Sample Letter to Potential Survivor Advising of Right to File Claim

 

Dear Claimant Name:

 

We have been advised that you may be an eligible survivor of the above-named employee under the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA).

 

Enclosed is Form EE-2, Claim for Survivor Benefits under EEOICPA. If you wish to be included in the claim for survivor benefits under our program, please complete the EE-2 form and return it to this office at the address noted above at your earliest convenience.

 

Once we receive your completed form, your claim will be added to the existing case file. We will use the Case ID number referenced above, so please include this Case ID number in any future correspondence or telephone inquiries concerning your claim.

 

If you have knowledge of other individuals who may also be entitled to claim benefits as a survivor of your [enter survivor’s relationship to deceased], please include their contact information on the EE-2 form, including name, address, and telephone number (if known).

 

For claims under Part B of the EEOICPA, the definition of an “eligible survivor” and the order of payment are as follows:

 

1. If there is a living spouse (married to the employee for at least one year immediately before the death):

 

a. Spouse receives entire amount;

 

b. UNLESS there is at least one child of the employee who is a minor at the time of payment and not a child of the spouse – in which case half of the award goes to the spouse and the rest is split between all living minor children of the employee.

 

2. If there is no living spouse, the award will be given in the following order:

 

a. Living children;

 

b. If none of the above, to living parents of the employee;

 

c. If none of the above, to living grandchildren of the employee;

 

d. If none of the above, to living grandparents of the employee.

 

For claims under Part E of the EEOICPA, the definition of an “eligible survivor” and the order of payment are as follows:

 

1. If there is a living spouse (married to the employee for at least one year immediately before the death):

 

a. Spouse receives entire amount;

 

b. UNLESS there is at least one living child of the employee at the time of the payment who is also a “covered child” under Part E (i.e., under the age of 18 years at the time of the employee’s death, or under the age of 23 years and continuously enrolled as a full-time student since attaining the age of 18 at the time of the employee’s death, or any age and incapable of self-support at the time of the employee’s death) and not a child of the spouse – in which case half of the award goes to the spouse and the rest is split between all “covered children” of the employee living at the time of payment.

 

2. If there is no living spouse, the award will be split between all “covered children” of the employee who are living at the time of payment.

 

Although there is no time limit for the filing of a claim for benefits under the EEOICPA, we ask that you respond to this request within 30 days from the date of this letter in order to prevent any delay in the adjudication and awarding of benefits for this case.

 

Also, please note that filing a claim does not guarantee your eligibility for benefits under the EEOICPA. Additional investigation will be required to determine if all statutory and regulatory requirements have been met before compensation can be awarded.

 

If you have any questions, please feel free to call or write us at the above address.

 

Sincerely,

 

 

Claims Examiner

(City) Office

 

 

Enclosure: EE-2, Claim for Survivor Benefits

EE-3, Employment History

EE-7, Medical Requirements