Top 3 Things to Know About EEOICPA Benefits

If you’re applying for a DOL white medical benefits card, here’s what you need to know

Anyone who has ever applied for a U.S. Department of Labor (DOL) white medical benefits card under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) will tell you that the process can often be lengthy and complicated. But the rewards are great, including the possibility of significant monetary compensation and free home healthcare benefits.

During the application process, as well as during your entire time as a white medical benefits card holder, you will undoubtedly have many questions. But here are the three that matter most:

1. Am I eligible?

Whether or not you’re considered eligible for a DOL white medical benefits card as part of the EEOICPA benefits program essentially comes down to what, when and where.

“What” is a three-part question: what type of job did you have when working at a nuclear weapons plant or uranium mine, what radiation and toxins were you potentially exposed to while working there, and what illness have you been diagnosed with?

The type of job you worked matters since some jobs are inherently more likely to be linked with radiation and toxic exposures than others. Someone working a desk job in an office was less likely to be adversely exposed (and for a shorter period of time) than someone who worked in the lab or inside a mine.

It’s also necessary for you to know what type of toxic materials you were exposed to. Don’t worry if you don’t know for sure. The DOL publishes a comprehensive list in the form of a searchable database called the Site Exposure Matrix. Visit sem.dol.gov which cross references various nuclear sites and specific toxins known to be present there, as well as common illnesses associated with those specific toxic materials

Your specific diagnosis is also a critical determinant. Currently, there are thousands of different diseases, including 22 SEC cancers, that are covered illnesses under EEOICPA. Being diagnosed with one of these illnesses puts you one step closer to qualifying for a white medical benefits card. Some diseases, such as lung cancer and certain pulmonary problems, may automatically qualify you for benefits, while others require a bit more development to lead to a successful claim.

When you worked at a covered site is also relevant as there is what’s known as presumptive causation if you worked at a particular site, or sites, during specific times. These are known as Special Exposure Cohorts, or SECs. That’s not to say that you wouldn’t be eligible if you worked at a covered site during different times, but if you worked at a covered site during the specified time period, you could qualify for EEOICPA benefits much easier.

2. What type of monetary compensation is available?

Under EEOICPA, up to $400,000 in compensation is available for current and former employees (or their survivors) who worked in the nuclear weapons or uranium industry and were exposed to radioactivity and other toxic substances.

The $400,000 in compensation breaks down as follows:

• Under EEOICPA’s Part B, U. S. Department of Energy (DOE) facility employees and certain contractors and subcontractors may qualify for up to $150,000 in financial compensation if they were diagnosed with radiogenic cancer, chronic beryllium disease, or chronic silicosis as a result of their work exposure.
• EEOICPA’s Part E provides potential compensation of up to $250,000 to DOE contractor and subcontractor employees, and uranium miners, millers, or haulers for certain illnesses related to their work as a result of exposure to toxic substances.

Part E also provides free lifetime health benefits with no co-pays, deductibles, or spending caps. If workers received $150,000 under Part B, any additional compensation under Part E brings the total possible compensation to $400,000. However, workers don’t need to have received Part B compensation to be eligible for Part E compensation.

3. What’s included in medical expense reimbursement?

Most workers with a white medical benefits card know that they can be reimbursed through EEOICPA for any out-of-pocket medical expenses incurred as a result of their covered illness. As part of the free lifetime health benefits, and in line with the objective of EEOICPA to provide what is referred to as compassionate compensation, workers have access to all the tools, resources and support needed to treat a covered condition. Generally, anything your doctor wants you to have to help treat, manage or live with your diagnosis is covered. This could include extensive surgery, such as a double lung replacement.

But not everyone realizes that they can be reimbursed for so much more beyond medical services.  Medically necessary travel expenses are just one example. This includes mileage (gas) or even the (pre-approved) cost of an airline ticket if you must fly to another state for specialty care.

Expenses related to consequential illnesses (those that are a result of a covered illness) can also be reimbursed. Items like pads or colostomy bags necessary for patients with colon cancer are reimbursable. Certain mental illnesses, such as depression, can also count as 100% reimbursable consequential illnesses, assuming a physician confirms that it is directly related to a covered illness.

Medically necessary upgrades to your home or vehicle modifications may also be reimbursed if you have mobility issues as a result of your covered illness and these renovations improve accessibility and your ability to move/drive around. Note, however, that items like wheelchair ramps and other major home modifications are subject to a pre-authorization process by the DOL that usually includes obtaining multiple bids and supporting doctor’s letters.

Within reason, almost anything you and your treating doctors believe will help you cope with your medical condition you can get. Assuming everything has been filed correctly, you shouldn’t have to spend a dollar of your own money.

Unfortunately, many workers and their families leave money on the table, either not receiving full compensation or paying out of their own pockets to cover expenses or co-pays for which they are not responsible. That’s why it’s important to do your homework. Organizations like Cold War Patriots (CWP), a division of Professional Case Management (the first approved EEOICPA home healthcare provider) can help. We have full teams available to answer questions and walk you through the program, helping you navigate the complexities of the EEOICPA approval process.

Among other services, CWP offers ongoing benefits reviews for covered workers, since benefits, qualification criteria and covered illnesses are always changing. Just this past year, for example, COVID-19 was added as a possible consequential illness. Unless you continue to stay updated, you wouldn’t know about important changes like this one, so it’s important to regularly get a benefits review.

To schedule a benefits review or to speak with someone in the CWP Help Center, call 888-903-8989 or email [email protected].