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What Are Presumptively Compensable Expenses?

Presumptively Compensable Expenses

If you’re a 9/11 responder or survivor who was diagnosed with a health condition in connection with the toxic dust cloud, you may be entitled to receive a monetary award from The September 11th Victim Compensation Fund. While medical documentation must be submitted to establish your economic and non-economic losses, it’s important to be aware that certain conditions do not require further proof when filing an amendment for medical expense reimbursement. Significantly, the VCF recognizes any expenses related to certain eligible conditions as “presumptively compensable expenses.”

In the event you were certified with such a condition, further documentation is not needed to obtain compensation for the economic loss associated with the necessary medication or medical procedures. 

Presumptively Compensable Expenses 

The VCF presumes that any expenses for medication or procedures in connection with certain eligible health conditions are related to that condition. These medical costs are referred to as “presumptively compensable expenses” and require no further proof of the relationship between the condition and the need for treatment. However, a responder or survivor must complete the Medical Expense Worksheet and list the specific expenses.

The VCF considers the following conditions and expenses as presumptively compensable:

  • Obstructive airway disease — This category includes conditions such as asthma, chronic airway obstruction, chronic obstructive pulmonary disease, reactive airways disease, reactive airways dysfunction, and bronchiectasis. A wide array of medications are deemed presumptively compensable for these illnesses, such as Flovent, antibiotics, oral corticosteroids, expectorants, Zyflo, oxygen, ProAir, Brethine, Spiriva, and many others. Presumptively compensable procedures include bronchoscopies, chest x-rays, chest MRIs, sputum cultures, thoracoscopies, lung transplants, and others.
  • Interstitial lung disease — Asbestosis, pneumonitis, sarcoidosis, pulmonary fibrosis, and granulomatosis are among the recognized conditions in this category. Presumptively covered medications include oral corticosteroids, antibiotics, oxygen, Imuran, Trexall, Cytoxan, and others. Procedures that qualify as presumptively compensable include bronchoscopies, chest x-rays, chest MRIs, thoracoscopies, lung transplants, sputum cultures, and others.
  • Gastroesophageal reflux — Presumptively compensable medications include proton pump inhibitors, Zantac, Pepcid, Prilosec, and others. Covered procedures include EGDs, laryngopharyngeal endoscopies, upper GI series, and gastric pathologies.
  • Upper respiratory disease — Rhinitis, sinusitis, laryngitis, pharyngitis, and tracheitis are among the illnesses in this category. Presumptively compensable medications include antibiotics, decongestants, oral corticosteroids, Nasonex, Afrin, Flonase, and Astepro. CAT scans of the head and sinuses, nasal pathologies, septoplasty, and laryngopharyngeal are all considered presumptively compensable.
  • Prostate cancer — A broad range of medications and treatments are presumptively compensable for prostate cancer, including chemotherapy, immunotherapy, and medications for urinary incontinence. MRIs, biopsies, cryotherapy, radical prostatectomy, and other medical procedures are among the procedures listed as presumptively compensable.

Importantly, the VCF only permits claims for past out-of-pocket medical expenses after an award has already been issued and medical expenses have exceeded $5,000. In such cases, you must file an amendment to your claim. You cannot include such expenses with your initial claim submission. There is no limit on the time to file an amendment as long as it is submitted before October 1, 2090.

What Is the VCF’s Medical Expense Worksheet?

To claim your presumptively compensable expenses, you must submit the VCF’s Medical Expense Worksheet with your amendment, which requires each medical expense to be listed and itemized. Information about the expense you are claiming must also be included. For example, you must specify your primary and secondary medical insurance carriers, the names of the medical providers with whom you treated, and the dates of service. 

On the Medical Expense Worksheet, the VCF also requires a description of the medical procedure, the amount paid, and proof of payment. To show the amount you paid, you may submit provider billing statements, canceled checks, a prescription history, pharmacy receipts, or EOB. It’s essential to ensure the form is filled out completely to avoid delay in your reimbursement or denial of your amendment.

Contact an Experienced New York City 9/11 Victim Compensation Fund Attorney

If you are a 9/11 responder or survivor who has been diagnosed with a 9/11-related health condition, you may be entitled to compensation. However, the process of filing a VCF claim can be confusing. It is critical to have the representation of a skillful attorney who can help ensure that you receive the maximum 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 over a decade. For a free consultation, contact us today. 


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