The September 11th Victim Compensation Fund (“9/11 VCF”) now generally requires all applicants to enroll in the WTC Health Program in order to have their conditions certified as being related to 9/11 (exceptions listed below). Previously, Claimants to the 9/11 VCF were permitted to have their conditions certified as being related to 9/11 by submitting medical records through the “Private Physician Process”. The 9/11 VCF released the following guidance on July 21, 2017:
We appreciate your continued patience as we work to implement the changes to the Private Physician process. We expect to begin sending letters next week to those claimants who have submitted a Private Physician packet but no longer meet the criteria for the process. As mentioned in an earlier email, this will also be discussed in detail at the meeting on August 9, and we are working to update all applicable references on our website.
We realized the recently updated criteria resulted in some unintended limitations specific to deceased victims and individuals diagnosed with cancer, and have modified the criteria as a result. The Private Physician process will be available in the following circumstances:
- For deceased victims who were not treated by the WTC Health Program for the claimed condition; or
- For individuals who were previously deemed eligible for compensation from the VCF based on a certified condition, and are now seeking to add a non-certified cancer as a claimed condition; or
- For individuals who are not able to go to a WTC Health Program center (either in the New York City metropolitan area or through the Nationwide Provider Network) to have their condition evaluated and certified for treatment without suffering significant hardship; or
- Other circumstances that the Special Master, in her discretion, deems appropriate for the process.
The changes to the Private Physician criteria were made after a series of conversations with the WTC Health Program, in light of the expanded capacity of CCEs and NPN providers, the Health Program’s interest in expanding their research base, and challenges we have had with the verification process. Although there is a short term impact to claimants, we believe the longer term benefits of these changes will be very positive.
Because the law firm meeting is still several weeks away, we have prepared the FAQs below based on questions several of you have asked, as well as questions our Helpline has received from claimants. We will be posting these to the website as a new section of the FAQs next week.
As always, thank you for your continued collaboration and partnership.
- Will this delay the processing of my claim since I now have to go get certified, and my appointment with the WTC Health Program is not scheduled for several months?
No. For those claims that have already been submitted and are impacted by the change in the Private Physician process, your claim’s priority order will not be impacted as it is established based on the submission of your compensation claim. This means that waiting for the certification will not change the order in which your claim is processed. Once your certification is received, your claim will be prioritized for processing based on the date on which your compensation claim was submitted.
- Should I still complete the online Private Physician forms based on answers to questions in the claim form?
No. You should only complete the online Private Physician forms if you meet the new criteria for certification of the condition through the Private Physician process. It will take time for the changes to be made to the online system and we realize this may create some confusion. In the interim, if you do not meet the new criteria, you should answer “No” to any questions that ask about treatment by a physician not affiliated with the WTC Health Program. You should also answer “No” if the system displays the question that asks if you are ready to provide information regarding the Private Physician process. Answering “No” to these questions will prevent the Private Physician questions from being displayed in the system.
- Is the Private Physician process available to victims who died of an ineligible condition and are claiming personal injury losses? For example, if a WTC survivor died of a heart attack, yet had suffered asthma and GERD while living, had treated with private doctors only, and had never been a member of the WTC Health Program, does the change mean the estate cannot seek verification of an eligible condition through the Private Physician process and has no way of becoming eligible for a VCF personal injury award?
The Private Physician process would be available in this situation so that the claimant could pursue a personal injury claim. The process remains available for deceased individuals who were not certified for treatment for the claimed condition prior to death.
- Is the Private Physician process available only to deceased individuals who were previously certified by the WTC Health Program and now claim a cancer, or is it also available to personal injury victims who were previously certified for a non-cancer and are now seeking compensation for a cancer?
The Private Physician process will remain available for all claims – deceased or personal injury – where the victim has already been certified for a condition by the WTC Health Program and is now seeking to add a cancer. Please note that the individual must have been previously certified for at least one eligible condition in order to seek verification of a cancer through the Private Physician process. For individuals claiming cancer who are not currently certified for treatment of any condition by the WTC Health Program, they must go to the WTC Health Program for certification of the cancer, although they can, of course, continue to be treated by their treating physician.
- Should I wait to receive a letter from the VCF explaining next steps on my claim or should I initiate the application/enrollment process at the WTC Health Program?
No – don’t wait! If you know you are seeking compensation for a condition that has not been certified for treatment by the WTC Health Program, please begin the certification process. You do not need to wait for the VCF to notify you if you are already aware you will need to seek certification based on the revised Private Physician criteria.
- I scheduled my appointment with the WTC Health Program but they told me it may take several months to be seen and to then receive a certification letter. Should I submit my claim even though I have not yet been certified?
As long as you have timely registered your claim, it is best to wait to submit your claim until you have been certified by the WTC Health Program. If you submit your claim without first being certified, the VCF will place your claim in Inactive status and it will remain in that status and will not be reviewed until you submit your certification letter.
- How do I request consideration for an exception to the Private Physician criteria? What do I need to submit if I want to claim a substantial hardship exception?
We are considering various options for submitting these requests and will notify you once we have decided on the process we will use.
The WTC Health Program released the following guidance regarding the new 9/11 VCF rules:
If you are a [9/11 VCF] claimant wanting to be certified for a health condition(s) by the WTC Health Program, information for applying to the Program can be found on our How to Apply to the Program page.
Once a member is enrolled in the Program, the member will then have to make an appointment with their Clinical Center of Excellence (CCE) or the Nationwide Provider Network (NPN) to have a monitoring appointment (responders) or an initial evaluation (survivors).
The first appointment requires history-taking, medical testing, and physical examination. The initial appointment may sometimes require additional diagnostic testing to determine if the member has a condition on the list of 9/11-related health conditions covered by the Program and meets the Program’s requirements for coverage (certification) of a condition (visit our Administrative Manual to learn more about the certification process).
If the member has a health condition covered by the WTC Health Program, the CCE or NPN will submit a certification request to the Program. It will be reviewed and a decision will be made to approve or deny the certification request. Once a decision is made, the WTC Health Program will notify the member, in writing, of the decision.
Since its founding, Pitta & Baione LLP has made it a firm policy to enroll our clients in the WTC Health Program. We have always believed it is best for our clients to be evaluated by physicians with experience in 9/11 toxins exposure. Additionally, we have found that certification by the WTC Health Program expedites the resolution of 9/11 VCF claims. The 9/11 community at large also benefits from research conducted by the WTC Health Program. Thanks to our firm policy, little will change for clients of Pitta & Baione LLP. However, if our clients are unable to attend the WTC Health Program, we will request that the 9/11 VCF make an exception for extenuating circumstances.
Individuals suffering from the following physical health conditions may be eligible for free medical treatment through the World Trade Center Health Program and financial compensation through the September 11th Victim Compensation Fund. In general, anyone who was present in Lower Manhattan below Canal Street, at the Fresh Kills landfill, on barges/trucks/piers along debris removal routes, the NYC Morgue, or at garages where emergency vehicles were cleaned between 9/11/01 and 5/30/02 may be eligible for free medical monitoring through the World Trade Center Health Program. Individuals who contracted one of the following covered illnesses listed on the WTC Health Program List of Covered Conditions may also be eligible for free treatment and medication, in addition to compensation through the September 11th Victim Compensation Fund.
The WTC Health Program List of Covered Conditions is subject to change as the Health Program Administrator, Dr. John Howard, and the Scientific/Technical Advisory Committee continue to review research, statistics, and studies in order to identify new conditions for coverage.
For more information call Pitta & Baione LLP at 844-WTC-COMP or email us at email@example.com