Shaping Smarter Regulations

EEOICPA - Coordination of offset or surplus

The postponement or denial of EEOICPA medical benefits because of a surplus amount is improper and inconsistent with intent of Congress in providing remedial compensation and medical benfits. There is no authorization in the Act for “offset” or “coordination of benefits” extended to “medical benefits” as is provided for in the associated regulations [20 C.F.R. § 30.505(b)(2)(iii) and 20 CFR §30.626(c)(2)(ii)]. Contrary to the regulatory language, the Act does not use the term “EEOICPA benefits” nor does the Act include the term “monetary payments.” The effect is that EEOICPA beneficiaries are put at risk because of the interdiction of medical benefits resulting from an earlier state workmen’s compensation or tort award covering the same condition.

 

§ 30.626, §30.505 and the implementing procedures in the Chapters 3-0400 and 3-0500 of the EEOICPA Procedure Manual contradict both the letter and spirit of the EEOICPA. When Congress amended the EEOICPA in 2004 by replacing Part D with the newly enacted Part E, a provision was incorporated in the statute requiring coordination of state workers’ compensation benefits received by a claimant with the EEOICPA “compensation.” See 42 U.S.C. §7385s-11(a). That provision reads in part as follows:

 

Congress, in the EEOICPA “offset” and “coordination” sections, specifically and intentionally excluded “medical benefits” from the definition of the term “compensation,” in describing the state benefits to be offset and coordinated with EEOICPA compensation.

 

An individual who has been awarded compensation under this part, and who has also received benefits from a State workers’ compensation system by reason of the same covered illness, shall receive compensation specified in this part reduced by the amount of any workers’ compensation benefits, other than medical benefits . . . .(emphasis added)

 

The exclusion of medical benefits from the definition of state workmen’s compensation to be offset is also reflected in § 30.626(c)(1).

 

OWCP will first determine the dollar value of the benefits received from a state workers compensation program by including all benefits other than medical . . . benefits received for the same covered illness or injury sustained as a consequence of a covered illness.

 

Under the EEOICPA describing the EEOICPA compensation to be coordinated with and reduced by state benefits, the term “compensation” does not include “medical benefits,” as Congress defined “compensation” as being separate and distinct from “medical benefits.”

 

The EEOICPA defines “compensation” separate and apart from “medical benefits.” 42 USC §7384s refers to “Compensation and Benefits” with “Medical Benefits” separately defined in with respect to Part B of the Act “compensation” in 42 USC §7384t. Under the statutory language of Part E, “compensation to be provided” is defined in §7385s-1 as being comprised of two (2) distinct categories: section 7385s-1(1) references the “compensation” provided to contractor employees [paid in accordance with §7385s-2] and §7385s-1(2)(A) and (B) specify the “compensation” paid to survivors.

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Idea No. 66