DII Industries, LLC Asbestos PI Trust

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Affidavit Guidelines

 

 

 




Deficiencies


Deficiency codes are used when a claim is missing information that is required by the Trust.

Deficiencies must be cured 120 days from the date of reciept of the deficiency letter or the claim will be disallowed.

NOTE:  Several of the deficiencies have changed.  For a quick reference of the revised deficiencies, please see the Updated Trustified Codes on the Quick Link tab.  Please also note that the old “500” series of deficiencies for HW have changed to the “800” series.

 

If the deficiency code is known, please enter the code:

OR

Enter a keyword(s) from deficiency, hold, status or other letter text:

Keyword(s):

This option will provide a detailed search of the entire letter database.

Type:   Deficiency (When a claim is missing information that is required by the Trust.)
Status (The position of a claim in the review process.)
Hold (An Administrative, Statute of Limitation or Trial Date hold placed on a claim.)
Option:  
CodeTypeOptionText
000DeficiencyBOTHFailure To Choose Claim Process
001DeficiencyBOTHDeath Certificate not Provided
002DeficiencyBOTHCertificate of Official Capacity
003DeficiencyBOTHInjured Party's Social Security Number not Provided
004DeficiencyBOTHInjured Party's Date of Birth not Provided
005DeficiencyBOTHOriginal Lawsuit State not Provided
006DeficiencyBOTHOriginal Lawsuit Date not Provided
007DeficiencyBOTH Date of Alleged Diagnosis and/or Alleged Injury not Provided
008DeficiencyBOTHSignature of Claimant and/or Personal Representative not Provided
009DeficiencyBOTH First and Last Dates of Exposure Not Provided
010DeficiencyBOTH Industry and Occupation not Provided
011DeficiencyBOTHIncomplete Personal Representative Information
013DeficiencyBOTHSSN, DOB, DOD and/or Name is inconsistent with Claim Form
014DeficiencyBOTHAttachments not Provided
015DeficiencyBOTHInconsistent or no Date of Death Provided
016DeficiencyBOTHDeath Certificate for Wrong Party
017DeficiencyBOTHDeath Certificate is Incomplete
018DeficiencyBOTHAlleged Injury is not Recognized by the Trust
019DeficiencyBOTHLitigation Page Failure to Elect Jurisdiction
020DeficiencyBOTHSmoking History not Provided
021DeficiencyBOTHEntity Claimed
022DeficiencyBOTHIncomplete Dependent Information
023DeficiencyBOTHFailure to Choose Description for Significant Occupational Exposure
025DeficiencyBOTHIndirect Claim Information
026DeficiencyIRDuplicate Financial Dependent
027DeficiencyBOTHFailure to Answer Question 3.7 on the Claim Form
028DeficiencyBOTHForeign Claim Information
029DeficiencyBOTHIncomplete Injured Party Information
030DeficiencyBOTHUnspecified if Asbestos Death
031DeficiencyBOTHOther Cancer - Description Missing
032DeficiencyBOTHFailure to Check Physical Examination Check Box
033DeficiencyBOTHIncomplete Exposure Information
034DeficiencyBOTHIncomplete Secondary Exposure Information
035DeficiencyBOTHFailure to Answer Litigation Received Money
036DeficiencyBOTHFailure to Answer Litigation Final Judgment
037DeficiencyBOTHFailure to Answer Litigation Tolling Agreement
038DeficiencyIRIncomplete Financial Dependant Information
039DeficiencyIRIncomplete or Not Provided Smoking History
040DeficiencyIRIncomplete Extraordinary Information
041DeficiencyBOTHIncomplete Litigation Information
042DeficiencyBOTHFailure to Answer Question 2.3
043DeficiencyBOTHSOL Intake Deficiency
044DeficiencyBOTHInconsistent 2.3 Response
103DeficiencyBOTHNo Causation or Causation From an Unacceptable Physician
104DeficiencyBOTHLatency Period does not Qualify
105DeficiencyBOTHNo Proof of Alleged Asbestos-Related Injury
110DeficiencyBOTHPFT Report not Provided
113DeficiencyBOTHPFT Disputes or Conflicts with Earlier Report
114DeficiencyBOTHMost Recent PFT Scores do not Qualify
116DeficiencyBOTHPFT is from an Unacceptable Facility
117DeficiencyBOTHPFT does not meet ATS Standards
