One of the requirements to have your September 11 Victim Compensation Fund claim reviewed by the VCF includes having your eligible condition certified through the WTC Health Program. The WTC Health Program has locations in New York City and throughout the country.
In very limited circumstances, the VCF makes an exception to the WTC Health Program certification requirement and allows a claimant to go through the Private Physician process to verify an eligible condition. However, before going through this process, the VCF must first approve the request.
The Substantial Hardship Exception
Although the WTC Health Program operates a nationwide network, the VCF recognizes an exception for those who would experience substantial hardship in order to be certified by a WTC Health Program network provider. In these cases, you must provide the VCF with a statement explaining the facts of your situation and why you think you should be considered for the Private Physician process, as well as supporting documentation. You must also notify the VCF hotline by phone that you submitted the request. If the VCF accepts your request, you will be required to submit the Private Physician packet and any supporting documentation.
Exception for those Living Abroad
If you live outside the United States, you are automatically eligible for the Private Physician process. In these cases, the VCF will work with the WTC Health Program to determine whether the condition can be certified as eligible. If you are a foreign resident, you should submit the Private Physician Form with your claim packet.
Private Physician Process in Deceased Claims
If a deceased individual did not have their eligible condition certified by the WTC Health Program prior to passing, the Private Physician process is available so that the personal representative may pursue a personal injury claim on their behalf — even in cases where the survivor or responder did not die from the eligible condition. In other words, the Private Physician process is automatically available for claims on behalf of deceased individuals.
Adding a Cancer to a Claim Based on a Certified Condition
If you were previously found eligible by VCF for at least one condition, and you were subsequently diagnosed with any form of cancer or another eligible condition, you may go through the Private Physician process to add the new condition to your VCF claim. The VCF does not require you to get a newly diagnosed condition certified by the WTC Health Program if you were already deemed eligible by VCF for another condition.
Presence at the Pentagon
Responders at the Pentagon may have their conditions certified by the WTC Health Program. However, if you were at the Pentagon and were not a responder, the VCF allows you to participate in the Private Physician process to have your eligible condition certified.
Filling out the Forms for the Private Physician Process
The VCF has specific criteria that must be met in order to have an eligible condition verified through the Private Physician process. If you do not meet the guidelines or one of the above exceptions, you should not submit the Private Physician process forms unless you were otherwise instructed by the VCF.
As with all documentation that must be submitted to the VCF to process a claim, there are specific procedures involved with the Private Physician process paperwork. It’s crucial to ensure that the VCF’s directions are followed to avoid delays in claim processing.
Separate forms must be submitted for those who were present in each the New York City Exposure Zone, as well as the Pentagon and Shanksville, Pennsylvania Disaster Areas. In addition, the “Treating Physician Information Form” and “Cover Sheet for Return of Private Physician Forms” must be included with your package.
A medical records release authorization must also be provided to the VCF for any doctor you listed as treating you for your condition. When filling out the authorization, it is essential to make sure you fill out the correct form. There is one for personal representatives to fill out regarding deceased claimants, and another for responders and survivors claiming personal injury.
Contact a New York City 9/11 Victim Compensation Fund Attorney
If you are a responder or survivor who has suffered a 9/11-related health condition, you may be entitled to compensation. Navigating the VCF regulations and the Private Physician process can be confusing, frustrating, and complicated. It is best to have an attorney on your side who can fight for your rights and ensure that you receive the maximum victim compensation payout to which you are entitled.
The 9/11 Victim Compensation Fund attorneys at The Dearie Law Firm, P.C. have represented claimants and their families in 9/11 VCF claims for over a decade. For a free consultation, contact us today.