If you’re a 9/11 responder or survivor who developed an illness linked to the toxic dust cloud that covered lower Manhattan after the terrorist attacks, you may be entitled to compensation for your out-of-pocket medical expenses. While the WTC Health Program provides medical monitoring and treatment, there may be certain circumstances under which some prescriptions or treatments are not covered. In such cases, the September 11th Victim Compensation Fund will reimburse you for past out-of-pocket medical expenses you paid in connection with your eligible condition.
Who Can Claim Out-of-Pocket Medical Expenses?
Responders and survivors may request reimbursement from the VCF for out-of-pocket medical costs incurred in connection with a 9/11 health condition as part of the economic loss component of their claim. Reimbursement may be requested for expenses paid before or after the date the illness was certified by the WTC Health Program. However, you are not eligible for reimbursement if your condition is being treated by a physician who is not part of the WTC Health Program — or if your prescriptions are filled at an unaffiliated pharmacy.
You also cannot seek reimbursement for treatment expenses already covered by the WTC Health Program, Medicaid, Medicare, Workers’ Compensation, your private health insurance, or another insurance provider. If you have insurance, the expenses must first be evaluated by the insurance company or any secondary payer before the VCF will compensate you for them.
Medical expenses that are billed as a co-payment after your insurance has denied coverage — or those that fall within the deductible — may be reimbursed if you can provide the appropriate documentation.
What Types of Out-of-Pocket Expenses Are Reimbursed?
Many different types of out-of-pocket medical expenses may be reimbursed by the VCF. But if a medical service or medication to treat your condition is available through the WTC Health Program, it is not eligible for reimbursement and should not be included with your claim.
Specifically, the VCF may reimburse you for out-of-pocket expenses in connection with the following:
- Prescription medicine
- Prescribed medical equipment
- Doctor visits
- Diagnostic tests
- Surgeries
- Other medical procedures
The VCF does not issue reimbursement for transportation or gas costs incurred while traveling to medical appointments. The VCF also does not compensate for anticipated or future medical expenses.
When Can You Submit a Claim for Out-of-Pocket Medical Expenses?
The VCF has specific criteria regarding when and how you can submit a claim for out-of-pocket medical expenses. For personal injury claims, the request must be made by submitting an amendment, along with the VCF’s Medical Expense Supporting Documentation Packet, after the initial determination on your award has been made. This allows the VCF to issue awards faster since it would not have to spend time during the initial review verifying each medical expense. You may also amend your claim after receiving a revised award decision.
In deceased claims, the request for out-of-pocket medical expenses must be submitted with the initial claim. This is because in these claims, you will not be allowed to submit an amendment after the VCF finalizes its substantive review of the claim.
It’s important to be aware that in both personal injury and deceased claims, a request for reimbursement can only be made if the out-of-pocket medical expenses exceed $5,000.
Contact a New York City 9/11 Victim Compensation Fund Attorney
If you incurred out-of-pocket medical expenses due to your 9/11-related health condition, you may be eligible to receive reimbursement. It’s critical to have the guidance of an experienced 9/11 VCF attorney who can assist you with your claim to help ensure you obtain the monetary recovery 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.