The Private Physician Process and How It Affects Individuals Who Died of an Ineligible 9/11 Condition

The Private Physician Process and How It Affects Individuals Who Died of an Ineligible 9/11 Condition

By Troy Rosasco

The 9/11 Victim Compensation Fund (VCF)  compensates survivors of  deceased persons who suffered from 9/11-related health conditions, and who have since died of those same conditions. The VCF also pays claims pays compensation to individuals who suffer from adverse health conditions resulting from their presence at a 9/11 exposure site, or from working in the subsequent cleanup efforts.

Obtaining VCF compensation requires proving a connection between a health condition and exposure to toxic dust or materials in connection with the 9/11 attacks or cleanup. Most commonly, eligible victims, or survivors of those who have since died, prove the necessary connection by obtaining certification of their covered condition from the World Trade Center (WTC) Health Program, the government-funded health screening, monitoring, and treatment program for 9/11 victims that is administered by the National Institute for Occupational Safety and Health (NIOSH).

Some victims, however, cannot or simply fail to access the WTC Health Program. Those victims can still establish their eligibility for VCF benefits by using the “Private Physician Process”, which is an alternative means of proving a connection between a health condition and 9/11-related exposure.

But, what if a 9/11 victim, who suffered from a covered condition, subsequently dies of a health condition that does not have a connection to a 9/11 toxic exposure (known as an ineligible condition). Can that victim’s survivors use the Private Physician process to establish the deceased person’s eligibility for VCF benefits?

The short answer to the question is “yes,” the Private Physician process is available to those individuals. Below we take a closer look at how that would work.

Overview of the Private Physician Process

The Private Physician process allows individuals who have suffered significant illness because of their presence at a 9/11 attack or cleanup site, but who cannot access the WTC Health Program to obtain certification of a covered condition. In a nutshell, it enables victims to establish that they suffer from a covered 9/11-related health condition by relying on records of treatment of that condition by a non-WTC Health Program medical provider.

The Private Physician process most frequently assists people who:

Died Without Ever Having Accessed the WTC Health Program

Some 9/11 victims who suffered from covered conditions, and who received treatment for those conditions from private physicians, died without obtaining certification from the WTC Health Program. In those cases, the victim’s survivors may use the Private Physician process to prove that the victim suffered from the condition.

Would Experience Hardship in Visiting a WTC Health Program-Certified Provider

In some cases, traveling to receive care from a WTC Health Program-certified physician within the United States can cause hardship for a 9/11 victim, such as when the victim lives in a remote area far from a Program-affiliated provider, or when that victim suffers from a health condition that makes it difficult to travel to see a provider.

Live Outside the United States

United States residents who have moved abroad since 9/11 and now suffer from a 9/11-related health condition may not have access to a WTC Health Program medical provider in the United States. The Private Physician process can enable them to establish eligibility for VCF benefits by permitting them to use records of treatment by an overseas medical provider as proof of their covered condition.

Can Someone Who Died of an Unrelated (i.e., Ineligible) Condition Use the Private Physician Process?

Yes.

Individuals who suffered from a 9/11-related covered health condition do not always die of that condition.

Many instead pass away in health events that are entirely unrelated to their covered condition, such as:

  • Heart attack;
  • Traumatic injuries in a car accident, fall, or other incident;
  • Old age; or
  • Diabetes.

If that individual received treatment from a private physician for their covered condition, but died without receiving certification of that condition from the WTC Health Program, then their surviving family members may use the Private Physician process to certify the condition in connection with claiming VCF benefits.

For example, suppose a 9/11 victim who suffered from a form of cancer recognized as related to a 9/11 toxic exposure, and who received treatment for that condition from a physician who was not affiliated with the WTC Health Program suddenly died in a car accident.

The estate of that victim can recover compensation for the victim’s cancer diagnosis and costs from the VCF by using the Private Physician process to establish the existence and treatment of the victim’s covered cancer. It does not matter that the victim died from some other cause. Damages the victim suffered due to the cancer itself qualify the victim for VCF compensation.

If you have questions about whether you have the right to seek compensation on behalf of the estate of a loved one who died after having suffered from a 9/11-related health condition, even if your loved one never received WTC Health Program certification of that condition, then contact an experienced 9/11 Victim Compensation Fund (VCF) lawyer  as soon as possible to discuss how to secure the benefits your loved one deserved.

The Compensation the Victim’s Estate Can Collect

Victims of the 9/11 attacks have the right to claim compensation for the financial and physical losses suffered in connection with the 9/11 attacks and clean-up efforts.

What compensation can victims, families and their estates expect?

Compensation for the Victim’s Pain and Suffering

The VCF also provides compensation for the victim’s pain and suffering caused by a 9/11-related health condition. In many cases, the victims suffer not only physical pain, but also significant emotional anguish related to the trauma of 9/11 and its aftermath.

