Part E compensates DOE contractor or subcontractor workers for all occupationally induced illnesses caused by any toxic substance. Claimants with approved claims can receive compensation for lost wages and impairment of up to $250,000 plus medical benefits for the covered illness.
Part E used to be known as Part D. Originally Part D was managed by Department of Energy (DOE). In 2004 Department of Labor (DOL) took over and now manages Part E claims.
Part E was created to compensate workers whose illnesses were caused, aggravated or contributed to by exposure to toxic chemicals. For a worker, or the family member of a deceased worker, to be compensated Department of Labor must determine that the worker’s toxic exposure was “at least as likely as not a significant factor in causing, aggravating or contributing to” the worker’s illness. These are the magic words of a Part E claim.
Part E is more complex than Part B. While living workers do not receive a lump sum payment as in Part B they are eligible for compensation for impairment and wage loss.
Part E covers workers with a covered illness who worked for a Department of Energy contractor, subcontractor, or Radiation Exposure Compensation Act (RECA) Section 5 uranium miners, millers and ore transporters. It does not cover Department of Energy Employees. Living workers with approved Part E claims will receive medical care for the covered illness and can receive up to $250,000 in compensation for impairment and lost wages.
Surviving family members of deceased workers can receive between $125,000 and $175,000 in compensation with an approved Part E claim. $125,000 is the base compensation. Another $25,000 is added in compensation for each 10 years of work lost before the worker would have reached retirement age up to a cap of $50,000. So a worker who died at age 45 would have lost 20 years of wages and the family would be compensated an additional $50,000. If the worker died after filing the claim the surviving family member may be reimbursed for medical costs that were paid but DOL is very specific in the documentation they require for reimbursement. If a worker dies of a non-covered condition after he has filed a claim but before the claim has been given a final decision the surviving family member can sometimes choose to take impairment and wage loss rather than the $125,000 compensation. Sometimes this makes sense as the amount of impairment and wage loss can exceed $125,000.
Another extremely important benefit of Part E for living workers is the medical card which covers medical care for the approved condition. It covers items like doctor visits, hospital stays, medication, in-home care, hospice care, vehicle modifications, housing modifications, medical alert systems, travel to medical appointments and medically necessary equipment. Many of these services must be approved by DOL in advance. There is a time limit for reimbursement for some expenses, so check with DOL or a Resource Center to make sure you submit your documentation on time. Workers with approved conditions will also be reimbursed for money spent on medical costs beginning at the date the worker filed his or her claim but the documentation needed for reimbursement is very specific, so be sure to check with DOL. One good idea is to set up a special place to save the necessary documentation so you can find it when you need to send it to DOL.
Some claimants report that no doctors in their area take the medical cards. If this is a problem for you can contact DOL or a Resource Center to get your doctor added to the program. DOL also has a webpage where you can work on adding a doctor.
Workers can also receive medical treatment for consequential illnesses. A consequential illness is an illness that develops because of a Part E covered condition. An example of this would be osteoarthritis developing because of steroids that are needed to treat a lung condition.
Once a worker’s covered condition is no longer improving a doctor meeting the criteria set by DOL can use the American Medical Association’s Guide to the Evaluation of Permanent Impairment 5th edition to establish the amount of impairment the worker has suffered. For each percent of impairment that the doctor rates the worker as having lost the worker is paid $2,500. DOL pays for the cost of the impairment rating and it may be done every 2 years because impairment can change over time.
An impairment rating does not automatically happen. A claimant must write DOL and request one. An impairment rating can by done by a DOL District Medical Consultant reviewing the worker’s medical records or it can be done by a qualified doctor of the claimant’s choosing and has a valid medical license, is Board certified in their specialty, such as neurology, occupational medicine, etc. The doctor chosen must also be certified by the American Board of Independent Medical Examiners, or the American Academy of Disability Evaluating Physicians. The doctor must also have knowledge and experience in using AMA’s Guides or have the background and experience to conduct impairment ratings. DOL sends the doctor a form on the information needed and how to apply to be paid for the evaluation.
Workers who had to retire early due to ill health caused by covered illnesses are eligible to file for wage loss under Part E. Again, to apply workers need to write DOL and state they wish to apply. DOL has its own criteria for establishing wage loss. Their criteria is different from Social Security Disability so workers on Social Security disability need to meet DOL’s criteria as well. The wage loss must be caused by the covered illness and based on medical evidence.
Courtesy of EECAP.ORG.