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The Victims Compensation Fund (VCF)
The September 11th Victim Compensation Fund (VCF) was created to provide compensation for any individual—or a personal representative of a deceased individual—who suffered physical harm or who died as a result of the terrorist-related aircraft crashes of September 11, 2001 or exposure to debris removal efforts in the immediate aftermath of those crashes, according to CDC.org.
Reimbursement for Past Medical Expenses for Out-of-Pocket Expenses That Were Not Previously Covered by the WTC Health Program or Insurance
As part of the economic loss component of individual claims, a claimant may request reimbursement for past out-of-pocket medical expenses he or she paid due to an eligible condition(s).
Claims for reimbursement of out-of-pocket medical expenses require submission and review of significant documentation establishing that the claimed medical expense was related to an eligible condition and that the claimant personally paid for the expense out-of-pocket. Processing claims does take time and may delay the award.
Because of this, as of May 2017, it is VCF policy that reimbursement claims for past out-of-pocket medical expenses be considered if specific criteria are met: The claim for medical expenses must be submitted as a compensation amendment to the claim after the claimant has received his or her initial award determination to enable the VCF to issue the initial award determination faster.
If a claim is amended to seek reimbursement for medical expenses, the VCF will review the amendment if the total amount of the claimed medical expenses incurred due to eligible conditions exceeds $2,000; and the amendment must be submitted with all required documentation, in the required format, which is posted under “Forms and Resources” on CDC.gov.
The VCF “Special Master may exercise discretion to waive one or more of these requirements as appropriate based on individual claimant circumstances.” Waivers are sought on the VCF Helpline.
Filing a VCF Claim
The VCF recently announced that it has streamlined and simplified the claim form and the other related documents that are necessary to process a claim.
The Eligibility, Compensation, Personal Injury, and Deceased claim forms have been combined into one form and the Private Physician packet is now part of the claim form. The VCF also minimized how many documents are necessary to process a claim and now provides a Document Checklist to help identify documents needed for claim filing as well as an online Navigation Tip Sheet with information on how to navigate the new online claim system. While the hard copy Claim Form remains available, the VCF encourages claim submission using it new online claim system.
New forms use the terms “Victim” and “Claimant.” A victim is an individual diagnosed with a September 11th-related physical injury or condition; a claimant is an individual filing the claim seeking compensation for the victim. Individuals who file an injury claim on their own behalf are both claimant and victim.
Both the Eligibility and Compensation portions of the claim must be submitted before the VCF may start its review, process a claim, and determine eligibility and compensation.
The VCF only awards compensation for economic loss to a claimant found to be disabled due to a 9/11 certified physical illness—not a psychological illness. The disability finding must be made by an independent governmental entity. Claimants not found to be disabled are generally not entitled to an award for economic loss.
The U.S. Department of Justice (DOJ) notes that the VCF does not pay the full award in the initial payment to ensure every entitled claimant receives some amount of payment.
The Zadroga Act dictates that first payments are portions of the total award amount; the amount of the award depends on the total award—the larger the award, the larger the first payment; the total number of claimants and total allocation the VCF has available for awards is a determining factor; and the greatest portion of the payment that claimants receive is at the close of the program.
The WTC and VCF Disability Evaluation Process
The VCF and the WTC Health Program have collaborated to implement a disability evaluation process for individuals who, although they are disabled due to an eligible condition, do not have a determination of a total and permanent disability from some other source, including the Social Security Administration, a state Workers’ Compensation program, a private doctor, or an insurance company.
This program enables individuals who have a disability evaluation for the purposes of the 9/11 Victim Compensation Fund claim.
The program is only meant for those victims who have a partial or full disability due to an eligible condition but who do not have, or are unable to receive, a disability determination from one of the standard third-party entities. Victims with a disability decision based on an ineligible condition may be candidates for the program should their eligible condition also became disabling.
Questions Concerning the Zadroga Act
Parker Waichman continues its efforts to protect those exposed to Ground Zero’s toxic cloud and the trauma of the 9/11 attacks and to ensure all deserved Zadroga Act compensation is received. To determine your eligibility for benefits and filing a claim, please contact our experienced team of Zadroga Act attorneys.