If you are a responder or survivor who suffers from a 9/11-related cancer or health condition, you may have incurred a considerable amount of out-of-pocket medical expenses in connection with your illness. You may be entitled to recover these economic losses by filing a claim with the September 11th Victim Compensation Fund. However, it’s important to understand that a claim for past medical expenses cannot be included with your initial claim submission — it must be made by filing an amendment after you have received your award.

What is the Process for Claiming Past Out-of-Pocket Medical Expenses?

To claim past medical expenses, you will need to file an amendment to your original VCF claim. The amendment can be filed at any time once your out-of-pocket medical expenses have exceeded $5,000, but it cannot be filed later than October 1, 2090, which is when all claim submissions close for the VCF.

A claim for past out-of-pocket medical expenses will only be considered by the VCF if the following criteria are met:

• The expenses were paid prior to the date the WTC Health Program certified your condition as eligible
• The expenses incurred are related to an eligible 9/11 health condition that was verified through the VCF Private Physician Process
• The VCF is able to verify at least $5,000 in claimed out-of-pocket expenses based on the documentation submitted
• The expenses claimed are acceptable as outlined under the VCF’s Acceptable Medical Expenses Claims
• The claim is submitted with the documentation required by the VCF to support a claim for out-of-pocket medical expenses

Since responders and survivors are eligible for treatment through the WTC Health Program, the VCF will not reimburse expenses incurred after the condition has been certified. The VCF also will not reimburse expenses for medication if you choose to have a prescription fulfilled at a pharmacy that is not affiliated with the Program. However, the Special Master has the discretion to waive any of the above requirements.

What Types of Past Out-of-Pocket Medical Expenses Can Be Claimed?

Under the Zadroga Act, the VCF does not compensate for potential or anticipated future medical expenses. It compensates for the out-of-pocket costs incurred for prescription medication, prescribed medical equipment, doctor visits, diagnostic testing, surgeries, and other medical procedures related to an eligible condition. The VCF will not award compensation for costs incurred while seeking treatment, such as travel expenses, hotels, and meals, unless there are extraordinary circumstances. You also cannot be reimbursed for costs that were reimbursed through insurance or a secondary payer such as Medicaid or Medicare.

It's crucial to provide adequate documentation to support a claim for out-of-pocket medical expenses. You must include the VCF Medical Expense Worksheet and the Medical Expense Supporting Documentation Packet with your claim for compensation. In addition, each medical expense must be listed and itemized. You are also required to provide other information such as your insurance carrier, the names of the providers with whom you treated, the dates of service, the amount paid, and proof of payment.

Contact an Experienced 9/11 VCF Attorney

If you incurred more than $5,000 in out-of-pocket medical expenses related to your 9/11 health condition, you may be entitled to reimbursement from the VCF. A knowledgeable VCF attorney can guide you through the process of filing an amendment to your claim and assist you with obtaining the compensation you rightfully deserve. 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 ustoday.