We examined how OJP has implemented the Hometown Heroes Act and how it processes PSOB claims submitted under the Act. As part of this review, we assessed the timeliness of claims processing and the reasoning behind claims determinations. We initiated this review after receiving congressional requests that expressed concern about OJP’s implementation of the Hometown Heroes Act. Specifically, several members of Congress raised concerns about the timeliness of OJP’s claims processing and whether OJP’s interpretation of the terms “ nonroutine stressful or strenuous physical activity” and “competent medical evidence to the contrary” was resulting in a high claims denial rate.
Scope and Methodology
The review encompassed the two offices involved in reviewing and processing PSOB claims: OJP’s PSOB Office, which organizationally is under the BJA, and OJP’s OGC. We examined each office’s role in the PSOB Program and gathered information related to the reasons for claims determinations, how OJP developed its definitions of terms for processing claims, factors affecting timely claims processing, and OJP’s initiatives to improve the claims adjudication process.28 Our fieldwork, conducted from July 2007 to October 2007, included in-person and telephone interviews, data analyses, and document reviews.
We interviewed 14 OJP management officials and staff, 5 contractors, 1 medical examiner, and 7 representatives from 4 public safety officer associations. Table 1 lists the individuals interviewed.
Table 1: Interviews Conducted by the OIG
|BJA, OJP|| • Director, BJA
• Director, PSOB Program
• Senior Benefits Specialist (3)
• Benefits Specialist (3)
• Paralegal Specialist
• Hearing Officer, Contractor (4)
|OGC, OJP|| • General Counsel
• Deputy General Counsel
• Staff Attorney (2)
• Attorney, Contractor
• Paralegal Specialist
|Armed Forces Institute of Pathology||• Armed Forces Medical Examiner|
|Public Safety Officer Associations|
|Congressional Fire Services Institute||• Director of Government Affairs|
|Fraternal Order of Police|| • Executive Director
• Senior Legislative Liaison
|International Association of Fire Fighters|| • Assistant to the General President
• Legislative Representative
|National Fallen Firefighters Foundation|| • Chairman of the Board
• Executive Director
Data Analyses and Document Reviews
We reviewed and analyzed data that the BJA provided on Hometown Heroes Act claims processed through November 29, 2007. These data included the number of PSOB claims submitted; the number of PSOB claims approved, denied, and pending; and the claim determinations for decided cases.
We reviewed OJP regulations, budget documents, organizational charts, position descriptions, contracts, staff performance plans, memoranda, policy guidance, and manuals. Additionally, we reviewed legislation, congressional testimony, and news articles related to the Hometown Heroes Act. We examined a sample of three PSOB death claim case files. We also reviewed the PSOB database and analyzed PSOB Office staff members’ notes on claims entered into the database. Our analysis was limited in part because the PSOB Office database does not capture the date a claim application is received by OJP and does contain fields to capture the progress of each case through the claims review process.
Because OJP OGC could not provide documentation or records related to its process for updating the PSOB regulations, we relied on the OGC staff’s verbal account of their activities and on interviews with public safety officer associations and the AFIP Medical Examiner regarding their involvement in the rulemaking process.