Can I Recoup Medical Expenses That I Paid Because of My 9/11-Related Condition?

Can I Recoup Medical Expenses That I Paid Because of My 9/11-Related Condition?

By Troy Rosasco

You may already know that the WTC Health Program provides cost-free medical care and monitoring services to eligible members of the WTC Health Program. You probably also already know that you can receive compensation for the expenses and impacts of your illness, such as lost earnings. However, what you might not know is that you can even pursue compensation for the past expenses that you incurred as a result of your 9/11-related medical condition before you obtained certification of that condition.

Learn more about how you can recoup the medical expenses you have paid by filing a VCF claim and about the services an attorney can provide to assist you in obtaining the benefits available through the two federal 9/11 programs by scheduling a free case evaluation with an experienced 9/11 benefits attorney.

Attorneys throughout New York have assisted 9/11 survivors, responders, and their family members in obtaining the medical care, monitoring, and compensation since before the establishment of these programs and have been actively assisting clients in applying and filing for their benefits nearly every day since. Reach out to an experienced attorney today for a free case evaluation and to determine your eligibility to pursue compensation for your injuries.

Why You Would Have Medical Expenses to Claim

Since the WTC Health Program provides free medical care and monitoring to eligible members through one of several New York City-located Centers of Clinical Excellence or its national provider network in every state in the nation, many members fail to receive a diagnosis or treatment for their 9/11-related condition until they become members of the WTC Health Program.

Because of this, those individuals have not incurred unpaid medical expenses as a result of the condition. However, this isn’t necessarily true for all of the members.

Many individuals received their 9/11-related condition diagnosis and began treatment for their condition before applying for the WTC Health Program, meaning that they could have incurred expenses that were not covered by their primary insurance provider.

Additionally, many individuals became ill with 9/11-related medical conditions before the creation of the WTC Health Program and the reopening of the September 11th Victim Compensation Fund (VCF) in 2011 or even died before the creation of these programs of a 9/11-related disorder and left behind unpaid medical expenses that family members now wish to seek reimbursement for.

When You Can Include Unpaid Medical Expenses in Your VCF Claim

According to the VCF, you can claim out-of-pocket medical expenses only if you incurred those expenses before you obtained certification of your medical condition. The only expenses you would accrue for the treatment of that condition after you obtain certification through the WTC Health Program involve treatments and medications provided outside the program’s Centers of Clinical Excellence and their nationwide provider network.

You cannot seek reimbursement for these expenses, as the requirements for participation include obtaining covered treatment and monitoring through affiliated providers. This is because the WTC Health Program covers the cost of treatment after your 9/11 condition is certified.

An Extensive Review Process

Submitting unpaid medical expenses for certified conditions requires the VCF administrators to undergo an extensive review process of your claim to determine that the expenses, in fact, relate to your medical condition, that you personally paid these expenses out-of-pocket, and that they did not result from out-of-network care for conditions that you already had certified.

Because of the amount of time such a review takes, the VCF requires these unpaid medical expenses to be submitted as an amendment to a claim that has already been reviewed and an initial award decision has been made for personal injury claims.

In wrongful death claims, however, you must submit documentation confirming these expenses when you file your claim, as you generally cannot amend a wrongful death claim.

The Process of Obtaining Reimbursement of Unpaid Medical Expenses

To obtain reimbursement of your unpaid medical expenses, below we provide instructions for a personal injury claim as well as for deceased claims.

#1. Personal Injury

You have to remember that the VCF will not review unpaid medical expenses as part of your initial claim due to the time involved, and will only reimburse medical expenses if you have at least $5,000 worth of unpaid expenses or a certified condition that you incurred before certification. Once you have received an initial award decision following the substantive review of your claim, you can request reimbursement through an amendment to your approved claim.

You can seek reimbursement if you paid out-of-pocket for prescription medication, prescribed medical equipment, doctor visits, diagnostic tests, and other services related to a condition that was certifiable through the WTC Health Program but for which you had not yet received certification. Travel expenses associated with your treatment don’t qualify for reimbursement.

Along with your amendment, you must submit supporting documentation, including a medical expense worksheet. You can use this worksheet to easily identify all expenses for which you want to seek reimbursement.

Unfortunately, if you fail to properly complete the medical expense worksheet or upload it to the website in a format other than Excel, the VCF will not review your amendment. Filling out these medical expense sheets accurately and including the proper documentation is one of the many services an experienced 9/11 benefits attorney can provide for you.

You must also include a properly labeled supporting documentation packet so that the VCF administration can readily identify the expenses and determine whether they qualify for compensation.

To amend your claim online, follow these steps:

  • Click on “Compensation Change.”
  • Use the checkboxes to indicate the specific change you would like the special master to consider.
  • In the text box, provide details of the type of request you’re seeking. Follow instructions and make sure to attach supporting documentation before submitting. When you add related medical conditions, you use the exact name of your condition as it appears on your certification.
  • Click “Submit Amendment” to submit your amendment for consideration.
  • Once you have submitted the amendment, you will then submit your supporting documentation. The amendment screen will list all types of documentation you need for this amendment type.
  • From the Amendments screen, click “Upload Files” from the upper right toolbar.
  • Select “Add Files” and choose the files from your computer that you wish to upload.
  • You must select the appropriate document type for each file before clicking “Start Upload.”
  • Once you have uploaded all associated documents, you will have the opportunity to review them as they appear in your claim by clicking “View Documents.”

#2. Deceased

Only deceased claims for unpaid medical expenses filed on or before December 18, 2020, or those filed before that date that did not include medical expenses, will qualify through the amendment process. For all other deceased claims going forward from that date, you must request unpaid medical expense reimbursement during the initial application.

#3. The Special Master’s Discretion

We should note that the VCF Special Master has the discretion to waive one or more of the eligibility requirements for claiming unpaid medical expenses if it proves necessary in light of a claimant’s unique circumstances, and claimants and their attorneys can seek a waiver by contacting the VCF Helpline.

The Difference An Attorney Makes

We often get asked whether an attorney is required to seek compensation through the VCF. While the law does not require that you have an attorney to file a claim, the successful outcome of your claim may depend on it. The federal 9/11 benefits programs require extensive documentation of both your presence at a 9/11 attack site during a period of high exposure as well as proof of related medical conditions.

Some of the strongest tools having an attorney provides you include extensive experience with the application process and a deep understanding of the eligibility criteria that the administrators of these programs use to evaluate and consider claims.

Filing an amendment to a personal injury claim for unpaid medical expenses constitutes an important part of your compensation, but it can also cause stress and heartache if you fail to submit the necessary information in the required format, at the time in which the VCF needs to see this information, and in a way that makes consideration of your amendment easy on administrators. For these reasons, retaining an attorney to take care of your claim can prove invaluable.

An Experienced Attorney Can Help

If you’ve incurred 9/11-related medical expenses, you should contact an attorney to determine whether you qualify to pursue compensation for the full cost of your injuries, illness, or loss. When the Zadroga Act reopened the VCF, even more survivors and responders began seeking compensation.

Posted under: 9/11 Cancers, 9/11 Victim Compensation, World Trade Center Health Program



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