Eligibility and Benefits
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Parker Waichman LLP, a National Plaintiff's Law Firm Headquartered in New York, Offers 9/11 Survivors a Primer on the Benefits for Which They Might be Eligible to Receive
The Zadroga Act, officially known as the James Zadroga 9/11 Health and Compensation Act of 2010, created two programs which conferred eligible participants healthcare benefits and/or financial compensation for their injuries and illnesses caused by the September 11, 2001 terrorist attacks. Those programs are the World Trade Center Health Program and the 9/11 Victims’ Compensation Fund. The two programs are separate sources of assistance the United States government will give to people who lived through the 9/11 attacks or fell ill because they assisted with the rescue, recovery, and cleanup of the three crime scenes: World Trade Center, or Ground Zero, the Pentagon, and Shanksville, PA.
The Consolidated Appropriations Act
In December of 2015, then President Barack Obama signed the Consolidated Appropriations Act. This Act was a trillion-dollar spending deal which included the James Zadroga 9/11 Health and Compensation Reauthorization Act. The Zadroga Reauthorization Act renewed benefits for the 9/11 Victim Compensation Fund and extended the life of the World Trade Center Health Program for 75 years, with a sunset provision which will terminate the World Trade Center Health Program (WTC) in 2090. By then, the hope is that all people who were alive or about to be born on September 1, 2001, will have been treated for 9/11-related diseases.
9/11-Related Injuries, Diseases and Psychological Trauma
Unfortunately, the terror attacks continue to claim lives. The potent toxins which were released into the atmosphere or blanketed the ground when the planes exploded, and the World Trade Center’s north and south towers collapsed, and the fires that ranged in the Pentagon and the field in Shanksville, PA have spread chronic and terminal diseases. The sick and dying are the folks who probably thought the worst was over. They had survived the attacks and made it home safely to their loved ones or gave their best during the rescue and recovery efforts. In a cruel twist of fate, many came to learn that because of their exposure to carcinogens and other toxic chemicals, they are falling ill and succumbing to horrific diseases like cancer, respiratory diseases like asbestosis, and other forms of organ failure. The psychological toll the attacks took on survivors, including those who have not suffered from a physical ailment.
Parker Waichman LLP is Reviewing Zadroga Act Claims
Parker Waichman LLP is a New York plaintiffs’ law firm with a national practice. Parker Waichman’s Zadroga Act attorneys understand what you and your family are going through if you were the victim of the 9/11 terror attacks. We welcome the opportunity to represent you and your family when applying for the healthcare benefits you deserve from the WTC program and the 9/11 Victims’ Compensation Fund. Our firm has tremendous experience — and success — representing 9/11 victims and their families by aggressively advocating for their rights and benefits so they can continue to focus on their health instead of worrying whether they will get the help they so desperately need.
WTC Program Benefits
The philosophical underpinnings of the WTC Health Program revolve around forming a comprehensive healthcare system for 9/11 victims. The Program, meaning the law which under which it is organized, the regulations that control it, the physicians providing care, and the people who run it, are exclusively concerned with delivering convenient, compassionate, competent, complementary, and comprehensive care.
- Convenient Care. According to the Centers for Disease Control (CDC), under whose auspices this program falls, conveniently located healthcare providers are essential, especially when so many people are very sick. The Program administrators do not want their patients traveling long distances to see their doctors. That is 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 additionally created a national provider network as well. The CDC recognizes that 9/11 victims might have moved away from the New York Metropolitan area. Accordingly, the program established a system of physicians across the country that will provide services to those in need.
- Compassionate Care. The healthcare providers, program administrators, and the like know firsthand what you are going through. They will provide you with a safe place to go to discuss their illnesses and how the events of September 11, 2001, continue to affect them.
- Competent Care. The Program retains some of the best physicians, counselors, and health care professionals around. They are all experts in treating 9/11-related illnesses and mental health problems.
- Complementary 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 required by the Affordable Care Act). Therefore, the Program will not charge you for services for doctors’ visits, treatments, or prescriptions. Furthermore, you will have no out-of-pocket expenses. The Program does not charge a co-pay or force you to pay a deductible.
- Comprehensive Care. The Program employs a team of experts who can help you in all phases of your life. These experts understand fully that physical and mental health problems affect other areas of your life like your relationships, work, finances, and substance misuse. The Program’s healthcare providers work in multi-disciplinary teams to make sure that you receive the right care for all of your needs.
