Zadroga Act Eligibility and Benefits

The Zadroga Act, officially known as the James Zadroga 9/11 Health and Compensation Act of 2010, created two programs to provide benefits for those harmed by the September 11, 2001, terrorist attacks: the World Trade Center Health Program and the September 11th Victim Compensation Fund. These programs can help those who lived through the 9/11 attacks or fell ill because they assisted with the rescue, recovery, and cleanup at Ground Zero, the Pentagon or the crash site in Shanksville, PA.

Parker Waichman LLP, a national law firm headquartered in New York, can help you to understand the available benefits under these programs and whether you are eligible. Our experienced attorneys can also assist you with applying for either of these programs.

The Consolidated Appropriations Act

In December 2015, President Barack Obama signed the Consolidated Appropriations Act, a trillion-dollar spending deal that included the James Zadroga 9/11 Health and Compensation Reauthorization Act. The Zadroga Reauthorization Act renewed benefits for the Victim Compensation Fund and extended the life of the World Trade Center Health Program for 75 years, with a sunset provision that will terminate the WTC Health Program in 2090. By then, all people who were alive or about to be born on September 11, 2001, are likely to have been treated for any 9/11-related diseases.

What Is the Purpose of the World Trade Center Health Program?

The philosophical underpinnings of the WTC Health Program revolve around forming a comprehensive health-care system for 9/11 victims. The program is exclusively concerned with delivering convenient, compassionate, competent, complimentary, and comprehensive care.

• Convenient Care: According to the Centers for Disease Control and Prevention (CDC), under whose auspices this program falls, conveniently located health-care providers are essential. That’s why the program established medical centers they call Clinical Centers of Excellence, or CCEs. Most people who were affected by 9/11 will find a CCE nearby. The CDC also created a national provider network, recognizing that 9/11 victims might have moved away from the New York metropolitan area.
• Compassionate Care: The medical providers and program administrators know firsthand what patients are going through.
• Competent Care: The Program retains some of the best physicians, counselors, and health professionals, all of them experts in treating 9/11-related illnesses.
• Complimentary Care: This is not an insurance plan (although one of the program requirements is that an applicant must have health insurance that satisfies the minimum standards of the Affordable Care Act). Therefore, the program will not charge you for doctor visits, treatments or prescriptions.
• Comprehensive Care: The program employs a team of experts who understand fully that physical and mental health problems can affect all areas of your life. The program’s providers work in multidisciplinary teams to make sure that you receive the right care for all of your needs.

WTC Health Program Eligibility

Anyone who has ever suffered an injury or illness, whether physical, mental or emotional, caused by or related to the events of September 11, 2001, or their aftermath is invited to apply for the WTC Health Program, provided that they fall into one of two groups.

The first class of eligible applicants consists of disaster responders. The program is open to Fire Department of New York responders and their families as well as others who worked or volunteered in rescue, recovery, demolition, removal, and cleanup efforts relating to the terrorist attacks. This includes NYPD officers, construction workers, iron workers, truck drivers, and personnel from the New York Medical Examiner’s Office. Those who responded to the Pentagon or the Shanksville, PA, crash site are also included in this group. Applicants need only to have worked at one of the disaster sites or provided cleanup services for one day to qualify for the program.

The second group of eligible applicants is World Trade Center survivors, which encompasses a broad spectrum of people. Eligible applicants were in the dust cloud on 9/11 or present in the area designated as the New York City Disaster Area. People who lived, worked, attended school or were in day-care programs in the disaster area on September 11, 2001, and in the months that followed are eligible to apply for the program. The disaster area includes lower Manhattan and part of western Brooklyn, encompassing the path that the dust plume took and the areas that were covered by dust after the towers fell.

Applicants must submit documentation showing their eligibility for the program, which should be obtained from a third party like an employer or landlord. If you are told that you do not qualify, you can appeal this decision; our knowledgeable attorneys can assist you with this process.

The WTC Health Program provides services based on the class into which the applicant fits. For example, a responder receives annual monitoring exams, while a survivor will receive a health screening once. They may be admitted to the program as an enrollee if the screening locates a qualifying health problem. If the screening is negative, they can pay for another exam from a participating physician if they wish.

WTC Program Benefits

Enrolled responders and survivors will receive:

• Annual monitoring exams
• Medical and mental health treatment for all symptoms caused by or related to the 9/11 terrorist attacks
• Counseling on other Zadroga Act benefits, such as the Victim Compensation Fund and the WTC Health Registry. These are distinct from the WTC Health Program, and enrollment in one does not automatically mean you are enrolled in any of the others. The Victim Compensation Fund compensates 9/11 victims for their losses related to 9/11 physical injuries and illnesses. The WTC Health Registry helps public health workers keep track of the people who were affected by 9/11 and their physical and psychological health.

What 9/11-Related Illnesses and Diseases Are Covered by the WTC Health Program?

