If you’re a 9/11 responder or survivor, you may be entitled to receive healthcare for your 9/11-related illness from the WTC Health Program at no cost. But it’s also important to understand that you may be able to recover compensation for out-of-pocket costs incurred in connection with medical treatment related to an eligible condition. The September 11th Victim Compensation Fund (VCF) seeks to ensure that those who meet the criteria are compensated for these expenses as part of their economic loss claims.              

Who is Eligible to Claim Out-of-Pocket Medical Expenses?

Responders and survivors who qualify for compensation from the VCF may be entitled to recover their out-of-pocket medical costs for expenses incurred both before and after certification by the WTC Health Program. However, the VCF will typically not reimburse costs if your condition was treated by a physician outside of the WTC Health Program or a prescription was filled at an unaffiliated pharmacy.

Reimbursement for out-of-pocket medical expenses cannot be sought from the VCF if the costs were already covered by a third-party such as the WTC Health Program, Medicare, Medicaid, Workers’ Compensation, or private health insurance. Significantly, the medical expenses must first be evaluated by any applicable private insurance company or secondary payer before the VCF will issue any reimbursement.

In some cases, 9/11-related medical expenses that have been billed as a co-payment due to a coverage denial by an insurance company may be reimbursed. In such instances, it is necessary to provide the VCF with adequate documentation to support your claim.

How Do You Recover Your Out-of-Pocket Medical Costs?

The VCF has specific criteria regarding when and how a responder or survivor can submit an out-of-pocket medical expense claim. Critically, the request for reimbursement is not made at the time a claim is submitted. Instead, the request for out-of-pocket medical cost reimbursement must be submitted as an amendment to the original claim after the award has been issued. This allows the VCF to process awards in an expedient manner, as it does not have to spend time verifying each expense during the initial review. 

The VCF may reimburse responders and survivors for the following out-of-pocket medical costs:

• Doctor visits
• Diagnostic testing
• Prescriptions
• Prescribed medical equipment
• Surgical procedures
• Other medical procedures

Importantly, a claim for out-of-pocket medical costs can only be submitted once the expenses exceed $5,000. However, it should be noted that the VCF does not provide reimbursement for travel costs incurred in connection with going to and from medical appointments or medical procedures. It also does not compensate for future or anticipated healthcare costs.

If you are a personal representative who is filing a deceased claim, the request for out-of-pocket expenses must be submitted with the initial claim — this is because amendments are not permitted in these types of claims following the finalization of the substantive review.  

Contact a New York City 9/11 Victim Compensation Fund Attorney

If you incurred out-of-pocket medical expenses as a result of your 9/11-related health condition, you may be able to receive reimbursement. It’s crucial to have the guidance of an experienced 9/11 VCF attorney who can assist you with your claim to help ensure you secure the monetary award 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 more than a decade. For a free consultation, contact us today.