… 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, handled over 1,800 claims. With that experience you learn things about the claims process, people behind the scenes, and what goes right, can go 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, namely Claims Examiners and Management, make mistakes, are likely to apply their own interpretation of the written word (policy and guidelines), and when supervised, trained, managed, the Claims Process usually goes pretty much to plan/expectation.
I first wrote about the “State of the EEOICPA Claims Process” in January 2022. Most all my observations from then continue to the present and are worth reiteration.
As a claimant here are a few facts you may be interested in:
- 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.
- There has been significant turnover in staff, Claims Examiners, Senior, tenured and mid-level management, starting in 2019 and more evident in 2020 to the present.
- 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.
Where are the impacts on the Claim Process most evident in 2023?
- Claims Examiners 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). How do you “know” what’s important or not important?
- Claims Examiners are a) requiring more specific narrative medical opinions, 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 are out of sequence, raise questions of confidence, increase frustration, and extend the claims timeline unnecessarily.
- 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”.
- Senior Claims Examiners have increased workload due to the oversight and training of newer staff. 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 approve consequential conditions. Sending “reminders” to the Claims Examiners has now become necessary more often.
Have there been improvements or positive changes that are noteworthy?
- Advances in the ECOMP portal for claimants to track progress of their claim has improved.
- The ability to submit basic claim forms, EE-1 and EE-2 online, expedites the initial filing process.
- EN 20 banking forms online saves time and expedites distribution of monetary awards. Look for further improvements in 2023.
- A high percentage of claims, those which contain all relevant and necessary documentation at the time of submission (well-organized from the start), are getting processed in less than the nominal 155 work days (the timeline Claims Examiners target for issuance of a Recommended Decision). This leads to claimants being awarded medical benefits sooner, becoming eligible for in-home care and receipt of monetary compensation in their hands sooner.
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.
There is a lot more that could be shared, and as I’ve said before 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.