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How Do I Request Consideration for an Exception to the Private Physician Criteria?

By Troy Rosasco

To receive compensation through the VCF, victims of the 9/11 attacks, including responders, volunteers, and workers who may have suffered severe diagnoses due to exposure to the dust cloud after 9/11, typically must seek diagnosis and certification through the WTC Health Program before they can qualify for assistance through the VCF.

The WTC Health Program may also provide free medical care to many of the victims of the 9/11 attacks, which can make treatment and care possible for many victims, including those who can’t afford the treatment any other way.

In some cases, however, seeking treatment through the WTC Health Program may prove more difficult than you thought. You may not physically be about to go to an office visit to a WTC Health Program doctor or you may live outside of the United States, thus requiring that a private physician conduct your exam so that the WTCHP can certify your condition for future treatment and also provide a basis for your eligibility for compensation from the September 11th Victim Compensation Fund.

The Private Physician Option

In some cases, the private physician process can help victims who may not have the ability to seek treatment through the WTC Health Program get certified for their conditions and seek compensation through the VCF. This includes people who:

Died before having their conditions certified.

In some cases, victims of the 9/11 attacks might have died before they had a chance to have their illness certified through the WTC Health Program. They may, for example, not have known about the treatment available through the program or the compensation they could receive through the VCF, or they might have chosen not to pursue certification and compensation while still living.

When the estate seeks compensation for the injuries the victim suffered, the estate must choose to pursue a private physician exception, which may make it possible to certify the victim’s condition without visiting the WTC Health Program clinics. This is required because a major element of being eligible for VCF compensation is having cancer or other disease certified by the WTC Health Program as caused by the deceased’s exposure to the 9/11 toxins. If the deceased was never a part of the WTC Health Program before he or she passed, then the only method to have a 9/11 condition certified is after death through the WTC Health Program private physician process.

Live outside the United States.

If you live outside the United States, getting to a WTC Health Program-certified clinic could cause immense hardship, including financial struggle. Many people responded following the 9/11 attacks, including people from around the world.

Since 2001, many people have also chosen to move. Some victims may choose to move out of the country long before their ailments came to light. If you live out of the country, you may apply to have a private physician certify your condition.

You received compensation for a certified condition, but need to add a non-certified cancer or condition to the claim for further compensation.

Some victims face more than one diagnosis related to their participation during 9/11. For example, you may have suffered more than one type of cancer as a result of your presence at Ground Zero following 9/11. If you have previously received certification for a condition related to 9/11, you may want to talk to a 9/11 attorney about whether you can use a private physician exception to help you receive compensation for the additional diagnosis.

You volunteered at the Pentagon, not at Ground Zero, and do not qualify for certification through the WTC Health Program.

Volunteers and responders at the Pentagon may have faced some of the same challenges as those who volunteered at Ground Zero, including increased risk of a cancer diagnosis. However, Pentagon volunteers may not have the same right to seek certification through the WTC Health Program, so they may need to seek certification through a private physician instead of going through the WTC Health Program.

You would suffer substantial hardship if you had to go to a WTC Health Program clinic for certification of your illness or condition.

Talk to an attorney about what qualifies as substantial hardship in having your condition certified through the WTC Health Program. Just like you have your own unique story about the events of September 11, 2001, you have unique challenges that may make dealing with your condition harder.

You might suffer immense physical hardship if you have to travel to a WTC Health Program clinic. Some people, for example, have a very hard time traveling due to weakness or pain associated with their injuries. Others may have a hard time forgoing treatment long enough to travel to see a WTC Health Program provider.

You may also suffer other hardships, including financial difficulties that could entitle you to a private physician exception for certification for your conditions. Talk to your attorney to learn more about what might qualify as a hardship that would allow you to use the private physician exception.

How to Request Consideration for an Exception to the Private Physician Criteria

Do you believe you have an exception that may qualify you for consideration for the private physician criteria? If so, follow these steps, as recommended by the VCF, to request your exception.

1. Get in touch with a 9/11 attorney.

If you have a condition that qualifies you for compensation through the VCF, you may already have an experienced 9/11 attorney who will help you fill out the private physician exception and the rest of your information. If you do not have an attorney, consider choosing a 9/11 attorney to help you fill out your claim for compensation and all the associated paperwork. An experienced 9/11 attorney can help you.

An attorney can help you seek the evidence you need to fill out your claim.

To file a claim through the VCF, you will need to collect evidence related to your involvement at Ground Zero. You will need to show that you were present in the 9/11 crash site area on 9/11 or that you worked or volunteered at Ground Zero or that you lived, worked, or went to school in Lower Manhattan in the months following September 2001. Often, collecting that evidence can prove difficult.