At this time, the program recognizes around 100 distinct illnesses that researchers and physicians have connected to exposure to contaminants from Ground Zero. These include:

• Anxiety disorders
• Asbestosis
• Asthma
• Cancer
• Chronic rhinosinusitis
• COPD
• Depression
• Gastroesophageal reflux disorder
• PTSD
• Sleep apnea

Sixty of the illnesses covered under the program are different types of cancer. And as medical experts connect more illnesses to 9/11, the list continues to grow.

What You Should Anticipate When Enrolling in the WTC Health Program

Every person enrolled in the WTC Health Program will receive an initial evaluation. If your examining physician determines that you have a medical condition related to or caused by 9/11, then they will seek to have your treatment covered by the program.

The program will cover your treatment only if you see doctors within their network. You can seek care outside of the WTC network, but you will pay out of your pocket for those services. The program could drop you for seeking treatment outside of the network, but you have the right to appeal that decision. Also, the program’s administrators cannot and will not seek your removal if you need emergency services for your 9/11 certified medical condition.

Your program physicians will work closely with your other medical care providers to make sure you receive the best care possible. For example, if you are hospitalized because of an emergency, the physicians treating you as an inpatient will consult with your program doctors to maintain the continuity of your care.

You need not wait for a medical emergency before seeking medical attention. The program gives its enrollees ample opportunity to request diagnostic testing, which will be covered if it is medically necessary to treat a certified or covered illness. Dental work will generally not be covered, but it may be covered if it was medically necessary to treat a certified medical condition.

Pros and Cons of the WTC Health Program

The WTC Health Program has many benefits, but there is one drawback that you should keep in mind: Unless your physician is included on the list of certified health providers recognized by the program, you cannot seek treatment from your primary care physician for your 9/11 certified medical condition if you want it covered by the program. However, your physician can apply to become an affiliated member of the program.

You should consult your physician as to whether applying for the benefits provided by the program are right for you. Participation in the program is by no means mandatory, but it does come with many benefits, some of which would be very costly if you had to pay for them yourself. For instance, if the day comes when you or your family can no longer care for you at home, you might require the services of a nursing home. The program will cover that cost if your condition satisfies the program’s rules and the nursing home is a certified provider. Without that benefit, the out-of-pocket costs to you for nursing home care could cause you and your family severe financial strain.

Another benefit of the program is that you can schedule a health scan free of charge. A health scan provided by the program is more extensive than a yearly physical. You can receive diagnostic tests and imaging in addition to blood tests that can help you get out in front of any potential health complications.

Time Limitations on Applications for Zadroga Act Benefits Under the WTC Health Program

Anyone who qualifies for the WTC Health Program can apply at any time until 2090. However, the program does impose some time constraints for certifying different health conditions. For instance, acute traumas and musculoskeletal complications would be expected to be diagnosed and certified fairly quickly, while some diseases, especially cancers, have a long latency period, meaning that the time between exposure and diagnosis could be a decade or more.

It’s also important to note that while 9/11 responders automatically get yearly health screenings under the program, those who fall into the survivor category only get one initial screening; if the screening finds a qualifying health condition, you will then be eligible for annual screenings, but if the initial evaluation does not find a qualifying condition, you will have to pay for your own screening if you develop symptoms later on. Therefore, for survivors, it often makes more sense to wait until you experience symptoms of a qualifying condition before applying to the WTC Health Program.

The program’s regulations also impose a time limit on appeals if you are denied coverage. You have 120 days from the day you receive the notice of denial to file an appeal. If this happens to you, Parker Waichman’s 9/11 lawyers can help you file your appeal promptly so you can get the benefits you deserve.

Where Is the World Trade Center Health Program Survivor Eligibility Application?

If you lived, worked or went to school in the New York City Disaster Area on Sept. 11, 2001, you can find the WTC Health Program application online and submit it by mail or fax. Keep in mind, though, that you may want to wait until you experience symptoms of a qualifying health condition to apply. If you need assistance or have questions about the application, contact our firm and we’ll be glad to help.

Victim Compensation Fund Eligibility

Eligibility for VCF benefits is limited to responders and survivors who were in the New York City Exposure Zone or at the Pentagon or the Shanksville, PA, crash site sometime between Sept. 11, 2001, and May 30, 2002. The New York City Exposure Zone is the part of Manhattan south of Canal Street and Clinton Street and also includes areas along the debris removal routes.

How Do You Apply for VCF Benefits?

The first step is to register with the VCF, which you can do at any time, whether or not you’re planning to file a claim, to protect your right to seek compensation. You can register online or by calling the VCF at 1-855-885-1555.

The second step, filing an actual claim, should be completed as soon as possible after the extent of your injuries is known and your condition has been certified by the WTC Health Program. Claims can be filed with the VCF online.

At Parker Waichman, our lawyers provide proven and superior advocacy that’s earned us numerous accolades, including inclusion in Best Lawyers and a rating of 9.8 out of 10 from AVVO. But what matters most to us is the results we get for our clients. Call us today at (516) 466-6500 or fill out our client contact form to let us assist you with your WTC Health Program application or appeal so you can focus on your health.