File Number:

Claimant Name:

Date of telephone call:






Good Morning/Afternoon, my name is ______ and I am calling from the ________________ Resource Center.  May I please speak with Mr./Ms. _____________________?


Hello Mr./Ms. _____________, I am calling regarding your claim under the Energy Employees Occupational Illness Compensation Program Act.  Our records indicate that your Part E claim was already accepted by the Department of Labor (DOL) in a decision issued on __________. 


If you have a few moments I would like to tell you about additional monetary benefits that you may also be entitled to.  Is this a good time to talk? (If they say no, ask them when would be a good time to call them back. Make note of a more convenient time to call back)


Before we start, I would like you to confirm some information we have on file.  We have your mailing address as: (state address we have on record).  Is that correct?


Did you receive a ______________ (final decision or letter) from the Department of Labor, regarding possibly filing a claim for impairment and/or wage loss benefits?  That __________ (final decision or letter) was sent to find out if you want to file a claim for additional compensation, specifically monetary benefits based on impairment and/or wage loss.


Each percentage of whole body impairment equals $2,500 in compensation.  The overall rating shows how much of your entire body’s function is impaired due to your covered illness.  An impairment rating may be performed once your covered condition has reached maximum medical improvement (MMI).  MMI means that your covered condition is unlikely to improve with additional medical treatment. A qualified physician can determine whether or not you are at MMI. 


The first step is to apply for benefits by providing a written, signed statement to DOL that you wish to claim impairment benefits. 


Once the district office receives your written request, a claims examiner will send you a letter describing what information is necessary for the impairment rating. 


When you receive this letter, please call me at                                       and I will be more than happy to assist you further. 


*****if claimant received “option letter” from the district office, continue with script*****.  If not, go to ### wage loss section


Impairment ratings are based on the evaluation of specific medical tests (i.e. pulmonary function tests, liver function tests, etc.) that can be done by any qualified physician.  In other words, medical evaluations that are necessary to evaluate the degree of loss of function of body parts that are affected by your covered condition.


The evaluation can be performed by a physician of your choice.  The physician must hold a valid medical license and Board certification/eligibility in the appropriate field of expertise (i.e. toxicology, pulmonary, occupational medicine, etc.) to perform such an evaluation.  The physician must also possess the necessary professional and medical background in interpreting the AMA’s Guidelines to provide such ratings. 


You will need to provide the name, address, and telephone number of the physician you have selected to perform your impairment evaluating.  The             District Office will send the physician a letter outlining the specific requirements for performing your evaluation.


Also, DOL can arrange for a qualified physician to review the medical information provided by your physician to determine the degree of impairment.  You will not be sent to a physician for this review.  If necessary, the physician may request medical tests to establish the degree of impairment.


DOL will pay the cost for obtaining the required medical tests and the cost for one impairment evaluation.


###Before I let you go, I’d like to ask you a few additional questions.  Did your covered illness cause you to stop working for any period?  Did it cause you to accept a lower paying job or work less hours? 


If yes, continue:


If prior to your age for full Social Security retirement you lost wages as a result of your covered illness, you may be also eligible to receive additional compensation.  Wage loss benefits are separate from what we were just talking about (impairment).  It is entirely your choice whether or not you want to claim compensation for impairment and/or wage loss.


How old were you when you stopped work or lost wages?  [If they respond that they were 65 or over (if born in xxxx or earlier, the age varies with the year of birth) they are probably not eligible for wage loss benefits.  If under that age, they may be).  


If you wish to apply for wage loss benefits, again, please send a written and signed request to the ______________________ district office and state that you are applying for wage loss benefits.  You should also show the date (month and year) when your covered illness started causing you to lose wages.  Once the district office receives your written request, a claims examiner will contact you to help you complete the claim with all appropriate documentation.  Compensation for wage loss ends when you reach normal retirement age (per Social Security), but each year of qualifying wage loss can pay you $15,000 if your covered illness caused you to earn no more than 50% of your previous average annual wages, or $10,000 if it caused you to earn no more than 75% of your previous average.  The DOL looks at wages in each calendar year, and even factors-in inflation. 


If you want to file a claim for impairment and/or wage loss, and it’s easier for you, please feel free to bring your request to this Resource Center and we will help you submit it to the district office.


Do you think that you are interested in filing a claim for impairment

 [record response]


Do you think that you are interested in filing a claim for wage loss?  [record response]  ONLY ASK IF APPLICABLE!



Mr./Ms. _________________ do you have any questions at this time?


Please do not hesitate to give me a call at ________________________ should you require assistance with filing a claim for these benefits or to get answers to any of your questions.


It has been a pleasure speaking with you.