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Talk to Terrie: Need help with a denied medical bill or the SEM?

June 26, 2019

June 26, 2019

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CWP Blog

By: Terrie Barrie

Helpful Hints – Medical Bills, Site Exposure Matrix

Over the Memorial Day weekend, I read comments posted to the Cold War Patriots Facebook page.  Many shared their experiences working with nuclear weapons at the Department of Energy (DOE) nuclear weapons facilities or with the final product in the military.  I thank all of you for sharing your experiences.

There were comments which voiced frustration with the Energy Employees Occupational Illness Compensation Program (EEOICP). One issue concerns the problems some workers, who have been approved under the program, are having getting medical bills paid.  The other concerned the Site Exposure Matrix (SEM).

There is good news for those who have had their medical bills denied by the Department of Labor (DOL) or who have not been reimbursed for out-of-pocket expenses incurred for their covered condition.  The 2017 Ombudsman Report to Congress alerted us that DOL now assigns the role to assist claimants with medical bill problems to the Resource Centers.  I recently had a pleasant encounter with the Denver Resource Center about an unpaid bill for my husband.  They explained what the problem was and advised me how to correct it.  To find the Resource Center near you click here

The concern that the SEM is not accurate or inclusive is an ongoing problem.  Claims have been denied because a job category was not included at a site or if no toxic substances were associated with it.

Here’s an idea that may help improve the SEM and, if successful, could be used to reopen a claim. It’s a bit time consuming and may be tedious but may well be worth the effort.

Click here to file a Freedom of Information Act Request with DOE asking for a copy of your job description and duties,  You can fill out the form linked on this page, mail or fax the request.  Here is a sample request,

I respectfully request a copy of (title of job description) and responsibilities for the (name of facility) for years (enter dates of employment). 

It will take a while for DOE to search and release the document.  Hopefully, the job description and responsibilities will include enough information to prove that the worker was in a building or was exposed to toxic materials which are not reflected in the SEM.  You can then submit it to the SEM Administrator by clicking on the “Submit Site-Related Information” button located by clicking here

You can also request a copy of your personnel records from DOE by clicking here. I suggest also asking for all reports of incidents you were involved with.

You can also request of a copy of your DOL case file by clicking here. The request must be made in writing by mailing or faxing a letter to the District Office.  Remember to include your case number or Social Security Number.  The file should include documents DOE provided to DOL through the Document Acquisition Request.

By comparing the two files you can determine whether DOL had everything it needed to decide the claim.

I hope these suggestions will help some of you.