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Below are the head notes for the final FAB decisions relating to the topic heading, Medical Benefits. The head notes are grouped under the following subheadings: Date of commencement, Entitlement to, and Termination of. In order to view a particular decision in its entirety, click on the hyperlink for that decision at the end of the head note.
Date of Commencement
- Member of the SEC who is diagnosed with a specified cancer is entitled to medical benefits related to that cancer retroactive to the date his claim was filed. EEOICPA Fin. Dec. No. 10522-2004 (Dep’t of Labor, November 14, 2003); EEOICPA Fin. Dec. No. 28766-2003 (Dep’t of Labor, June 20, 2003).
- Where NIOSH has not completed dose reconstruction for all primary cancers because the 50% probability of causation threshold has been reached, the claimant will still be eligible for medical benefits for all of the cancers, retroactive to the date of filing the claim. EEOICPA Fin. Dec. No. 10522-2004 (Dep’t of Labor, November 14, 2003).
- Where the employee’s claim for beryllium sensitivity was approved, and his subsequent claim for CBD was approved, the commencement date of medical benefits for CBD was the same as the commencement date of medical benefits for beryllium sensitivity. EEOICPA Fin. Dec. No. 12177-2002 (Dep’t of Labor, September 17, 2004).
- In accordance with OWCP policy, the filing date for the EEOICPA claim was the date on the claim transmittal cover sheet from the resource center, and not the date that the employee signed the claim form. EEOICPA Fin. Dec. No. 16917-2004 (Dep’t of Labor, September 23, 2004).
- Employee’s entitlement to medical benefits for covered illness under Part E was retroactive to the earliest date that he filed a claim for that illness. EEOICPA Fin. Dec. No. 10001749-2005 (Dep’t of Labor, December 14, 2005).
Entitlement to Medical Benefits
- Where NIOSH has not completed dose reconstructions for all primary cancers because the 50% probability of causation threshold has been reached, the claimant will still be eligible for medical benefits for all of the cancers, retroactive to the date of filing the claim. EEOICPA Fin. Dec. No. 10522-2004 (Dep’t of Labor, November 14, 2003).
- Claimant who received an award from DOJ under section 5 of RECA for pneumoconiosis was also entitled to receive EEOICPA medical benefits for pneumoconiosis under Part B. EEOICPA Fin. Dec. No. 22218-2003 (Dep’t of Labor, May 8, 2003).
- Where employee died before payment could be issued based on his CBD, survivors who subsequently filed claims were entitled to reimbursement of the medical expenses for his CBD, retroactive to the date he filed his original claim, through the date of his death. EEOICPA Fin. Dec. No. 59062-2004 (Dep’t of Labor, September 13, 2004).
- Under Part B, in case where employee filed his claim but died prior to a final decision accepting his claim, survivors may be entitled to medical benefits for medical bills that were incurred for treatment of employee’s lung cancer for dates beginning when employee first filed his claim to the date he died. EEOICPA Fin. Dec. No. 61109-2004 (Dep’t of Labor, November 4, 2004).
- Compensation for medical benefits for deceased covered employee who filed for benefits prior to death, for treatment of the covered illness from the date of filing through death, was paid to the employee’s estate. EEOICPA Fin. Dec. No. 74593-2007 (Dep’t of Labor, March 2, 2007).
- Claimant is entitled to medical benefits under Part E for asbestosis where the evidence of record established that: (1) a Physicians Panel review under former Part D was completed; and (2) the Secretary of Energy accepted the Panel’s affirmative determination that the claimant had sustained a covered illness at a DOE facility. EEOICPA Fin. Dec. No. 10000216-2005 (Dep’t of Labor, March 4, 2005); EEOICPA Fin. Dec. No. 10002490-2005 (Dep’t of Labor, July 8, 2005).
Termination of Medical Benefits
- FAB issued a final decision on October 29, 2002, awarding beneficiary medical benefits and periodic monitoring for his beryllium sensitivity. On June 4, 2003, he joined a tort suit against a beryllium vendor alleging both occupational and non-occupational exposures resulting in beryllium sensitivity. Section 7385d(c) explicitly bars further receipt of benefits under Part B by any beneficiary who files a tort suit covered under § 7385d(d) after April 30, 2003, if that date is more than 30 months after the diagnosis of a covered beryllium disease. In this case it was, since beneficiary was first diagnosed with beryllium sensitivity on March 6, 1998, and 30 months after that date was September 6, 2000. Accordingly, he was no longer entitled to any benefits effective June 4, 2003, the date he joined the covered tort suit. EEOICPA Fin. Dec. No. 5781-2002 (Dep’t of Labor, September 12, 2006).
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