What is the value of an Impairment Evaluation?

Why you can’t afford to skip it or just let the DOL do it for you

If you’re a nuclear defense worker who has received a Department of Labor (DOL) white medical benefits card for your Part E eligible illness, you are qualified for an array of valuable benefits. In addition to qualifying for free medical care and in-home care, you could actually receive money—up to $250,000 during your lifetime—to use however you wish. How? By receiving an impairment evaluation.

What is an impairment award?

According to dol.gov, it is “monetary compensation for the permanent loss of function of a body part or organ due to a covered illness under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), as established by medical evidence and measured by percentage points.”

When can you be evaluated for an impairment award?

Although a claim for impairment benefits may be filed at any time, you must first receive a Part E final decision from the DOL confirming that you have contracted a covered illness due to exposure to a toxic substance at a covered Department of Energy (DOE) facility. Once benefits for your illness are approved, you then need to request an impairment evaluation. Once approved, you can schedule your impairment evaluation and, assuming all goes well, simply watch to see the money deposited directly into your bank account.

How is the amount of your award determined?

Under Part E of EEOICPA, qualified workers (and their survivors) can qualify for up to $250,000 in compensation based on their percentage of impairment as determined by a certified impairment physician. Each one percent of impairment is worth $2,500 and impairment ratings can range from 0 to 100%. A percentage rating is assigned by your impairment physician based on a review of your medical records and the impact of your covered illnesses on your ability to perform daily activities.

How much does an impairment evaluation cost?

There is absolutely no cost to file for an impairment award, regardless of which approved impairment physician you choose to conduct the evaluation. This is just one of the many FREE benefits provided to nuclear defense workers under the EEOICPA.

What are some of the more common illnesses that can have an impairment?

There are many impairments that could qualify nuclear defense workers for compensation. Some of the more common include respiratory illnesses, such as COPD and asthma, cancers of various organs, neuropathies, hearing loss and many more.

How often can you be re-evaluated for additional compensation?

A claimant may request re-evaluation every two years. In addition, if you are diagnosed with a new illness that is covered by EEOICPA, you can (and should) be re-evaluated to potentially receive an increased impairment rating which will qualify you for more money, even if it has been less than two years since you were last evaluated by a doctor. (Note that if you have been diagnosed with a terminal illness, your application for an impairment award will be expedited so you can receive your money sooner.) Regardless of how many evaluations you receive, however, the total amount of money you can receive is $250,000.

Can you also claim lost wages?

Although less common, workers can also file for wage loss replacement under this same Part E provision. If your covered illness shortened your available work years, the DOL will apply a specific formula to grant either $10,000 or $15,000 for each year you were not able to work before your normal retirement age. These amounts count toward your $250,000 lifetime cap in monetary benefits under Part E.

Who can perform an impairment evaluation?

Only physicians board-certified in impairment medicine conduct an impairment evaluation. That’s because the guidelines for submitting and garnering approval for an impairment award are lengthy, complicated and rigorous. It’s not simply about having the medical expertise to diagnose an illness. Rather, these specialized physicians (and there are not many of them) must be familiar with what DOL claims examiners will be expecting to see in the impairment report.

Why should you consider being evaluated by a board-certified impairment physician from PCM?

Whether or not you are already receiving your EEOICPA free home care benefits from Professional Case Management (PCM), the first enrolled provider in the U.S. to serve clients under the EEOICPA program, you can have your impairment evaluation completed by one of PCM’s three board-certified impairment physicians. While there are other physicians approved by the DOL to conduct these evaluations, there are benefits of working with a PCM physician. These include:

• Experience. PCM physicians have conducted thousands of EEOICPA-specific impairment evaluations over the years. They know what to look for, what questions to ask and how to help you get maximum benefits.
• Dedicated focus. Evaluating nuclear and uranium workers for EEOICPA impairments is all PCM physicians do. While many doctors may have general practices and do impairment evaluations on the side, PCM impairment physicians focus their work entirely in this area, being certain to stay abreast of the latest guidelines and possessing the understanding of how to best navigate the approval process.
• Personal attention. If you go directly through the DOL and use one of their appointed impairment physicians, your evaluation will likely be completed entirely online. That means you have to be able to “make your case” and adequately explain your impairment in writing and rely on your medical records to qualify you. PCM physicians, in contrast, will schedule a phone call to get to know you and your situation better. In some regions, it is even possible to schedule an in-person appointment. Through these direct communications, PCM impairment physicians are able to get a fuller picture of how your illness is impacting your daily living. They ask questions about challenges that likely are not revealed in a standard medical exam, including possible sleep disruptions, sexual performance challenges, digestive issues, and the ability to enjoy basic hobbies as a result of your diagnosis. This gives them greater insights into your case and more ammunition for justifying an accurate and, sometimes, higher impairment rating—which means more money for you and your loved ones.

Why should you be evaluated?

As a worker in the nuclear defense industry qualified for DOL benefits under EEOICPA, you have already earned the right to receive the various benefits offered under the government Program. If you don’t get evaluated, you’re leaving money you deserve on the table. And if you don’t continue to be re-evaluated every two years or whenever you are diagnosed with a new covered health condition, you are not taking advantage of the full benefits that you have already earned.

Are there any restrictions on how you can use the money?

No. This is the best part of an impairment award. The money you receive is yours to spend as you wish. No restrictions. It doesn’t have to be spent on medical bills or care or anything related to your covered illness. Depending on your personal interests, that could look like a new sports car or tropical vacation or anything you desire. And it’s also tax free and does not interfere with pensions or social security payments.

What should you do if you still have questions or are having difficulty scheduling an impairment evaluation?

As part of its PCM Impairments Division, PCM employs Professional Navigators who are dedicated to helping workers and their families every step of the way of the impairment evaluation process. They can answer questions about the application form itself, provide you with the documents you will need to apply, request medical records from your Providers and schedule an appointment with one of our board-certified impairment physicians. They can also guide you about when to be re-evaluated if new diagnoses have been made so you don’t lose time, or money, from failing to be re-evaluated on time. PCM estimates that 25% of eligible workers have not had an impairment evaluation in six years, which means they are losing out on substantial sums of money.  Don’t be one of these people. Make sure you’re being evaluated on a timely basis.

To learn more about the benefits of impairment evaluations and how you can get started on applying for your award today, contact the Cold War Patriots Outreach Help Center at 888-903-8989 or email [email protected]. As a division of PCM, Cold War Patriots serves as a community resource to help nuclear weapons and uranium workers and their families get the recognition, monetary compensation and healthcare they have earned.