Presentation on theme: "EEOICPA Subtitle D Making EEOICPA Work Bunning Bingaman Reform Amendment of 2004."— Presentation transcript:
EEOICPA Subtitle D Making EEOICPA Work Bunning Bingaman Reform Amendment of 2004
2 July 12, 2004 Bunning Bingaman EEOICPA Subtitle D Reform of 2004 How We Got Here EEOICPA was passed into law in 2000 Subtitle B assigned to DOL 55,000 claims more than 95% processed Subtitle D assigned to DOE Almost 25,000 claims; only 3% of cases processed through physician panels Bipartisan Senate staff group studied options to fix the Subtitle D problems and drafted an amendment to: Make the program operate as intended Assure prompt processing and payment Keep costs to reform program as low as possible
3 July 12, 2004 EEOICPA 2000 Subtitle D State Workers’ Compensation Benefits for Sick Workers DOE was given 2 Major Responsibilities: Case Processing Gather worker employment, exposure and medical records Gather facility exposure records Assemble case files for review Review worker illness to see if it was caused by DOE work Claims Payment Assist claimants in applying for state workers’ compensation benefits Work with DOE contractor employer, insurers and others to assure payment of valid claims
4 July 12, 2004 DOE has failed at both Case Processing and Claims Payment There have been three Senate hearings on DOE’s failure to perform GAO found major problems with both case processing and claims payment The Hays Report, prepared by Workers’ Compensation Experts at DOE’s request, noted problems with both case processing and DOE’s data systems DOE’s promise in March 2003 to complete 100 cases per week through physician panels has gone unmet
5 July 12, 2004 Bunning Bingaman Solves the Current Subtitle D Problems In the first 3 years of operation, DOE has only processed 769 cases through physician panels to determine if a worker was made ill by their exposures at DOE.
6 July 12, 2004 DOE EEOICPA Claims Paid $95 Million; 24,000 claims; only 10 payments DOE has received $95 Million in funding for EEOICPA DOE has been accepting EEOICPA claims since July of 2001 DOE has received more than 24,000 claims DOE has paid only 10 claims 1 claim paid 03/ claims paid 05/ claims paid 07/2004
7 July 12, 2004 Current DOE Subtitle D Production 769 claims out of 24,000 total have been processed by DOE DOE physician panels have found 302 cases where illnesses were caused by DOE work and DOE has paid only 10 of those cases More than 8,000 claims, or one third of total claims filed, have not yet had work begun on them.
8 July 12, 2004 DOE’s Proposed Path Forward More Time and Money for a Flawed and Failed Process DOE’s Plan has No Payer for Valid Claims DOE’s Plan is Based upon Unmet Production Goals DOE has received $95,000,000 in the past 4 years and has paid only 10 claims At Current DOE Production Rates, DOE will not complete today’s Cases until 2013 Every Negative Case will take % longer to process
9 July 12, 2004 Bunning Bingaman EEOICPA Subtitle D Reform Amendment Making Subtitle D work as intended Makes Subtitle D work as Congress intended in 2000 by providing timely payment of valid claims Assures prompt payment of all valid claims by ensuring a willing payer Maintains causation standard for seamless transfer of causation determination operations Processes Cases in their current order. Claimants already in the program do not start over, but retain their place in line Ensures no delay during transfer by maximizing efficiency of transfer of program to DOL. DOE will continue to have physician panels review cases during the transfer until DOL takes over the program.
