Does the VCF Receive My Medical Records from WTCHP – World Trade Center Health Program?
Did The VCF Receive Your Medical Records
A very common question asked is “Does the VCF Receive My Medical Records from WTCHP?” The most common way for an individual who has suffered a 9/11-related illness to satisfy the eligibility requirements to seek compensation from the September 11th Victim Compensation Fund (VCF) is by first applying for the World Trade Center Health Program (WTCHP) and going through certifying the condition.
While the VCF and the WTCHP are similar in that they are both federal programs created to benefit the responders and survivors of the 9/11 terror attacks, they are different programs. However, they share information, including some information about your medical condition. In addition, additional medical records must be supplied directly to the VCF by either you or your attorney.
Your Permission for the Two Programs to Share Medical Information
Among the many documents, you must submit when seeking compensation from the VCF is Exhibit A. Exhibit A authorizes the VCF to share your health information with the WTCHP and for the WTCHP to share your health information with the VCF. This authorization is necessary for the consideration of VCF claims.
However, you can revoke this authorization by writing to the providers and entities authorized to share the information. Otherwise, the authorization is valid for six years.
What Kind of Medical Information Is Shared by the WTCHP?
When the claim is filed and considered for review by the VCF, they can obtain the following information about your medical condition from the WTCHP:
- Which diagnosed and certified program-covered conditions you have.
- The WTCHP category for the condition. For example, if you have a certified cancer condition, the category would be cancer. If you have obtained certification for 9/11-related asthma, the category would be airway disorder.
- The associated medical diagnostic code for the 9/11-related illness you suffer from.
In addition to providing this information, once the claimant has submitted a signed Exhibit A form, the WTCHP will notify you when the condition is certified. You can use that certification to provide the needed information to the VCF on your own.
What Other Medical Information Does the VCF Need?
The VCF claims process includes a request for several documents, including medical records.
Your medical records contain valuable information that can help them make decisions regarding:
- Whether you are eligible to receive compensation
- The severity of the condition you suffer from, with more serious illnesses generally resulting in a higher level of compensation or even a faster approval process in emergencies.
- Information about your exact diagnosis and any secondary conditions you’ve incurred due to the diagnosis.
- Information about your treatment, including whether it was provided through WTCHP or your private health insurance plan. This information can show if you have incurred out-of-pocket expenses for medical treatment. Having a medical condition that requires lengthy treatment will also commonly impact your quality of life, resulting in a higher level of compensation for pain and suffering.
- With deceased claims, a personal representative must submit medical documentation showing the presence of a 9/11-related illness and a death certificate that lists the 9/11-related condition either as a cause or a significant contributing factor to the death.
The bottom line is that even if you obtained certification of your medical condition through the WTCHP and were told you do not need to submit medical documentation with your VCF claim, providing this information makes it easier for the VCF administrators to evaluate your claim. There are certain situations in which this information is crucial, including the following.
You Want to Increase Your Non-Economic Damage Claim
If you have a WTCHP certification and choose not to submit medical records, you will likely qualify for the minimum award. That is, provided you can meet other eligibility criteria, such as proving you were present at one of the terror attack sites within the period of high exposure to toxins.
However, if you wish to obtain more compensation for pain and suffering than the minimum award, you will have to show that the illness profoundly impacts your daily life. One of the easiest ways to prove this is by providing documentation that indicates a higher level of treatment, a lengthy treatment time, and particularly painful or impactful treatment methods.
You Have Received a Second Diagnosis
Many VCF claimants suffered more than one condition due to the toxic exposure they experienced on or after 9/11. The WTCHP will certify all 9/11-related conditions with which you have been diagnosed. Each time you receive a new diagnosis, you can provide information about the newly-diagnosed condition to the VCF. If the newly diagnosed condition is cancerous, it will generally result in additional compensation.
You can claim new certified conditions via an amendment to the initial personal injury claim. If the condition is non-cancerous, it will generally not increase compensation unless considered presumptively severe and debilitating.