118DeficiencyBOTHFull PFT Report is Required
120DeficiencyBOTHMedical Report not by a Qualified Physician
1203DeficiencyBOTHLitigation Date is Prior to Alleged Exposure
1207DeficiencyBOTHFailure to Answer Question 3.7 on the Claim Form
1209DeficiencyBOTHFailure to Provide Medical Documents in Response to Question 2.3
121DeficiencyBOTHChest x-ray Report does not Identify the Physician
1212DeficiencyBOTHFailure to Provide Complete Deposition
1213DeficiencyBOTHEarlier Diagnostic Medical Document
122DeficiencyBOTHCertified translation of foreign document required
1220DeficiencyBOTHDocumentation to Support ATS Standards
1222DeficiencyBOTHDocumentation Provided is not Highlighted or Relevant Pages Identified
1223DeficiencyBOTHIndirect Proof of Claim Form not provided or is incomplete
128DeficiencyBOTHNo Medical Documents Provided
129DeficiencyBOTHMedical Report does not Qualify as a Physical Exam
130DeficiencyBOTHPhysical Exam Report not Provided
131DeficiencyBOTHMedical Report Unacceptable Diagnosis
132DeficiencyBOTHMedical Report Disputes and/or Conflicts with Earlier Reports
133DeficiencyBOTHMedical Report for Wrong Party
134DeficiencyBOTHMedical Report is Incomplete
135DeficiencyBOTHPathologist not Board-Certified
136DeficiencyBOTHMedical Report is Unacceptable, Final Request
137DeficiencyBOTHMedical Report is from an Unacceptable Physician
138DeficiencyBOTHMedical Report is from an Unacceptable facility
140DeficiencyBOTHChest X-ray Report Not Provided
141DeficiencyBOTHChest X-Ray Report Unacceptable Diagnosis
142DeficiencyBOTHChest X-Ray Report Disputes or Conflicts with Earlier Reports
143DeficiencyBOTHChest X-Ray Report is for the Wrong Party
144DeficiencyBOTHCXR Report is Incomplete or the CXR is Not of Acceptable Quality
145DeficiencyBOTHChest X-Ray Report Findings are not Bilateral
146DeficiencyBOTHChest X-Ray Report is Unacceptable, Final Request
147DeficiencyBOTHChest X-Ray Report is from an Unacceptable Physician
148DeficiencyBOTHChest X-Ray Report is from an Unacceptable Facility
149DeficiencyBOTHSevere Asbestosis (Disease Level IV)/ILO Score does not Qualify
150DeficiencyBOTHPathology Report not Provided
151DeficiencyBOTHPathology Report for Wrong Injury
152DeficiencyBOTH Pathology Report is not for a Primary Site
153DeficiencyBOTHPathology Report is Incomplete
154DeficiencyBOTHPathology Report has an Unacceptable Diagnosis
155DeficiencyBOTHCausation statement is not based on a Physical Exam
156DeficiencyBOTHFailure to Choose Description for Significant Occupational Exposure
158DeficiencyBOTHFailure to Provide Evidence of Union Employment
159DeficiencyBOTHB-reader/ILO report based on Review of Digital X-ray is Unacceptable.
160DeficiencyBOTHPFT for Wrong Party
161DeficiencyBOTHPFT is Incomplete
162DeficiencyBOTHUnderlying Link to Asbestos Disease is not Provided
163DeficiencyBOTHPathology Report for Wrong Party
165DeficiencyBOTHPFT Facility not Provided
168DeficiencyIRSmoking History Does Not Match Medicals
170DeficiencyBOTHChest X-ray Diagnosis Unacceptable for Asbestosis
171DeficiencyBOTHThe Physical Exam Diagnosis Disputes Chest X-Ray Findings
172DeficiencyBOTHFor Deceased Claimants/Chest X-Ray was not Read by a Qualified Physician
173DeficiencyBOTHNo Causation Statement Provided
174DeficiencyBOTHCausation Statement is Incomplete
175DeficiencyBOTHCausation-Doctor not Qualified/Unacceptable Doctor
180DeficiencyBOTHMeso Medical Documentation Needed
182DeficiencyBOTHMeso Diagnosed by Cytology
210DeficiencyIRDuplicate Financial Dependent
212DeficiencyBOTHDescription for SOE does not meet Criteria (Disease levels III,IV, V & VII Only)
228DeficiencyBOTHSignificant or Cumulative Occupational Exposure is Insufficient
229DeficiencyBOTHExposure is all Post 1982
231DeficiencyBOTHPre-1983 Significant Occupational Exposure is Insufficient
269DeficiencyBOTHCheck Box for Previously Submitted Physical Examinations
270DeficiencyBOTHIncomplete or No Vessel Service History Provided (Maritime)