10 July 12, 2004 Bunning Bingaman EEOICPA Subtitle D Reform Amendment Making Subtitle D work as Intended CBO estimates minimal costs to transfer Subtitle D from DOE to DOL DOE retains record retrieval responsibilities – they will be able to focus on this important responsibility instead of continuing to try to learn claims processing on the job Case processing goes to the country’s most efficient claims operation: DOL Reforms retain state workers’ compensation level benefits, fulfilling Congress’ intent with the original EEOICPA law
11 July 12, 2004 Bunning Bingaman EEOICPA Subtitle D Reform Amendment Making Subtitle D work as intended – Transfer to DOL Bunning Bingaman Assures a Smooth Transfer of Operations and Prompt and Certain Benefits Minimal Additional Costs CBO estimates minimal costs to transfer program to DOL No Delay for Current Cases During transfer of program to DOL, DOE will continue review of cases in the system to ensure no delay DOE currently has more than 1,600 cases awaiting panel review. Those cases will proceed to DOE physician panels It will take DOE more than 6 months to complete the physician panel reviews currently pending DOL Review of Cases: DOL runs the most efficient claims operation in the country DOL will begin reviewing cases before DOE has completed its physician panel causation reviews Same causation standard is used by both agencies - allows both agencies to produce findings simultaneously during transfer of operations and ensure uniformity with cases already reviewed by DOE DOL will maintain claimants’ ‘place in line’ DOE has not yet assembled 17,000 cases. Records for those cases will be requested, gathered, and sent to DOL for case assembly
12 July 12, 2004 Bunning-Bingaman Reforms versus DOE Path Forward Bunning Bingaman Provides a willing payer for all claims Maximizes coordination between Subtitle B and Subtitle D programs to accelerate claims processing. A positive finding in Subtitle B equals a positive in Subtitle D Retains any work already completed by DOE for a smooth transition of claims processing No risk to applicants of losing their current place in line for claim processing No delays in case processing Assures proper and timely case processing Cases will be completed by 2007 DOE Path Forward Lacks a willing payer for all valid claims. As many as 50% of valid claims will go unpaid Maintains current case development with inadequate database and inefficient case preparation and causation review DOE promise to complete 100 cases per week through panels still unmet New DOE path takes % longer for each negative case At current processing rate, DOE will not complete current claims until 2013 (6 years longer to process claims than DOL)
13 July 12, 2004 Current Subtitle D Cases Completed Bunning-Bingaman v. DOE DOE’ Current Processing Rate Bunning Bingaman reform DOL Processing Rate
14 July 12, 2004 STATE 1 CASES CURRENT EEOICPA: PREDICTED OUTCOME DOE PATH FORWARD: PREDICTED OUTCOME BUNNING- BINGAMAN % CLAIMS PAID Alaska 3,7 97no willing payer, 0% paid 100% paid California 7 658payer not identified 10 unknown100% paid Colorado 2 1,750no willing payer, 0% paid 100% paid Florida 4,7 495no MOU0% paid100% paid Iowa 2 654no willing payer, 0% paid 100% paid Idaho 2 1,005no willing payer, 0% paid 100% paid Illinois 4,7 58no MOU0% paid100% paid Kentucky 5 2,961no willing payer, 0% paid 100% paid Missouri 4,7 679no MOU0% paid100% paid New Jersey 8,7 100no willing payer, 0% paid 100% paid New Mexico 6,8 1,713payer not identified 10 Unknown100% paid Nevada 7 555no willing payer, 0% paid 100% paid New York 4,7 91no MOU0% paid100% paid Ohio 2 1,617no willing payer, 0% paid 100% paid South Carolina 2 3,6203 payments % 9 unknown100% paid Tennessee 6 5,0245 payments % 9 unknown100% paid Texas payment % 9 unknown100% paid Washington 6 2,0891 payment % 9 unknown100% paid West Virginia 4,7 143no MOU0% paid100% paid EEOICPA Subtitle D Claim Payments: Bunning-Bingaman v. DOE Footnotes for this exhibit are on the following page
15 July 12, 2004 Notes to accompany prior slide EEOICPA Subtitle D Claim Payments Bunning Bingaman v. DOE 1 States with current or former DOE facilities and that have at least 50 claims. 2 GAO stated no willing payer – May States with no willing payer according to DOE – submission 07/02/04. 4 States with no MOU between the state and the DOE. With no MOU, DOE will not review claims for causation. 5 GAO reported that DOE claimed a willing payer for Kentucky claims. DOE has not provided any such evidence. 6 GAO identified a potential willing payer. 7 These jurisdictions were not addressed by GAO. 8 No willing payer identified by DOE in a state where the system may have a mechanism for payment. 9 According to DOE report – 07/02/04 – this represents 100% of DOE payments made. 10 DOE has not identified a payer in states where the system would permit such a payer.