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DOL Advisory Board Continues Its Mission to Provide Guidance to Claims Examiners

December 21, 2016

December 21, 2016

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News & Events

The Department of Labor’s Advisory Board on Toxic Substances and Worker Health’s Subcommittee on Medical Advice, re: Weighing of Medical Evidence, held a teleconference on December 12, 2016.  The agenda included discussion of the findings after a review of 14 claims, a review of some training materials, and talk about the logistics for a few of the Subcommittee members to meet with claims examiners in a focus group.

Claims Review

The claims reviewed by the Subcommittee ranged from cancers to hearing loss. While this is an extremely small sampling (a total of 90,508 Part E claims have been filed as of 12/11/16), the Subcommittee found a number of common deficiencies among the claims they reviewed.

Half of the claims reviewed had at least one disease that was not developed, or was stopped from being developed, because a search of the Site Exposure Matrix did not produce a link between the disease and exposure to a toxic substance.

One claim was approved for hearing loss even though the worker was not employed in one of the labor categories DOL specifies as being susceptible to hearing loss in their procedure manual.

Another claimant was approved for kidney disease because of his exposure to trichloroethylene (TCE) at a gaseous diffusion facility.  This claimant was employed less than a year but the CMC found a scientific study which implicated TCE as causative factor in causing kidney cancer in workers who had less than one year’s exposure.

One claim had over 500 pages of documents.  It was well organized and easy for the Subcommittee member to review.  Other files were not so organized and at least one had a copy of the CMC’s report missing.

The Subcommittee members voiced the opinion that the Contract Medical Consultant (CMC) must have a copy of the complete file.  The current policy is that the claims examiner will decide which information in the file will be forwarded to the CMC in the Statement of Accepted Facts (SOAF).  The Subcommittee has serious concerns that some valuable information will not be included and that may result in a faulty opinion.

It was noted that it appears that the sick claimants or their survivors are not in a good position to advocate for themselves.  One claim that was reviewed revealed that only with the help of an authorized representative was the claimant able to prove that he qualified as a member of the Special Exposure Cohort.

Training Materials

The next discussion concerned the training manuals.  A couple of members questioned why these materials weren’t provided to the Board when they asked for them during the April 2016 meeting.  They thought they were told by the DOL that there weren’t any materials. However, they have since been provided over 60 documents.  One member said this would have been helpful in the beginning so she could have had a sense of the claims process.  A DOL representative explained that these materials only provide a “basic framework” for the claims examiners but that the National Office performs a “huge volume of case-by-case scenarios” with lots of hands-on evaluation.

Overall, the Subcommittee was pleased with the training materials, however, they did find a few problematic issues.  For example, one document instructs the claims examiner not to deny a claim based on the lack of information in the Site Exposure Matrix.  As noted above in the review of the claims, there appears to be a disconnect between the training materials and what actually happens in the claims process.

The disease link in the Site Exposure Matrix is no longer updated because there is no longer a Memorandum of Understanding between DOL and the Institute of Medicine.  One Subcommittee member asked how new information showing a link between a disease and a toxic substance will be included in the database.  This question will be referred to the Subcommittee reviewing the database.

Claims Examiner (CE) Focus Group

The Subcommittee wants to meet with claims examiners in a small focus group. The DOL representative said that meeting with the union CEs may be a problem but DOL will make the managerial level supervisors and policy people available.  The Subcommittee said that will not be as useful.  They asked DOL to explore the labor relations issue and try to allow it.  The Subcommittee said they need to hear from the CEs not the department heads because the Subcommittee needs to understand things/problems at the CE level to identify problems.