276DeficiencyBOTHEntity/Site Relationship Inconsistent
277DeficiencyBOTHSite Code
279DeficiencyBOTHUndocumented Site Information not Provided
281DeficiencyBOTHEntity/Product Relationship Inconsistent
401DeficiencyBOTHExposure Information does not Match Claim Form
402DeficiencyBOTHName of Ship/Plant/Site not Provided.
404DeficiencyBOTHCompany Exposure Insufficient
407DeficiencyBOTHIncomplete Work History Verification
409DeficiencyBOTHNeed Information for Occupationally Exposed Person
418DeficiencyBOTHExposure to Occupationally Exposed Person is Inadequate
4204DeficiencyBOTHIndustry Not Provided
4205DeficiencyBOTHOccupation of Injured Party not Provided
4214DeficiencyBOTHRevisions to Verified Documents
4215DeficiencyBOTHChange in Response to Question 3.7
4216DeficiencyBOTHIncomplete or Changed answer to 5.2g and 5.2h
4217DeficiencyBOTHShip/Shipyard Exposure Conflict
4218DeficiencyBOTHForeign National
4219DeficiencyBOTHInsufficient PID Evidence
424DeficiencyBOTHExposure Dates not Provided
425DeficiencyBOTH Separate the Years of Exposure at Each Site
427DeficiencyBOTHVerified Company Exposure
430DeficiencyBOTHPre-1983 Exposure is Insufficient
432DeficiencyBOTHExposure Dates Outside Recognized Range
433DeficiencyBOTHOccupationally Exposed Person's Name and/or Social Security Number
437DeficiencyBOTHCompany product was not specified, is generic or is not recognized
438DeficiencyBOTHAffidavit contains multiple company products and/or multiple sites.
439DeficiencyBOTHChest X-ray was not read by a Qualified Physician
450DeficiencyBOTHNo Verified Company Exposure Provided
451DeficiencyBOTHVerified Company Exposure is Insufficient
457DeficiencyBOTHChange of Occupation
471DeficiencyBOTHCompany Exposure Insufficient (Maritime)
473DeficiencyIRIntermittent or On and Off Exposure
474DeficiencyIRExtraordinary Exposure
475DeficiencyBOTHProof of Economic Loss Not Provided or Insufficient
477DeficiencyBOTHAffidavit Signed by POA/ Need POA
478DeficiencyBOTHProduct Dates Outside Recognized Manufacture Dates
480DeficiencyBOTHUndocumented Site Information - Products/Operations not Provided
481DeficiencyBOTHImproper Jurisdiction Selected
484DeficiencyBOTHAffidavit for Company Exposure is not acceptable.
485DeficiencyBOTHThe Site(s) of Exposure Listed on Claim Form does not Match the Site Code selected.
486DeficiencyIRAdditional Information for Financial Dependents
487DeficiencyBOTHSOL Deficient
488DeficiencyBOTHFailure to Provide a Verified Work History or Work History is Incomplete
489DeficiencyBOTHAffidavit not Notarized or Does not Otherwise Meet the State Requirements
491DeficiencyBOTHAudit Document Not Provided
492DeficiencyBOTH Medical Report not Provided
493DeficiencyBOTHMedical Report Language is Unacceptable
494DeficiencyBOTHMedical Report Disputes and/or Conflicts with Earlier Reports
495DeficiencyBOTHChest X-Ray Report Disputes or Conflicts with Earlier Reports
496DeficiencyBOTHFailure to Specify Length of Company Exposure Prior to 12/31/1982.
497DeficiencyBOTHAdditional Information Required for Other Cancer Claim
498DeficiencyBOTHIndustry and/or Occupation does not match Site/Plant name submitted on the Claim Form.
507DeficiencyBOTHIncomplete Work History Verification
580DeficiencyBOTHUndocumented Site Information - Products/Operations not Provided
588DeficiencyBOTHFailure to Provide a Verified Work History or Work History is Incomplete
801DeficiencyBOTHExposure Information does not Match Claim Form
802DeficiencyBOTHName of Ship/Plant/Site not Provided.
804DeficiencyBOTHCompany Exposure Insufficient
807DeficiencyBOTHIncomplete Work History Verification
809DeficiencyDCPNeed Information for Occupationally Exposed Person
818DeficiencyDCPExposure to Occupationally Exposed Person is Inadequate
8204DeficiencyBOTHIndustry Not Provided
8205DeficiencyBOTHOccupation of Injured Party not Provided
8214DeficiencyBOTHRevisions to Verified Documents
8215DeficiencyBOTHChange in Response to Question 3.7
