Date Employee:
Case ID:
Requester name
Address
City, State, Zip Code
Dear Mr./Mrs. Requester:
I am writing concerning the alternative filing request you filed under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) to receive a determination as to whether your [employee relationship to survivor] contracted an illness as a result of exposure to a toxic substances while working at [facility].
Under the EEOICPA implementing regulations (20 CFR § 30.101(f)), a finding can be made by the program acknowledging the hazards faced by a deceased employee who worked in the Department of Energy atomic weapons program, even when there are no qualifying survivors eligible to receive benefits.
The Division of Energy Employees Occupational Illness Compensation (DEEOIC) will investigate the details of your [relationship’s] employment history to determine if he/she contracted an illness as a result of occupational exposure to a toxic substance while working at a DOE facility. You will receive a determination letter outlining the results of this investigation.
You should be aware that the information gathered as a result of this investigation does not change your eligibility to receive compensation under the EEOICPA. Additionally, the results reported to you cannot be used as evidence that your [relationship’s] illness was caused by his/her employment for the purposes of any law suit or workers’ compensation program, including the EEOICPA.
Should you wish to have your case fully investigated and adjudicated, you can choose to file a claim at any time. If you file a claim, after gathering and assessing the necessary evidence, you would receive a recommended and final decision. You will need to complete and submit a form EE-2 (which can be found on DOL’s website at http://www.dol.gov/owcp/energy/regs/compliance/EEOICPForms/ee-2.pdf, the District Offices, or any Resource Center) to begin the adjudication process.
Sincerely,
Claims Examiner,
(City) Office