Energy Employees Compensation:
DOL Generally Followed Its Procedures to Process Claims but Could Strengthen Some Internal Controls
GAO-16-74: Published: Mar 10, 2016. Publicly Released: Mar 10, 2016.
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What GAO Found
The Department of Labor's (DOL) adjudication process for compensating Department of Energy contract workers or their survivors for illnesses linked to work in the nuclear weapons industry generally follows guidance and procedures implementing Part E of the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA). Although GAO's analysis of a generalizable sample of 200 claims filed by workers from 2010 through 2014 found the adjudication process generally followed DOL's guidance and procedures, GAO identified some inconsistencies in an estimated 10 percent of the claims, including errors in correspondence to claimants and in development of claims. The procedure manual stipulates that written decisions should clearly convey information that led to the decision and that decisions are to be reviewed by the appropriate signatory. GAO found that decisions sometimes contained inaccurate, conflicting, or incomplete information, such as listing the wrong medical condition. DOL also did not always run accurate searches of its Site Exposure Matrices (SEM)—an online electronic database of facilities, toxic substances, and associated illnesses—when processing claims, or responding to requests for reopening claims. In addition, GAO found that supervisory review is at the discretion of each district office and, as a result, recommended decisions on claims were not always reviewed. This may increase the likelihood of poorly written decisions, which is inconsistent with procedures and which, in turn, increases the potential for claimant confusion and delays in adjudication.
DOL uses the SEM to, among other things, document newly identified causal links between toxins and diseases on the basis of medical research. According to DOL officials, since 2006 the number of such links listed in the SEM has increased from about 300 to over 3,000. They said that due to the large volume of information updates, DOL provides limited notification to claims examiners and the public when they occur. It has issued 10 notices specifically on new links since 2006. Therefore, it is usually incumbent on claims examiners and claimants to make themselves aware of new links by continuously checking the SEM for updates. As a result, new links are applied to claims largely to the extent these checks are performed. However, claims examiners are not always required to document that they checked whether the SEM had been updated prior to issuing a recommended decision to deny a claim. This gap in documentation hinders DOL's ability to monitor program performance, consistent with federal internal control standards.
According to DOL's monitoring, its process for adjudicating Part E claims is working satisfactorily, but persistent deficiencies remain. DOL conducted reviews from fiscal years 2010 through 2014 based on random sampling and found that the process for adjudicating claims met DOL's acceptability standards in any given year. Nonetheless, DOL consistently found deficiencies in certain adjudication steps across all years, including insufficient use of program resources to fully develop claims and improperly written decisions, as GAO also identified in its claim file review. DOL took corrective actions, such as training for claims examiners, to address deficiencies in 2010 through 2012, but determined that corrective actions were not warranted in 2013 and 2014.
Why GAO Did This Study
EEOICPA was enacted in 2000 to compensate employees and contractors of the Department of Energy whose illnesses are linked to their work in the nuclear weapons industry. Part E of the Act, enacted in 2004, compensates these contractor and subcontractor workers, or their eligible survivors, for medical expenses, impairments, and lost wages up to $250,000. GAO was asked to review DOL's management of this program.
GAO examined (1) the extent to which DOL follows its procedures to adjudicate Part E claims, (2) how DOL captures new links between toxic substances and diseases and applies them to adjudication, and (3) what DOL's monitoring indicates about the adjudication process and whether any corrective actions have been taken to address identified problems. GAO reviewed a generalizable stratified random sample of 200 Part E claims filed from 2010 through 2014; reviewed applicable federal laws, regulations, guidance, internal audit reports, and other agency documentation associated with internal monitoring; and interviewed DOL officials.
What GAO Recommends
GAO recommends that DOL take steps to ensure all decision letters receive supervisory review, and require that claims examiners document that they checked whether the SEM had been updated just prior to issuing a decision to deny a claim. DOL agreed with the recommendations and indicated it would take steps to implement them.
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Recommendations for Executive Action
Status: Closed - Implemented
Comments: The Department of Labor agreed with our recommendation noting that a second level supervisory review will provide a higher degree of internal quality control. Labor has implemented a process whereby all supervisors in the district offices and Final Adjudication Branch offices review a sample of 10 percent of Recommended Decision and Final Decision letters prior to issuance to claimants. Errors such as misspelling of names and misidentification of information are corrected. Labor catalogues these reviews using an electronic system that generates summary statistics on the number of reviews and letters requiring corrections. Results data for the first two quarters of fiscal year 2019 show over 2,700 letters had been reviewed, with both the district offices and the Final Adjudication Branch exceeding the 10 percent review criteria. Corrections were required in less than 10 percent of the decision letters reviewed.
Recommendation: To enhance consistency with DOL policy and procedures in adjudicating EEOICPA Part E claims, the Secretary of Labor should strengthen internal controls by requiring district offices to take steps to ensure that all claimant correspondence for Recommended and Final Decisions receives supervisory review.
Agency Affected: Department of Labor
Status: Closed - Implemented
Comments: The Department of Labor agreed with our recommendation pertaining to documenting searches of the Site Exposure Matrix (SEM) during claims processing. In direct response to our recommendation, Labor has updated the Federal Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Procedure Manual with guidance (Section 15.14) to claims examiners (CE) stating that, when issuing a Recommended Decision (RD), "a new SEM search is to be conducted before the RD is released to ensure that no substantive changes have occurred. The CE is to image the new search results into OIS to clearly document that a new review took place." At Labor's initiative, the updated Procedure Manual also contains guidance stating that a similar SEM search, and documentation of the search results, be conducted prior to issuing a Final Decision.
Recommendation: To enhance consistency with DOL policy and procedures in adjudicating EEOICPA Part E claims, the Secretary of Labor should strengthen internal controls by requiring district offices to document that the SEM was checked for updates just prior to issuing a Recommended Decision to deny a claim in cases in which the date of the last SEM update has not changed since the claims examiner's prior check.
Agency Affected: Department of Labor