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Talk to Terrie: Claims Examiners Target Timelines

December 13, 2021

December 13, 2021

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How long does it take?

Frequently claimants ask how long it normally takes the Division of Energy Employees Occupational Illness Compensation (DEEOIC) to process claims. There is no hard and fast rule on this and there are cases which are complicated and may cause a delay in the process. However, documents obtained through a Freedom of Information Act (FOIA) request provides the information on the approximate time the adjudication process takes.

In response to the FOIA request DEEOIC provided its most recent Performance Management Plan for Non-Managers and Non-Supervisors for two classes of Claims Examiners (CE) and one for the Final Adjudication Board’s Hearing Representative (HR). These documents provide the goals these employees should meet.

CEs should complete,

  • The initial processing of Part B and Part E claims within 275 days 94%-95% of the time.
  • The initial processing of impairment and wage loss claims within 185 days 90-92% of the time.
  • The initial processing of consequential conditions and new primary conditions (after Final Decision) within 145 days 85-87% of the time.

HRs should issue Final Decisions (FD),

  • No later than 65 days after a Recommended Decision (RD) for claims with waivers 94%-96% of the time.
  • Within 75 days after a RD for non-contested claims 90-93% of the time.
  • Review of the written record should be completed within 75 days after receipt of the objection 90-93% of the time.
  • Response to requests for reconsideration should be issued within 45 calendar days 90-93% of the time.

This next criterium for the HR’s performance confused me.

To be fully successful, final decisions or remand orders are issued within 300 days of the recommended decision with no more than 2 cases going over 300 calendar days during the rating period.

I’ve reached out to DEEOIC asking to explain how a HR could be fully successful by reaching the 75-day target date but also be fully successful if they are given 300 days to issue a Final Decision. DEEOIC immediately responded. DEEOIC explained that this criterium is related to the regulations. The regulations state that if a Final Decision is not issued within a year, the Recommended Decision is considered a Final Decision. This standard is in place to ensure that no claims are not forgotten or ignored.

The baseline performance standard “Fully Successful” means that a CE’s work has been rated as “…a level of good, sound performance.”  The categories of the review include:

  • Timeliness of Development and Adjudication
  • Quality Development and Adjudication
  • Data Integrity
  • Case Management and Audits

The areas HRs are evaluated for are:

  • Quality of Decisions and Written Products
  • Issue Timely Final Decisions
  • Data Integrity
  • Customer Service
  • Hearings

These documents provide a glimpse of what is expected of the DEEOIC employees who are involved with the claims adjudication process.  There are other areas that the CEs and HRs are evaluated. For instance, a CE is rated on how long they take to return a phone call. This information hopefully helps the claimants and authorized representatives gauge when a decision should be issued.