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When the Courts get involved with EEOICPA claims
October 11, 2019
October 11, 2019
by: Terrie Barrie
Full disclosure – I am not an attorney, nor have I formally studied the law. But I was alerted to this court decision, Adams v. US Dept. of Labor (DOL), by an authorized representative for claimants and I thought some of you would be interested.
I’m not sure how many claimants know this but the Energy Employees Occupational Illness Compensation Act of 2000, as amended, allows a claimant to file a complaint in federal court system after a final decision to deny a claim. The court can decide in the claimant’s favor if they can prove that a DOL decision to deny was made in an arbitrary and capricious manner.
I cannot get into the “arbitrary and capricious” standard. That is an area where you would need to consult an attorney. However, I am aware of a couple of decisions, prior to this decision, where the court ruled in the claimant’s favor and made DOL re-adjudicate the claim – Barrie v. DOL (2009), Brigham v. DOL, and Lucero v. DOL.
According to this decision, Claimant Adams was denied Part E benefits for Chronic Obstructive Pulmonary Disease (COPD) due to her exposure to beryllium. She was previously approved by DOL for beryllium sensitivity which proved that DOL determined that she was exposed to this metal. DOL rejected her arguments and the supporting scientific studies she provided to them linking beryllium exposure to COPD. The court agreed that DOL acted in an arbitrary and capricious manner and sent the claim back to DOL.
I’m not going to detail all of the court’s findings. However, I noticed that the court found practices by DOL that are common to other denials I have heard from claimants or their authorized representatives. For example, the court found that DOL,
…the Final Decision’s reliance upon the Industrial Hygienists and Contract Medical Consultant’s conclusions became glaringly problematic because those conclusions were exclusively grounded in the SEM, ignored the new, relevant science, and failed to consider Adams’ beryllium exposure.”
I’m not advocating that every denied claim should go to federal court. That process is long and arduous and not for the faint of heart. Proving that DOL acted in an arbitrary and capricious manner is difficult. Plus, the claimant only has 60 days after the final decision to file the federal complaint.
However, it appears to me that the above observation by the court on DOL’s reliance of the Site Exposure Matrix (SEM) by the claims examiner, industrial hygienist and contract medical consultant could be used to help claimants whose claim was denied because DOL’s decision relied strictly on what information is in SEM.
The court’s decision also included two links to government agencies’ papers on beryllium induced COPD, which may help claimants in a similar position:
National Institute for Occupational Safety and Health, HEALTH CONCERNS FOR WORKERS WHO WORKED AROUND BERYLLIUM (2011)
I hope this will benefit some claimants. If you need additional assistance, please call our Help Center at 888-903-8989.