While many employers, schools, and even landlords who operated during that time may have experienced a wide range of requests in the past, others may not have such clear records. Most businesses have a record retention policy of seven years — after seven years, the records are destroyed. An experienced 9/11 attorney can help you hunt down the records that you, specifically, need to establish your claim.

An attorney can help you determine whether you qualify for an exception that would allow you to use a private physician.

Using a private physician exception may make it more difficult for you to move forward with your 9/11 claim, since you may need to wait for the VCF to allow your exception. Having an attorney on your side, especially an experienced 9/11 attorney who has dealt with the VCF and the private physician process in the past, can make it easier for you to determine whether you stand a good chance of qualifying for an exception based on a specific hardship.

An attorney can help streamline your claim and make it go more smoothly.

Filing a claim through the VCF involves a great deal of paperwork, and you may struggle to deal with all the paperwork associated with your claim. An experienced 9/11 attorney can ensure that you fill out all the information correctly the first time and that your application doesn’t miss anything, which can help decrease the odds that the VCF will send your claim back for more sufficient information.

2. Upload a statement or letter that details your request and why you feel that you may suffer hardship if you have to seek certification through the WTC Health Program.

Explain why you believe you should qualify for a private physician exception, including what hardships you might face from trying to go to the WTC Health Program clinic to receive certification for your condition. Consider:

Would going to the WTC Health Program clinic cause you to suffer unnecessary physical hardship?

Traveling to a WTC Health Program clinic could cause immense discomfort, especially if you are in the middle of cancer treatments or other substantial treatment associated with your illness. You may need to detail the extent of that suffering, including how traveling has the potential to worsen your symptoms or what additional physical suffering you might go through.

You may need to stay near the clinic for quite some time while you get your condition certified, which could also interfere with ongoing treatment for your condition. Talk to your doctors about whether travel will pose undue hardship and help you determine whether you may have grounds for an exception, especially if you worry about travel. Then, contact an experienced 9/11 attorney to learn more about whether you may have the right to an exception and the likelihood of having it approved.

Would going to the WTC Health Program clinic cause undue financial hardship?

You may, for example, have to travel from far away to reach the WTC Health Program clinic, or you might not have the funds on hand to easily travel to your destination. You might also have to miss considerable time at work to travel to a clinic for certification, which may cause further financial hardship during an otherwise difficult time.

Do you have another hardship that may qualify you for an exception?

Talk to your lawyer about personal hardships and challenges, including childcare issues, personal hardships, or issues that may make it very difficult for you to travel or to leave home for any length of time. You may qualify for a private physician exception if you live a considerable distance away from a WTC Health Program clinic or one of the physicians in the WTC Nationwide Network of Providers. An experienced 9/11 attorney can give you a better idea of whether your hardship has a high likelihood of getting qualified for an exception.

3. Notify the VCF that you have filed a request for a private physician exception.

As part of the instructions issued by the VCF, you must call the VCF Helpline to notify the VCF about your request for a private physician exception. That phone call will help start the process moving so that the VCF can review your request.

The phone call does not have to be complicated; instead, you must simply inform the VCF that you need a private physician exception. If you have an attorney working with you, the attorney can handle that call.

4. Wait for the VCF to approve your request.

Filing a claim through the VCF does not mean a fast resolution, and you may have some time to wait at each stage of the process. If you need to apply for a private physician exception, you may need to wait for the VCF to review your potential hardships and ultimately determine whether you qualify for that exception.

You will have better odds of having the VCF approve your request if you have an attorney help you fill out the paperwork and put together your letter, since an attorney can provide the support and guidance you need to ensure that you include all the necessary details in your claim and that you do not miss anything that could slow down the process.

5. Fill out the packet once you have received approval through the VCF for a private physician exception.

Once the VCF has approved your private physician exception, you will need to fill out the packet. The packet includes all information associated with your claim, including your physician’s evaluation of your condition, how long you faced dust cloud exposure, and where you faced exposure to the dust cloud: directly at Ground Zero in the immediate aftermath of the accident or because you lived, worked, or went to school in Lower Manhattan in the months following September 2001. You will need to have your physician fill out any relevant information associated with your condition, your claim, and your request.

Do you need a private physician exemption that will allow you to pursue certification through your physician, rather than seeking treatment through a WTC Health Program-certified clinic? Do you need to learn more about whether you may qualify for an exception? An experienced 9/11 attorney can provide you with guidance and support as you move through your claim with the VCF.

Posted under: World Trade Center Health Program

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