WTC Health Program Eligibility
The Program divides eligible participants into two primary classes. Each will be discussed in turn. The eligibility requirements are fairly broad so that the Program can include as many enrollees as possible. Anyone who has ever suffered an injury or illness, whether physical, mental or emotional, caused by or related to the events of September 1, 2001, and the aftermath is invited to apply.
The first of the two classes of eligible applicants are known as World Trade Center responders. The Program is open to Fire Department of New York responders and their families as well as and General responders. The Program defines a General responder as a person who worked or volunteered in rescue, recovery, demolition, removal, and cleanup tasks relating to the terror attacks. This included NYPD officers, construction workers, iron workers, truck drivers, and personnel from the New York Medical Examiner’s Office. Not every member of these groups is eligible to apply for the Program. Notwithstanding, the applicant need only have worked at the Towers on 9/11, worked at Ground Zero, or provided cleanup services for one day.
The World Trade Survivor class encompasses a broad spectrum of people. Eligible applicants were in the dust cloud on 9/11 or present in the area designated as the NTC disaster area. People, who lived, worked, attended school, or daycare on September 11, 2001, and the months that followed that were in the disaster area also eligible to apply as well. Additionally, eligibility is extended to those who qualified for residential or employment grants in lower Manhattan.
The disaster area is a large geographical area comprised of lower Manhattan and the southwest corner of Brooklyn. The disaster area encompasses the path that the dust plume took when the north and south towers fell. Additionally, the disaster area includes parts of Manhattan and Brooklyn which was covered by dust from the pulverized buildings. In Manhattan, the northern limit of the disaster area is East and West Houston Streets and extends 1.5 miles from the World Trade Center site into Brooklyn. The width of lower Manhattan falls within the designated disaster area.
The Program mandates that you submit supporting documentation along with your claim application to help determine your eligibility. The documentation you need should include information you obtain from a third-party like your employer or former landlord, so you can show that you qualify for services. The Program is designed to welcome as many people as possible. However, there is a screening process before you can enroll. You do have the right to appeal the decision of the Program if you receive a ruling that you do not qualify. Your right of appeal extends to the proximity requirement as well as the requirement that you suffer from one of the diseases that Program covers.
The WTC Program provides services based on the class into which the applicant fits. For example, a Responder receives annual monitoring exams whereas a survivor who is eligible for screening will receive a health screen once. The person may be admitted to the program as an enrollee if the screening locates a qualifying health problem. Also, the person can pay for another exam from a participating physician if the person’s screen was initially negative but believes he or she has a 9/11-related illness.
Enrolled Responders and Survivors whom the Program has admitted will also receive:
- Annual monitoring exams,
- Medical and mental health treatment for all symptoms caused by or related to the 9/11 terrorist attacks, and
- Counseling as to the benefits provided by Zadroga Act programs. Additional Zadroga Act benefits include the 9/11 Victims’ Compensation Fund and the WTC Health Registry. Both programs are distinct from the WTC Health Program and enrollment in one does not automatically mean you are enrolled in any of the others. The 9/11 Victims’ Compensation Fund compensates 9/11 victims for their losses related to 9/11 injuries and illnesses. Unfortunately, the Fund cannot compensate victims suffering from mental illnesses caused by 9/11. 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, especially on a long-term basis.
Covered Illnesses and Diseases
If you can prove that you satisfy the employment or proximity requirements imposed by the Program, then the only hurdle that remains is whether your ailments meet the Program’s requirements. At this time, the Program recognizes approximately 100 distinct illness that researchers and physicians have connected to exposure to contaminants from Ground Zero. Sixty of those illnesses are cancer. Incredibly, the list continues to grow. The Program’s administrators will add diseases not previously connected to 9/11 or will admit people to the program who suffer from an illness not previously associated with 9/11 exposure. Fortunately for many, the Program recognizes several forms of mental illness that are easily traceable to the events of 9/11 and its aftermath.
The Program provides victims healthcare for illnesses that the Program previously “certified.” A certified disease or medical condition is one in which is covered on the extensive list of requirements provided by the CDC or is one in which the Program considers it very likely that your exposure to the 9/11 tragedy aggravated existing medical conditions, is contributing factor in, or leads to your present health condition.
