[Follow-up Development Letter]
Claimant Name (or auth rep) File Number
Street Address Accepted Conditions
City, State, ZIP
Dear Claimant (Insert Claimant Name):
This letter affects medical benefits you have requested and requires your immediate attention and response.
We have received a request to provide you (or the claimant that you represent) with in-home medical care for the accepted condition(s) shown above, arising out of your claim with the Energy Employees Occupational Illness Compensation Program (EEOICP), administered by the Division of Energy Employees Occupational Illness Compensation (DEEOIC). We are currently evaluating this request. In a letter dated (date of first letter) we requested additional medical information. As of this date, we have not received a response.
Without the additional information your request for home health care may be denied. It is imperative that we receive a response from your doctor. We need an updated verification of the type and level of in-home care that you require, and verification that this care is for the accepted condition(s) that have been approved for benefits through the EEOICP.
Please contact your treating physician’s office immediately, and ask your doctor to provide us with this information. Extra copies of our previous letter concerning this matter are attached for your use. This information must be received within 30 days or the request for in-home health care may be denied. If you are unable to contact your doctor, and/or if you have questions regarding this verification process, you may call me at the telephone number listed below.
(Insert POC CE Name, Signature and Telephone Number)