Victims and families of deceased victims may seek compensation for the full range of physical, emotional, and life difficulties inflicted on them in connection with a 9/11-related health condition. This compensation is available even if the victim ultimately died from a health condition that was unrelated to 9/11, so long as the victim experienced pain and suffering due to the covered condition while still alive.

Compensation for “Loss of Earnings”

If the victim was working at the time of death, the estate may be entitled to an award for “Loss of Earnings” in addition to a “Pain & Suffering” award.

Compensation for Funeral Bills & Medical Expenses

If the victim died of a 9/11 related covered condition, the VCF will reimburse the individual who paid for funeral bills. We have seen reimbursements for some of our clients approach $20,000.

All victims of the 9/11 attacks typically incur at least some out-of-pocket medical expenses for treatment of their covered conditions. A victim who seeks care through the WTC Health Program will generally have relatively low out-of-pocket medical expenses because the program foots the bill for most eligible treatments.

In contrast, a victim who obtains care for a covered condition from a private physician who is not affiliated with the WTC Health Program may face relatively high out-of-pocket medical expenses, even when their health insurance covers some costs.

Victims or the estates of victims who have died may seek compensation for out-of-pocket medical expenses related to treating a covered condition by filing a claim with the VCF, so long as those expenses exceeded $5,000.

What Should You Do After Your Loved One’s Death?

You lost a loved one who had a 9/11-related illness, but who had not yet sought compensation through the VCF or had not received compensation offered through a VCF claim. Your loved one died of a non-covered condition, but you think that your loved one deserved compensation through the VCF due to having also suffered from a covered condition while still alive. What should you do next?

1. Get in touch with an experienced 9/11 attorney.

As soon as possible after your loved one’s death, get in touch with an experienced 9/11 VCF claims attorney to discuss your rights, including your loved one’s right to compensation and how to file a claim for compensation that your loved one deserved but did not receive before dying. An attorney can also go over the next steps and help you understand how to manage a claim.

Having an attorney on your side can also help the claim proceed smoothly. By working with an attorney, you can help to ensure that you make an accurate, well-documented claim for VCF benefits, that you meet any necessary deadlines, and that you respond appropriately to any follow-up from the VCF about your application—all of which can facilitate the efficient processing of your claim and can increase your odds of a favorable financial outcome.

2. Collect your loved one’s medical records.

Your loved one’s medical records will likely serve as a critical piece of evidence in supporting a claim for VCF benefits. Have your attorney collect all medical records documenting your loved one’s diagnosis with a 9/11-related health condition, treatment of that condition, and any expenses associated with that care.

The process of obtaining your deceased loved one’s medical records can also assist you in identifying any outstanding medical bills, which can facilitate the settlement of your loved one’s estate. In addition, the medical records may help clearly establish what other conditions your loved one suffered from and how those conditions impacted your loved one’s daily life.

3. Locate proof of toxic exposure related to 9/11.

The VCF provides compensation for all victims of the 9/11 attacks, including those who did not develop serious illnesses until years later. Establishing eligibility for VCF benefits involves proving exposure to 9/11-related toxic dust or materials during or soon after the attacks.  Your attorney can help with the proof process. That proof can consist of any documentation or visual evidence of your loved one having lived, worked, or otherwise spent time near the 9/11 attacks and/or cleanup sites where they may have encountered toxic materials.

For example, you might establish that presence through:

  • Eyewitness affidavits;
  • Photographs or video of your loved one at a 9/11 site; or
  • Pay stubs or other employment records reflecting that your loved one worked at a cleanup site.
  • A utility bill in your loved one’s name from an apartment near a 9/11 site where your loved one lived;
  • A report card showing your loved one attended school in Lower Manhattan at the time;

These are only some examples of the types of evidence that may establish your loved one’s exposure to toxic materials in connection with the 9/11 attacks and their aftermath. Talk to an experienced VCF claims attorney to discuss how you might go about proving that your loved one was exposed to dangerous toxins at a 9/11 site that led to your loved one suffering from a covered condition.

How Do I Know If My Loved One Deserved Compensation Through the VCF?

To file a claim through the VCF on behalf of a deceased individual, you will need to prove that your loved one, had he or she lived, would have had grounds for a claim based on several key factors.

An individual who can seek compensation through the VCF must:

  • Have a history of toxic exposure after 9/11, either due to working or volunteering at the scene or because of living, working, or going to school in Lower Manhattan in late 2001 and early 2002; and
  • Have a diagnosis of a covered condition related to exposure to toxic materials.

If your loved one met these two qualifications, then your loved one may have had grounds for a claim for VCF benefits. An experienced VCF claims attorney can help you learn more about your loved one’s rights and the rights you may have as you handle your loved one’s estate.

Do you have grounds for a VCF claim on behalf of a deceased loved one? If so, then an experienced 9/11 benefits claims attorney can help you learn more about the estate’s right to compensation and how to move forward. Contact Hansen & Rosasco, LLP as soon as possible at (855) 353-4907 to learn more about the next steps you need to take.

Posted under: 9/11 Victim Compensation, The Victims' Compensation Fund

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