Potential Claims Processing Delays in Energy Program

The Department of Labor’s Inspector General audited the Department’s Office of Workers Compensation Programs to determine if the COVID-19 is having any impact on processing claims.  Below is the IG’s report for the Division of Energy Employees Occupational Illness.

POTENTIAL CLAIMS PROCESSING DELAYS IN THE ENERGY PROGRAM

DEEOIC administers claims filed under the Energy Employees Occupational Illness Compensation Program Act. The Act provides compensation and medical benefits to current or former DOE employees and contractors who contracted certain illnesses as a result of occupational exposure during the production of nuclear weapons.

According to DEEOIC officials, DEEOIC has not received any COVID-19 claims to date. COVID-19 would only be covered under the Energy Employees Occupational Illness Compensation Program Act as a consequential condition. Because of this, DEEOIC officials stated that they do not expect many, if any, COVID-19 related claims. However, COVID-19 has still had an impact on DEEOIC claims processing.

SOCIAL DISTANCING IMPACT ON CLAIMS PROCESSING

As a result of COVID-19 and social distancing mandates, some DOE facilities have completely closed or are operating with minimal staff. This has impacted the Energy Program because it relies on employment information from these facilities to adjudicate claims and the records research required is not always considered essential by DOE. DEEOIC is monitoring the situation and maintaining frequent communication with DOE through scheduled conference calls, ad-hoc telephone calls, and emails. As of May 19, 2020, 59 claims were experiencing delays caused by difficulty obtaining records from DOE.

DEEOIC has also been impacted by COVID-19 because some physicians are unable or unwilling to conduct medical evaluations and complete medical reports. DEEOIC needs this information to issue a decision on a claim or to award monetary compensation, and is being flexible regarding the timeframes for medical evidence on a case-by-case basis. As of May 19, 2020, 123 claims were experiencing delays caused by difficulty in obtaining medical documentation from physicians or other COVID-19 related issues.

According to DEEOIC officials, as of May 29, 2020, these delays had not yet impacted DEEOIC’s performance measures for timeliness. However, DEEOIC officials stated they are tracking any delays that occur and will be able to identify any cases where adjudication was delayed as a result of COVID-19.

ASSISTANCE TO CLAIMANTS

To assist claimants during the pandemic, DEEOIC has published answers to frequently asked questions on its website and issued two policy bulletins. These bulletins allow for the temporary use of telemedicine for nonemergency, routine medical appointments, and for evaluations related to initial requests for, or requests for increased levels of, home/residential health care and durable medical equipment requests. The bulletins expire September 30, 2020.