The following is a list of the questions answered below:
1. What is the purpose of the Physician Panel Rule?
3. Why is the Physician Panel Rule limited to DOE contractor employees?
4. What determinations under the Physician Panel Rule may be appealed?
5. What is the purpose of an appeal?
6. What is the deadline for filing an appeal?
7. What happens when an appeal is filed?
8. How long does it take for the DOE Office of Hearings and Appeals to make a decision?
9. Does an applicant need a lawyer to file an appeal?
10. May a Department of Labor determination be appealed to the DOE Office of Hearings and Appeals?
12. Who prepared these questions and answers?
The purpose of the Physician Panel Rule is to assist DOE contractor employees in obtaining state workers’ compensation benefits. The Rule provides for independent physician panel review of workers’ illnesses. If a panel determines that the illness at issue was related to exposure to a toxic substance during employment at a DOE facility, the DOE does not oppose a state workers’ compensation claim based on the illness, and the DOE does not support contractor opposition of the claim.
No, the Physician Panel Rule does not provide for a DOE award of any monetary or medical benefits. The Physician Panel Rule is limited to assisting workers with state workers’ compensation claims, as described in the answer to Question #1 above.
The Physician Panel Rule is limited to DOE contractor employees, because DOE and DOE contractors would not be present as parties in state workers’ compensation proceedings involving non-DOE facilities. The primary benefit of the process - that DOE not oppose the claim directly or indirectly through its contractor - would have no value to a worker who was not employed at a DOE facility.
The following determinations may be appealed:
- a determination by the Office of Worker Advocacy that an applicant is not
eligible for physician panel review;
- an Office of Worker Advocacy determination to accept a negative physician panel determination; and
- an Office of Worker Advocacy determination not to accept a positive physician panel determination.
The purpose of an appeal is to identify whether an error occurred in the determination being appealed. Accordingly, in an appeal, the applicant should explain why he or she believes the determination is wrong, and identify any relevant information in the record. Examples of panel error are: 1) failure to consider a claimed illness, 2) failure to explain the basis of the determination, or 3) a significant factual error in the explanation. On the other hand, mere disagreement with the panel opinion is not a basis for finding panel error.
An appeal is not the appropriate format for requesting consideration of matters not presented to the physician panel - such as new illnesses or additional medical records. If the applicant wishes consideration of additional illnesses or evidence not presented to the panel, the applicant should contact the Office of Worker Advocacy.
The deadline is 30 days from the date of the determination letter being appealed. If an applicant misses the 30 day deadline, the applicant may still file an appeal, with an explaination of why the appeal is late. The DOE Office of Hearings and Appeals will determine if good cause exists for accepting the late appeal.
The DOE Office of Hearings and Appeals logs in the filing, assigns a case number, and sends the applicant a letter, explaining the appeal process. The letter provides a contact point for the appeal. The final decision on the appeal is in writing and is sent to the applicant.
Each case is different. In most cases, decisions have been issued in two to three months.
A lawyer is not required, but a lawyer may be able to make a stronger case for the applicant. Most applicants who file appeals do not have lawyers, and the staff of the Office of Hearings and Appeals encourages applicants to ask the staff any questions they have about the appeals process.
No, a Department of Labor proceeding is separate from a DOE proceeding.
The applicant may submit the statement to the Office of Worker Advocacy and that office will include the statement in the application file. There is no reason to submit the statement to the Office of Hearings and Appeals, since the statement is not intended to be an appeal, and the Office of Hearings and Appeals is not the custodian of the applicant’s records.
These questions and answers were prepared by Janet N. Freimuth, a senior attorney in the DOE Office of Hearings and Appeals. They are intended as a general description of the Rule and the appeals process. More detailed information is available at www.eh.doe.gov/advocacy and www.oha.doe.gov. If you have questions, you may contact Ms. Freimuth at HG-40/L’Enfant Plaza Bldg., 1000 Independence Ave., SW, Washington, DC 20585-1615, janet.freimuth@hq.doe.gov, (202) 287-1439.
Last updated September 7, 2004