What You Should Anticipate When Enrolling in the WTC Health Program
Every person enrolled will receive an initial evaluation. Some people, as mentioned above, might be excluded by the first exam. However, if your examining physician determines that you have a medical condition related to or caused by 9/11, then the examining physician will seek to have your medical issue covered by the Program provided that it is medically necessary.
Your treatment will continue within the network of WTC Health Program providers. The Program will cover your treatment if you only see doctors within the 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 or “dis-enroll” you from the Program for seeking treatment outside of the network. Fortunately, you have the right to appeal that decision if you were aggrieved by a decision made by the Program’s medical review staff.
The Program, by its terms, will not punish you if you seek emergency care. Despite, reserving the right to dis-enroll a participant from the Program for failing to follow the rules and regulations, the Program’s administrators cannot and will not seek your removal if you need emergency services for you 9/11 certified medical condition.
Hospitalization may be required depending on the program participant’s condition. The Program will pay for admission if it is medically necessary to do so 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 through the Program. The Program will cover it provided that it is medically necessary to treat a certified or covered illness. Dental work may be included within those medically essential health complications. While the Program does not provide dental coverage generally, it might if the dental work was medically necessary to treat a certified medical condition.
Understanding precisely what the phrase “medically necessary” means will assist you in understanding why the Program does not cover some of your conditions or ailments. According to the CDC, medically necessary means that treatment must be given to relieve, manage, treat, or cure a qualifying medical problem. Complications resulting from a certified medical condition can be treated as well. The Program defines that treatment as “medically associated” treatment. Any treatment provided to an enrollee as medically necessary must conform to the Program’s guidelines for treatment.
Drawbacks of the Program
The Program has many benefits and has served, and will continue to serve, people whose lives depend upon them. Regrettably, unless your physician is included on the list of certified health care 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. 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. As we have discussed, there are many benefits that you can receive free of charge. Some of those benefits would otherwise be very costly if you had to pay out of pocket. For example, 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 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. Health problems can strain anyone’s resources. Even co-pays and deductibles, which health insurance companies are ever so fond of imposing these days, can take a toll on you, especially if you are unable to work due to your health problems. With the WTC Program, you receive high-quality health care at no financial cost to you.
Another benefit of the Program, assuming you qualify, 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 complication or, as with many cancers, catch it early before it metastasizes.
Time Limitations on Applications for Zadroga Act Benefits
The Program imposes time constraints on some diseases and health conditions. Acute traumas and musculoskeletal complications have time limitations on making a claim. On the other hand, the Program recognizes that many diseases, especially cancers, have a prolonged “latency” process. In other words, the time between the exposure and the diagnosis could be separated by a decade or more. However, you should apply as soon as you can for coverage. The Program’s regulations impose a time limitation on when you can appeal an adverse decision. You have 120 days from the day you receive the notice to file an appeal.
Parker Waichman’s 9/11 lawyers will help you file your application and any appeals you need to file timely. That way, you will not miss out on the benefits to which you could be eligible.
Why Choose Parker Waichman LLP for Your Case?
Our lawyers provide proven and superior advocacy. We are proud to have received honors from the legal community and beyond, including:
- A Rating of 9.8 out of 10 by AVVO’s peer review system.
- (Martindale-Hubbell® top rating of “AV Preeminent Lawyers.”
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- A listing in the Best Lawyers publication, as determined by extensive legal peer review.
Let One of Our 9/11 Compensation Lawyers Help You With Your Claim
You may choose to have a legal representative file an application on your behalf for benefits. You can also change representatives provided that you inform the Program of your decision. The application process can be daunting, and with so much worry on your mind, why not trust your application to the law firm who has helped many people just like you obtain the benefits they deserved? The Zadroga Act lawyers with Parker Waichman LLP are New Yorkers just like you. They had family and friends suffer through the terror attacks on 9/11, and just when they thought they could go on with their lives, they were stricken by a horrible disease related to the events of September 11, 2001.
Help With Your WTC Health Program Application and Appeal is Only a Phone Call Away
The very last thing you need is someone telling you that you cannot receive the medical treatment you need. We will focus on your legal needs so that you can focus on your health. Call Parker Waichman LLP today at 1-800-YOURLAWYER (1-800-968-7529) or fill out our client contact form so we can take the first steps toward securing the healthcare coverage you need from the WTC Health Program.