EEOICPA Denied Claims and Non-Filed Illnesses

When initiating a claim for EEOICPA benefits, claimants want to give themselves the highest probability of getting their claims approved. Unfortunately, many self-filing claimants slowly proceed through the process, and they wait for the U.S. Department of Labor to respond before moving on to the next step. The reason for this slower timeline is because these claimants are not familiar with the filing process. By not fully understanding the process, it can leave you susceptible to a denial. Denials can cause claimants to give up of their claims because they do not fully understand what other paperwork might be required or how to obtain it. Denials also cause claimants to hire Authorized Representatives who can legally charge you 10 percent of your awarded financial compensation. It is urgent that all the appropriate paperwork is submitted in a timely manner, and ideally, you would submit that paperwork before the Claims Examiner requests it. 

Through my experience with assisting claimants with initial claims, consequential illnesses, and denied claims, you must understand that the claims examiners overseeing the cases are not people with vast medical backgrounds. Within the last six months, I saw a claims examiner prolong a claim for two consequential illnesses because the claims examiner completely missed the medical documentation that was submitted through the local Resource Center. 

Atomic Home Health was able to assist in re-submitting the paperwork with annotations on the medical records to highlight the precise medical evidence. One month later, I spoke with the claimant and their claims examiner about the consequential illnesses. The claims examiner stated that they had been looking through the approximate 50 pages of medical records for over TWO hours, and they needed help finding the highlighted evidence! This was after the medical records were submitted for the second time! 

With my medical experience as a registered nurse, I was able to prove the medical link between consequential illnesses and the previously awarded illnesses. Now, imagine a claimant who is unfamiliar with the paperwork filing process, and they are working with a claims examiner with limited experience in the medical field. This is the perfect formula for a denied claim. There are many common reasons for claims to be denied such as:

  1. Incomplete or Missing Medical Evidence
  2. Incomplete or Missing Employment Proof
  3. Medical Conditions that are not Supported by Provided Evidence
  4. Physician Letters that are Incomplete or Insufficient
  5. Various Exposure(s) that are Not Supported

In the last few months, I met with a claimant who had gone through the claims process for cancer in 2018. At that time, the claimant was denied after going through the dose reconstruction process. Unfortunately, this past year, his cancer had metastasized. Because of this spread of cancer, he became eligible for benefits through his secondary cancer. He waited 3 months to apply for his EEOICPA benefits after his new cancer diagnosis, only because he was unaware that the new diagnosis allowed him to refile for benefits.  He did receive approval for his condition with the personal assistance he received from me. 

If you have previously been denied and/or got diagnosed with a new illness, it is important to re-check your eligibility status through the EEOICPA. Atomic Home Health can assess your claim free of charge.

In addition to denied claims, some claimants might not be aware of other illnesses that they can file for. This past year, a claimant asked me for assistance to sort out an issue with his claim. While looking over his records, I was able to find diagnoses that the claimant was unaware that he could even apply for. One of those illnesses, that I found, has been given a recommended decision for approval. The claimant almost missed out due to not filing for those illnesses, prior to Atomic Home Health’s assistance.

The process of filing a claim through the EEOICPA can be daunting if you are not familiar with the process. Atomic Home Health helps assist with the paperwork process for free, and we will help as little or as much as you would like. If you have previously been denied or you are unsure if you are eligible for benefits, please call Atomic Home Health for a free consultation.

ABOUT STEPHEN

Stephen Wendt is the founder and owner of Atomic Home Health and he is passionate about helping current and former Department of Energy workers obtain and maximize their EEOICPA benefits.

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