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EEIOICPA Procedure Manual Changes – Part 5 Miscellaneous

December 13, 2019

December 13, 2019

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Industry News

The Department of Labor’s Division of Energy Employees Occupational Illness Compensation (DEEOIC) revised its Procedure Manual on November 21, 2019.  Cold War Patriots has reviewed the changes and will provide a summary and how they may affect your claim. This is Part 5 of a 5 part series.

The other changes to the Procedure Manual (PM) include:

  • PM describes what information must be included in a Letter of Medical Necessity (LMN) for oxygen therapy. A letter of medical necessity, following a face to face visit with the doctor, specifying why the medical service is necessary for his covered disease.

The LMN must clearly identify the type of ancillary medical service sought, explain why it is medically necessary for the accepted condition, and specify the duration of use. The requestor is to    submit any supporting documentation substantiating the medical need for the requested service (i.e.; medical reports, prescriptions, therapy reports, diagnostic reports.

  • Authorized Reps no longer able to sign EE-1 or EE-2. Only claimant, guardian or POA.  This also applies to consequential diseases and metastatic cancers.
  • If a claimant withdrew a claim but now wants to pursue it, the claimant, guardian, or POA must submit a signed letter or new EE-1 or EE-2 claiming the same conditions. DOL will then resume development where it was left off.  If the withdrawal request was submitted after a RD was issued a new RD will not be issued.  If a hearing was scheduled before the claimant withdrew a new hearing will not be rescheduled.  Instead FAB will conduct a review of the written record.  If a claimant withdrew the claim before filing an objection to the RD he does not lose the right to a hearing.
  • If a claimant has designated an authorized representative, DEEOIC still can contact the claimant directly if the AR is unresponsive, provides unclear guidance or direction or a contradiction exists between information received from an AR versus the claimant.
  • Leukocytosis and thrombocytosis are not a diagnosis of and SEC cancer.
  • Medical Benefits’ claims examiners will now decide and authorize payment of services, appliances, supplies, modifications or travel expenses. This includes home health care, durable medical equipment and therapies.
  • Time to respond to requests from DEEOIC for additional medical documentation which supports the request for medical benefits (DME, therapy, etc.) has been reduced from 30 days to 15 days. If the requested information is not provided DEEOIC has the option to send to a CMC.
  • DEEOIC will now allow HHC care givers to accompany claimants to doctor visits. Pre-approval will not be required if the travel is under 200 miles round trip and 3 or less trips per week.  DEEOIC will reimburse mileage to either the claimant or the care giver depending on whose car was used.

If you have any questions or concerns about this policy change our Help Center is here for you, 888-903-8989.