of the program (e.g., complex medical terminology/issues, facilities lists, exposure determination and SEM, precedent-setting decisions, RCs). This training may include advanced CE and FAB training. In addition, training on ECS is available.

6. Jurisdiction. This paragraph describes the jurisdiction of the four DEEOIC DOs. The DO that handles a claim is determined by where the employee last worked as a covered employee. A DO acquires jurisdiction if the last covered facility is/was located within the geographical area it serves. (Exhibit 2-1 contains a DEEOIC Jurisdictional Map.)

a. Survivor Claims. This rule applies to claims from survivors as well as those brought by the employee.

b. Uranium Workers. All claims for uranium workers (or their survivors) who may have been awarded benefits under Section 4 or 5 of RECA are within the jurisdiction of the Denver DO.

7. Resources: DEEOIC district and FAB offices have full access to a range of reference materials and programmatic resources that are available through a publically accessible website. In addition, DEEOIC makes locally available other material that assists its staff in adjudicating claims. A list of programmatic references and resources available to staff can be seen in Exhibit 2-3.