State of the EEOICPA Claims Process – January 2022

… there is no more important time for workers, former workers, or surviving family who are navigating the EEOICPA Claims Process to have a professional guide, an Advocate/Authorized Representative, leading the way.

I’ve been at this business of representing claimants under EEOICPA since 2013, and have handled over 1,500 claims. With that experience, you learn things about the claims process, people behind the scenes, and what can go right or wrong along the way.

I think I “know” the right way to get things done quickly, efficiently, with a high degree of success; I also learn every day that human beings (I’m talking EEOICPA Claims Examiners and Management) make mistakes. They are likely to apply their own interpretation of the written word (policy and guidelines) at times. But when supervised, trained, and managed properly, the Claims Process usually goes pretty much to plan/expectation. 

However, there have been significant operational changes in the EEOICPA Claim process recently, paired with staff turnover and mandatory “Work-From-Home” with limited supervisor oversight. The frequency of mistakes and likelihood for extended claim processing timelines has significantly increased. The latter is the environment we are dealing with as the State of the EEOICPA Claims Adjudication Process in January 2022.

Here are contributing facts you should know about:

1. DEEOIC Senior Management decided in 2019 to move away from a geographic District Office based assignment of cases/claims (based on the location of worker’s last work site), to a broader assignment of cases/claims across all Claims Examiners, regardless of worker’s work site and Claims Examiner location.
2. There has been significant turnover in staff – Claims Examiners, Senior, tenured and mid-level management. This turnover started in 2019 and became more evident in 2020 to the present.
3. With mandatory Work-From-Home scenarios, many Claims Examiners continue to struggle to learn how to use at-home technology, telephony, and are limited in the capability to share work product with their peers or supervisors.

It goes without saying, the pandemic has affected all of us as individuals, consumers, at our favorite restaurants and stores, and in our own workplaces. So, somewhere in this, we need to mindful that we are all in this together. That does not mean we roll over and let the Claims Process go whatever direction or misdirection it takes. So, what “signs” should we be on the lookout for?

Here are some “travel warnings” and comments related to the “facts”:

1. Claims Examiners, those that are new to the game, are “following the book” and sending out a lot (more than usual) of standard, boilerplate letters. There are certain communications that are required for every case, but other letters are optional (and unnecessary) depending on the type of claim and ascertained facts. How do you “know” what’s important or not important?
2. Claims Examiners (again, newbies) are asking for:
   a) narrative medical evidence when pathology reports are already on file (for SEC cancer claims)
   b) requesting additional employment information (after employment was previously verified through ORISE)
   or c) sending out causation letters to claimant’s doctors BEFORE an Industrial Hygienist referral and report.
   Some of these actions out of sequence raise questions of confidence, increase frustration, and extend the claims timeline unnecessarily.
3. Claims are being assigned and reassigned frequently. One day, you receive correspondence from a Claims Examiner in Seattle District Office, and the next week, you get returned phone calls from a Claims Examiner in the Cleveland District Office. You’d like to think you have one person managing your claim and taking responsibility to move things along. Unfortunately, there’s not much you can do on this point. It has become more important to use the Electronic Document Portal to communicate with the assigned Claims Examiner, as contrasted with USPS to the Central Mail Room in London, KY.
4. Claims Examiners are not always aware of the unique employment history at various work sites. With the decentralization of case/claims assignment, the Claims Process has lost quite a bit of “institutional knowledge”. This manifests in letters stating a) that your employer did not have a contract at the work site you know you were at for 10+ years, or b) for your job titles, there are no chemicals found in the Site Exposure Matrix, or c) there is no confirmed employment at a work site at all. Again, the Claims Examiners are “playing by the book” when they do not have access to “work site experts/experience” and it is a case of “they do not know, what they do not know”.  Some of this is correctable, takes more time to work through and unfortunately, leads to claims being denied because of the lack of knowledge/experience of Claims Examiners.
5. Senior Claims Examiners are being taxed with increased workload due to the oversight and training of newer staff. I suppose this is a normal business process whenever there has been staff turnover. The impact is noticeable in that even Senior Claims Examiners are taking longer to respond to inbound communications, longer to issue Recommended Decisions, Impairment approvals and approved consequential conditions. Sending “reminders” has now become necessary more often.

I have raised these issues, my observations, with DEEOIC management, and there is an awareness at a Senior level. Unfortunately, some of these issues are common in the business world whenever there are major operational directives and staff turnover, and the response is that “it will get better” in time.

I guess I understand that we are dealing with humans, and nothing is going to be perfect all the time (especially not the federal government during such difficult circumstances).

That all said, and there is a lot more that could be shared, there is no more important time for workers, former workers, or surviving family who are navigating the EEOICPA Claims Process to have a professional guide, an Advocate/Authorized Representative, leading the way. At AtomicWorkers, we are here to help with answering basic questions as to process and what to expect on your claim, fighting to overturn prior denials, and ensuring that your new claims get to the finish line as quickly and efficiently as possible. Know the road before you go.