NIOSH, as part of the  Centers for Disease Control and Prevention within the Department of  Health and Human Services, is responsible for performing several  technical and policy-making roles in support of Labor’s program, including    establishing by regulation methods for arriving at reasonable estimates  of radiation doses received by an individual at a covered facility;    establishing by regulation guidelines to be used by Labor to determine  whether an individual sustained a cancer in the performance of duty  for purposes of the compensation program if, and only if, the cancer  was “at least as likely as not” related to the radiation dose received by  the employee;    establishing procedures for considering petitions to be added to the  special exposure cohort; and    providing the Advisory Board on Radiation and Worker Health with  administrative and other necessary support services. Labor Has Fully Processed Most Claims Not Referred to NIOSH for Dose Reconstructions and Has Generally Met its Timeliness Goals for Claims Processing

As of January 31, 2004, Labor had fully processed 83 percent of the nearly  30,000 claims for benefits under Subtitle B that had not been referred to  NIOSH for dose reconstruction. Forty-two percent of claims  with final decisions were approved, resulting in more than $625 million in  lump-sum compensation payments. The remaining 58 percent were  denied, in most instances because they did not meet medical or  employment eligibility criteria. On average, it took about 7 months to fully  process claims not needing dose reconstruction. Labor Has Taken Steps to Ensure Consistency, Including Accountability Reviews and a Major Update of its Procedures Manual

Labor has taken several steps to help ensure that Subtitle B claims are  processed consistently. Claims Needing Dose Reconstructions Face Large Processing Backlog

In the first 2½ years of the program—July 31, 2001, through January 31,  2004—Labor and NIOSH fully processed about 9 percent of the claims  referred to NIOSH for dose reconstruction, leaving a large backlog of these  claims. However,  NIOSH’s time frame for completing the remaining profiles is uncertain,  and as a result, some claims associated with facilities that do not have site  profiles may take a considerable period of time to be fully processed. To  ensure the consistency of claim decisions, NIOSH’s Advisory Board is  overseeing an effort to evaluate dose reconstruction decisions and site  profiles. In some cases where a  site profile has not yet been developed, these claims are essentially on  hold until the site profile is developed. Fifty-one percent of claims with final decisions as of January 31, 2004,  were approved, resulting in $65 million in lump-sum compensation  payments. Forty-nine percent were denied because the results of the dose  reconstruction were used by Labor to determine that the claimed illness  was not “at least as likely as not” to have been caused by work-related  radiation exposure. Appendix I: Scope and Methodology

To determine how well the Department of Labor’s (Labor) procedures and  practices ensure the timely and consistent processing of claims that are  not referred to the National Institute of Occupational Safety and Health  (NIOSH) for dose reconstruction but are being processed by Labor, we  reviewed Labor’s regulations, procedures, and practices related to  processing claims. To determine how well Labor’s and the NIOSH procedures and practices  ensure the timely and consistent processing of claims that are referred to  NIOSH for dose reconstruction, we reviewed Labor’s and NIOSH’s  regulations, procedures, and practices related to processing claims. We  did not assess the quality of Labor’s claims decisions.
Why GAO Did This Study

Subtitle B of the Energy Employees Occupational Illness Compensation Program Act, administered by the Department of Labor (Labor), provides eligible workers who developed illnesses from their work, or their survivors, with a onetime total payment of $150,000, and coverage for medical expenses related to the illnesses. For some claims, Labor uses radiation exposure estimates (dose reconstructions) performed by the National Institute for Occupational Safety and Health (NIOSH), part of the Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC), to determine if the illness claimed was "as least as likely as not" related to employment at a covered facility. GAO was asked to determine (1) how well Labor's procedures and practices ensure the timely and consistent processing of claims that are not referred to NIOSH for dose reconstruction but are being processed by Labor and (2) how well Labor's and NIOSH's procedures and practices ensure the timely and consistent processing of claims that are referred for dose reconstruction. GAO did not assess the quality of Labor's claims decisions.

What GAO Found

In the first 2 and 1/2 years of the program--July 31, 2001, through January 31, 2004--Labor had fully processed 83 percent of the nearly 30,000 claims that had not been referred to NIOSH for dose reconstruction; these claims correspond to nearly 23,000 cases for individual workers. (Multiple claims can be associated with a case as eligible survivors may each file claims.) Labor took an average of 7 months to fully process these claims. About 42 percent of claims with final decisions were approved, resulting in $625 million in lump-sum compensation payments. The remaining 58 percent of claims with final decisions were denied--the majority because they did not meet medical or employment eligibility criteria. Labor generally met its timeliness goals for processing claims and is working to ensure that claims are processed consistently by conducting accountability reviews and creating a task force to update its procedure manual. In the first 2= years of the program, Labor and NIOSH had fully processed about 9 percent of the more than 21,000 claims (which correspond to about 15,000 cases) that were referred to NIOSH for dose reconstructions, taking an average of 17 months to fully process claims. Fifty-one percent of the processed claims were approved, and Labor has paid out about $65 million in lump-sum compensation. Forty-nine percent were denied because it was determined that the claimed illness was not at least as likely as not related to employment at a covered facility. A backlog of claims needing dose reconstruction developed because NIOSH needed time to get the necessary staff and procedures in place to complete the dose reconstructions and develop site profiles. Efforts are under way to develop site profiles that contain facility-specific information that is useful in completing dose reconstructions. However, processing claims associated with facilities that do not have site profiles, in some instances, has essentially stopped, and NIOSH has not established a time frame for completing these remaining site profiles because of limited expert resources and site complexities. As a result, some claimants could wait a considerable period of time to have their claims fully processed. To help ensure the consistency of claim decisions, HHS's Advisory Board is conducting an independent external evaluation of dose reconstruction decisions and site profiles.