Your Condition Is Not Presumptively Severe and Debilitating
If your newly certified non-cancer condition is not considered presumptively severe and debilitating, you usually will not obtain additional compensation simply by amending your initial claim to include it. To obtain additional compensation, you must be able to show how it has impacted your life and resulted in the loss of the ability to complete important tasks of daily living. Medical records can provide information to help support this claim.
What Medical Records Should Your Provide?
Suppose you are planning to provide medical documentation to support your VCF claim. In that case, there is no need to provide all of the information about every appointment you’ve attended or scan you have received. Often, the necessary information can be provided through a written statement by your doctor.
The statement should include:
- The treatment you received and the tests performed to diagnose or determine the extent of your condition.
- The symptoms you have suffered from due to your 9/11-related medical condition.
- The impacts that the illness and its treatments have had on your daily life.
- Your long-term prognosis.
Because medical documentation is extensive, even the VCF requests that you not send all of your records to them, as it adds to the time it takes to review your claim. Additionally, you should highlight relevant information in the documents so that reviewers can quickly find the information they need to evaluate your claim.
The Process the VCF Uses to Make Compensation Decisions
Except in the case of an expedited claim for emergency reasons, VCF claims reviews and award decisions occur on a first-in, first-out basis, and the review process can take more than a year to complete. This is true regardless of how much medical documentation you submit along with the claim.
While submitting too much medical information can increase the time it takes for administrative staff to review your claim, filing a claim without enough medical documentation can place your claim on inactive status. More information is necessary to complete a comprehensive review.
- The claimant registers with the VCF to file a claim at any time before October 2090.
- The claimant completes the claim form online or by hard copy and submits it to the VCF.
- The claim undergoes an initial review process to ensure the presence of all required documentation. If there is missing information, the program administrators will send you a letter requesting that information. The claim will be inactive until you submit all required information. After 60 days, if there has been no response to the request for missing information, the claim will be denied. The claimant will have to amend the claim to include the missing information and resubmit it for review.
- Once all required documents are received, the claim will undergo a substantive review. During this period, staff will verify that the claimant registered with the VCF by the deadline, the victim has an eligible 9/11-related medical condition, provided proof that they were at an affected site, and the claim requires no additional information. As with the preliminary review process, if the information is missing during the substantive review process, the claimant will be notified and allowed to provide that information. Failure to provide the requested information within 30 days of a request made during the substantive review will generally result in a decision being rendered based on the available information.
- Once eligibility is approved, staff will conduct an initial review of the requested compensation.
- After reviewing the requested compensation, the claim will undergo a complete compensation review and award calculation. This review includes determining both pain and suffering and economic losses, including wage loss and out-of-pocket expenses. This part of the process also includes determining collateral offsets, which involves assistance for the condition received from other sources such as pension funds, life insurance, or Social Security benefits.
- After the complete compensation review, administrators will inform the claimant of their decision on the claim and, if applicable, the award. The claimant will also receive information on the appeals process if they disagree with the claim decision or the award received. You can file a VCF appeal within 30 days of the decision. If you don’t appeal, the staff will process the award for payment about 20 days after the appeals period has expired. Payment generally comes through direct deposit to the bank account provided in the claim.
How an Attorney Can Help You Obtain Benefits
An experienced 9/11 benefits attorney can provide many services to help responders and survivors with their claims, including:
- Assistance with registering with the VCF or filing a claim.
- Determining the best medical records to include with the claim so that claims reviewers can quickly obtain the information needed to properly review and consider the claim. An attorney can also help clients obtain these needed records from medical providers.
- Helping claimants to have their claims expedited in emergencies, such as terminal illness or high risk of homelessness, if needed funds aren’t received quickly.
- Ensuring that all documents needed to review the claim are submitted to avoid having the claim placed in inactive status due to missing information. In addition to documents about the claimant’s medical records, a heavy focus is also placed during the review process on documents that can prove the claimant’s presence at an affected site.
- Helping clients amend their claims after a denial or when adding a new certified condition.
- Exploring other programs that can also assist the claimant, such as Social Security Disability Insurance. An attorney can also help their client understand how other assistance programs can impact the amount of compensation they can receive through the VCF and chart a path to obtaining the most robust assistance for their condition.
- Assistance with the appeals process. Contact Hansen & Rosasco, LLP for a free consultation today.