Report faults Hanford claims rejections
YAKIMA – Tom Peterson labored at several jobs on the Hanford Nuclear Reservation for 14 years. But three years into working there, the ironworker began complaining about night sweats, shortness of breath and a chronic cough.
Peterson thought he was having a heart attack. Ten years passed before doctors diagnosed him with chronic beryllium disease, believed to have been caused by breathing in dust or mist of the lightweight metal.
Peterson and his wife have been fighting his health problems and the workers’ compensation program for Hanford workers ever since.
“Unless you have a clear-cut case – ‘I fell at work, broke my leg, everybody saw me’ – it’s going to be a fight,” said Janet Peterson, Tom’s wife, who handles the mountain of paperwork that came with the disease.
Workers and retirees navigate a maze of state and federal agencies and third-party administrators when they get sick or injured on the job. In recent months, dozens of Hanford workers have complained about their workers’ compensation programs.
Congress pulled the Energy Department’s oversight of one such program for federal nuclear workers last year amid complaints that claims were languishing, transferring the program to the Labor Department.
Now, another program is under fire from a Hanford watchdog group. In a report being released Wednesday, the Government Accountability Project in Seattle contends that Hanford workers’ claims were denied at twice the rate of self-insured companies in Washington in 2004.
“Our concern is that DOE is creating another generation of workers that don’t have access to health care and basically are sacrificing their health to fulfill the federal government’s mission,” said Lea Mitchell, an investigator for the Government Accountability Project.
To manage the workers’ compensation claims, the Energy Department hired Irving, Texas-based Contract Claims Services Inc. in 2000. The move came after the state Department of Labor and Industries, which had been administering the program, urged the agency to join other large employers in Washington, such as Boeing, as a self-insured entity.
The state still ultimately decides whether claims are denied or approved for self-insured companies but does not administer their programs. The companies themselves pay for all approved claims.
The change created an environment ripe for interference by the Energy Department and its contractors, GAP contends. The report accuses CCSI of routinely using independent medical exams that made denying or diminishing claims easier, and contends that those doctors often base their decisions on incomplete information.
After a number of workers complained, the Energy Department asked the state to audit the program. The audit, released in April, concluded that the system was being appropriately administered.
Jean Vanek, self-insurance program manager for the state Department of Labor and Industries, noted that the state agrees with the recommendation to deny a claim 80 percent of the time at Hanford, compared to 85 percent for other self-insured companies.
Vanek said many workers have unrealistic expectations of workers’ compensation.
“It isn’t intended to cover all of their medical expenses, and sometimes … the expectation gap between what the program should deliver and what it could deliver is part of the confusion,” she said.
However, when comparing data from two years during which the state managed the program with two years since CCSI assumed claims processing, the percentage of claims denied nearly tripled, according to information provided by the state.
In 1997-98, Hanford workers filed 1,369 claims with the state, which rejected 137 of them, or about 10 percent. In 2002-03, after CCSI took over claims processing, Hanford workers filed 1,230 claims. The state ultimately rejected 355 of those claims, or about 29 percent.
“That does seem to be fairly dramatic,” Vanek said. “I can’t imagine the nature of the claims has changed dramatically.”
GAP’s report recommends that the Energy Department remove CCSI and return the program to the state – a proposal the workers’ union endorses. A CCSI spokeswoman declined to comment because she had not yet seen the report.
The Energy Department also declined to discuss the report but released a statement.
“We care about our workers. That’s why last year we asked the state of Washington to commission an independent, comprehensive review of this program. It found us to be in full compliance with applicable regulations,” the statement said. “Still, we are actively working to improve the program further, to ensure that claims are handled with care and that employees know what to expect from the process.”
The state audit reviewed the files of more than 40 random workers, while the GAP report reviewed medical files of 15 selected workers, about half of which the group represents. While finding that that the current program meets regulatory compliance, the state audit also offered several recommendations, such as reducing the caseloads for claims managers.