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Below are the head notes for the FAB decisions and orders relating to the topic heading, State Workers’ Compensation Benefits. The head notes are grouped under the following subheadings: Apportionment, Calculating amount of ongoing benefits, Coordination with Part E award, Relationship of coordination and the maximum amount payable, and Settlement of claim. To view a particular decision or order in its entirety, click on the hyperlink for that decision or order at the end of the head note.

Apportionment

  • Where the claimant settled a state workers’ compensation claim based on his CBD and FAB subsequently accepted his EEOICPA claims for that same covered illness and for consequential illnesses causally related to that covered illness, it was not necessary to apportion the claimant’s impairment award between his CBD and his consequential illnesses.  EEOICPA Fin. Dec. No. 20230602-58887-5 (Dep’t of Labor, August 15, 2023).
  • The regulations provide that when an employee’s impairment rating is comprised of multiple impairments and at least one of those impairments is subject to coordination of Part E benefits, the potential Part E impairment award must be reduced proportionately.  EEOICPA Fin. Dec. No. 20221201-48314-5 (Dep’t of Labor, December 13, 2022).
  • Because the claimant had received state workers’ compensation benefits for two of the same covered illnesses for which benefits were awarded under Part E, his 87% combined whole-person impairment rating had to be apportioned to reduce the dollar amount of his award attributable to the organ or body function subject to coordination.  EEOICPA Fin. Dec. No. 20221201-48314-5 (Dep’t of Labor, December 13, 2022).
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Calculating amount of ongoing benefits

  • Before calculating the amount of a Part E impairment award involving coordination with state workers’ compensation benefits, DEEOIC uses the most updated and accurate information possible.  However, in this case, the employee was not able to provide the most recent amount of his ongoing state workers’ compensation benefits, and because the employee had a large surplus due to his receipt of both tort settlements and state workers’ compensation benefits, obtaining the exact figures was less crucial. Thus, DEEOIC used evidence already in the employee’s file to estimate the amount of state workers’ compensation benefits he had received in the nine months since the insurer provided its last report.  EEOICPA Fin. Dec. No. 20221201-48314-5 (Dep’t of Labor, December 13, 2022).
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Coordination with Part E award

  • No coordination of benefits payable under Part E to the surviving spouse is required to account for state workers’ compensation benefits previously received by the employee for the same covered illness but not by the surviving spouse. EEOICPA Fin. Dec. No. 53489-2006 (Dep’t of Labor, December 14, 2005); EEOICPA Fin. Dec. No. 70540-2005 (Dep’t of Labor, October 26, 2005).
  • Where employee had filed a Part E claim but died before payment could be issued for his lung cancer, Part E medical benefits awarded to the survivor needed to be coordinated with the amount of the state workers’ compensation benefits that the employee had received for the same covered illness since the Part E medical benefits were based on the employee’s entitlement to Part E benefits. EEOICPA Fin. Dec. No. 70540-2005 (Dep’t of Labor, October 26, 2005).
  • When an employee’s spouse receives state workers’ compensation benefits due to the employee’s death and the spouse subsequently dies, Part E benefits payable to the employee’s child are not coordinated with the amount of state workers’ compensation benefits received by the spouse. EEOICPA Fin. Dec. No. 10002848-2005 (Dep’t of Labor, July 27, 2005).
  • EEOICPA provides that Part E benefits must be reduced to reflect the amount of any benefit (other than medical benefits and benefits for vocational rehabilitation) that the claimant has received under a state workers’ compensation system by reason of the same covered illness(es).  Because the claimant received $94,072.31 to settle his state workers’ compensation claim, the claimant was not entitled to an increased impairment award and a surplus of $4,072.31 was calculated that would need to be absorbed out of any future Part E benefits.  EEOICPA Fin. Dec. No. 20230602-58887-5 (Dep’t of Labor, August 15, 2023).
  • Where the evidence of record was insufficient to determine that a claimant’s state workers’ compensation settlement included both covered and non-covered illnesses that arose out of and in the course of the same work-related exposure, the claimant’s Part E benefits had to be coordinated with the settlement.  EEOICPA Fin. Dec. No. 20230607-77830-5 (Dep’t of Labor, September 29, 2023).
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Relationship of coordination and the maximum amount payable

  • To give the proper effect to both EEOICPA and the regulations, an employee’s potential Part E benefits are capped when the combination of impairment and/or wage-loss benefits reach the statutory maximum of $250,000, and this amount must then be coordinated with the state workers’ compensation benefits that the employee received (if appropriate) to arrive at the net lump-sum Part E benefit amount to be paid to the employee. EEOICPA Fin. Dec. No. 10032182-2006 (Dep’t of Labor, March 3, 2008).
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Settlement of claim

  • A judge issued an order approving a settlement of a state workers’ compensation claim that the employee filed for asbestos-related lung disease, the same covered illness that the FAB later accepted in his Part E claim. Although the judge’s order contained language implying that the settlement was also for a “non-malignant respiratory injury,” the medical evidence of file only established that the claimant had been diagnosed with asbestos-related lung disease. Thus, the amount of the settlement of his state workers’ compensation claim was coordinated with the Part E award because the claimant did not receive state workers’ compensation for an actual non-covered illness in addition to a covered illness. EEOICPA Fin. Dec. No. 10013372-2006 (Dep’t of Labor, May 9, 2007).
  • Coordination of Part E award for asbestosis with state workers’ compensation settlement was required where the employee’s workers’ compensation complaint alleged “asbestosis or asbestos-related lung disease, due to, or as a consequence of his exposure to asbestos” and the court order approving the settlement found that the employee had contracted one work-related illness, “asbestos-related lung disease.” The court’s statement that the settlement would relieve the employer of all liability to the employee for “the claimed occupational asbestos-related lung disease and any non-malignant respiratory injury” did not mean that the settlement was for anything other than the employee’s covered illness of asbestosis, which was the only work-related disease established by the medical evidence of record. EEOICPA Fin. Dec. No. 10039710-2007 (Dep’t of Labor, November 30, 2007); EEOICPA Fin. Dec. No. 10068242-2008 (Dep’t of Labor, July 25, 2008).
  • Coordination of a Part E award for increased impairment benefits with state workers’ compensation settlement was required where the claimant did not establish entitlement to the exception to coordination in the regulations.  While the settlement agreement noted the existence of a claim for two illnesses that were not covered under EEOICPA, neither the agreement nor the claimant’s EEOICPA case file supported a finding that those non-covered illnesses were related to the same occupational exposures as his covered illnesses, which is required for the exception to coordination to apply.  EEOICPA Fin. Dec. No. 20230607-77830-5 (Dep’t of Labor, September 29, 2023).
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