[CPEO-MEF] Eneregy Department Employees' Radiation Claims

[Lenny Siegel <lsiegel@cpeo.org>]

"Energy Employees Compensation: Many Claims Have Been Processed, but
Action Is Needed to Expedite Processing of Claims Requiring Radiation
Exposure Estimates"
GAO-04-958  September 10, 2004

Subtitle B of the Energy Employees Occupational Illness Compensation
Program Act, administered by the Department of Labor (Labor), provides
eligible workers who developed illnesses from their work, or their
survivors, with a onetime total payment of $150,000, and coverage for
medical expenses related to the illnesses. For some claims, Labor uses
radiation exposure estimates (dose reconstructions) performed by the
National Institute for Occupational Safety and Health (NIOSH), part of
the Department of Health and Human Services' (HHS) Centers for Disease
Control and Prevention (CDC), to determine if the illness claimed was
"as least as likely as not" related to employment at a covered facility.
GAO was asked to determine (1) how well Labor's procedures and practices
ensure the timely and consistent processing of claims that are not
referred to NIOSH for dose reconstruction but are being processed by
Labor and (2) how well Labor's and NIOSH's procedures and practices
ensure the timely and consistent processing of claims that are referred
for dose reconstruction. GAO did not assess the quality of Labor's
claims decisions.

In the first 2 and 1/2 years of the program--July 31, 2001, through
January 31, 2004--Labor had fully processed 83 percent of the nearly
30,000 claims that had not been referred to NIOSH for dose
reconstruction; these claims correspond to nearly 23,000 cases for
individual workers. (Multiple claims can be associated with a case as
eligible survivors may each file claims.) Labor took an average of 7
months to fully process these claims. About 42 percent of claims with
final decisions were approved, resulting in $625 million in lump-sum
compensation payments. The remaining 58 percent of claims with final
decisions were denied--the majority because they did not meet medical or
employment eligibility criteria. Labor generally met its timeliness
goals for processing claims and is working to ensure that claims are
processed consistently by conducting accountability reviews and creating
a task force to update its procedure manual. In the first 2= years of
the program, Labor and NIOSH had fully processed about 9 percent of the
more than 21,000 claims (which correspond to about 15,000 cases) that
were referred to NIOSH for dose reconstructions, taking an average of 17
months to fully process claims. Fifty-one percent of the processed
claims were approved, and Labor has paid out about $65 million in
lump-sum compensation. Forty-nine percent were denied because it was
determined that the claimed illness was not at least as likely as not
related to employment at a covered facility. A backlog of claims needing
dose reconstruction developed because NIOSH needed time to get the
necessary staff and procedures in place to complete the dose
reconstructions and develop site profiles. Efforts are under way to
develop site profiles that contain facility-specific information that is
useful in completing dose reconstructions. However, processing claims
associated with facilities that do not have site profiles, in some
instances, has essentially stopped, and NIOSH has not established a time
frame for completing these remaining site profiles because of limited
expert resources and site complexities. As a result, some claimants
could wait a considerable period of time to have their claims fully
processed. To help ensure the consistency of claim decisions, HHS's
Advisory Board is conducting an independent external evaluation of dose
reconstruction decisions and site profiles.


see http://www.gao.gov/docdblite/details.php?rptno=GAO-04-958

-- 


Lenny Siegel
Director, Center for Public Environmental Oversight
c/o PSC, 278-A Hope St., Mountain View, CA 94041
Voice: 650/961-8918 or 650/969-1545
Fax: 650/961-8918
<lsiegel@cpeo.org>
http://www.cpeo.org
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