Printing - FECA-PT2 - National Association of Letter Carriers

2-080 Exhibit 2: Sample Letter to Claimant--Asbestosis
Dear CLAIMANT NAME:
I am writing in reference to your claim for benefits under the Federal Employees' Compensation Act
(FECA) for an asbestos-related illness. We have received and reviewed [DESCRIBE WHAT WAS
RECEIVED]. This information is not sufficient for us to determine whether you are eligible for benefits
because [EXPLAIN WHY EVIDENCE INSUFFICIENT].
Please provide the information requested below to us at the address on the letterhead. Include as much
detail as possible. Send a copy of your response to your employer for comments.
1. List your work history by employer, job title, and inclusive dates. Include all employment (Federal
and non-Federal) as well as military service. For each job title, describe the work you performed, the type
of asbestos material used, locations where exposure occurred, period of exposure, number of hours per
day and days per week exposed, and the type and frequency of safety precautions used (mask, respirator,
protective clothing, ventilation, etc.)
2. Describe any exposure you have had to other toxic substances affecting the lung. If none are
known, so state.
3. Describe all previous pulmonary conditions and allergies, particularly those of a respiratory nature.
Have you ever had asthma or bronchitis? Provide all relevant details.
4. Do you smoke cigarettes, cigars or a pipe? How much and for how long have you smoked? If you
don't smoke now, have you ever? How much, for how long, and when did you quit?
5. Provide a detailed medical report from your treating physician which describes your symptoms;
results of examinations and tests (including chest x-ray report); diagnosis; the treatment provided; the
effect of treatment; and the doctor's opinion, with medical reasons, on the cause of your condition.
Specifically, if your doctor feels that exposure in your Federal employment contributed to your condition,
an explanation of how such exposure contributed should be provided.
5. We have received a medical report from your physician. However, it is not sufficient to support
your claim because [EXPLAIN WHY REPORT INSUFFICIENT]. Please provide an additional report which
specifically discusses the following: [EXPLAIN WHAT NEW REPORT SHOULD INCLUDE].
6. Give the date you first became aware of your lung condition.
FECA-PT2 Printed: 06/08/2010 237
OR
7. Give the date you first related your lung condition to work exposure and explain how you realized
this.
8. Have you ever previously filed a workers' compensation claim for a lung condition? If so, give date
of claim, name and address where filed, benefits received, and file number.