8216DeficiencyBOTHIncomplete or Changed answer to 5.2g and 5.2h
8217DeficiencyBOTHShip/Shipyard Exposure Conflict
8218DeficiencyBOTHForeign National
8219DeficiencyBOTHInsufficient PID Evidence
824DeficiencyBOTHExposure Dates not Provided
825DeficiencyBOTHSeparate the Years of Exposure at Each Site
827DeficiencyBOTHVerified Company Exposure
830DeficiencyBOTHPre-1983 Exposure is Insufficient
832DeficiencyBOTHExposure Dates Outside Recognized Range
833DeficiencyDCPOccupationally Exposed Person's Name and/or Social Security Number
837DeficiencyBOTHCompany product was not specified, is generic or is not recognized
838DeficiencyBOTHAffidavit contains multiple company products and/or multiple sites.
839DeficiencyBOTHChest X-ray was not read by a Qualified Physician
850DeficiencyBOTHNo Verified Company Exposure Provided
851DeficiencyBOTHVerified Company Exposure is Insufficient
857DeficiencyBOTHChange of Occupation
871DeficiencyBOTHCompany Exposure Insufficient (Maritime)
873DeficiencyIRIntermittent or On and Off Exposure
874DeficiencyIRExtraordinary Exposure
875DeficiencyBOTHProof of Economic Loss Not Provided or Insufficient
877DeficiencyBOTHAffidavit Signed by POA/ Need POA
878DeficiencyBOTHProduct Dates Outside Recognized Manufacture Dates
880DeficiencyBOTHUndocumented Site Information - Products/Operations not Provided
881DeficiencyBOTHImproper Jurisdiction Selected
884DeficiencyBOTHAffidavit for Company Exposure is not acceptable.
885DeficiencyBOTHThe Site(s) of Exposure Listed on Claim Form does not Match the Site Code selected.
886DeficiencyIRAdditional Information for Financial Dependents
887DeficiencyBOTHSOL Deficient
888DeficiencyBOTHFailure to Provide a Verified Work History
889DeficiencyBOTHAffidavit not Notarized or Does not Otherwise Meet the State Requirements
891DeficiencyBOTHAudit Document Not Provided
892DeficiencyBOTH Medical Report not Provided
893DeficiencyBOTHMedical Report Language is Unacceptable
894DeficiencyBOTHMedical Report Disputes and/or Conflicts with Earlier Reports
895DeficiencyBOTHChest X-Ray Report Disputes or Conflicts with Earlier Reports
896DeficiencyBOTHFailure to Specify Length of Company Exposure Prior to 12/31/1982.
897DeficiencyBOTHAdditional Information Required for Other Cancer Claim
898DeficiencyBOTHIndustry and/or Occupation does not match Site/Plant name submitted on the Claim Form.
Intake DeficientStatusBOTHThe claim is missing basic information that is required prior to being sent for review.
Offer IssuedStatusBOTHA settlement offer has been issued.
PaidStatusBOTHThe claim settlement check is issued.
R01DeficiencyBOTHCertificate of Official Capacity
R02DeficiencyBOTHPersonal Representative's Name Not Provided
R03DeficiencyBOTHNew Personal Representative Information Needed
R04DeficiencyBOTHMissing Two Witness Signatures
R05DeficiencyBOTHNo Death Certificate
R06DeficiencyBOTHNo Notary Stamp/Embossed
R07DeficiencyBOTHIncomplete Release Received/Uploaded
R08DeficiencyBOTHCorrected SSN
R11DeficiencyBOTHPOA Papers
R13DeficiencyBOTHMissing Releases from all Personal Representatives
R14DeficiencyBOTHIncorrect Release Received
R16DeficiencyBOTHNotary not complete or missing information
R17DeficiencyBOTHSignature dates do not match on the release
R18DeficiencyBOTHNo claimant signature
R19DeficiencyBOTHMissing signature page of release
R20DeficiencyBOTHNotary stamp/seal not legible
R21DeficiencyBOTHNew release with new PR information needed
R22DeficiencyBOTHPersonal representative is deceased
R23DeficiencyBOTHWithdrawn Release Returned
Ready to Re-ReviewStatusBOTHThe claim is awaiting medical and exposure re-review of the alleged injury(s).
Ready to ReviewStatusBOTHThe claim is awaiting medical and exposure review of the alleged injury(s).
Review StatusBOTHThe claim is in the review process.
Review DeficientStatusBOTHThe claim has been reviewed for the alleged injury(s) and is missing information necessary to comple
WithdrawnStatusBOTHThe claim is withdrawn.