How Changes to the VCF Private Physician Process Affect New and Pending Claims

In July 2017, the September 11th Victim Compensation Fund (“VCF”) updated the criteria for claimants to seek verification of their conditions through the Private Physician Process. The new guidelines only apply to certain claimants as discussed in our prior post. However, VCF has provided additional guidance on how the Private Physician Process applies to those with new and pending claims.

Answers to frequently asked questions have been provided as follows:

  1. Will this change in the Private Physician process delay the processing of my claim since I now have to go get certified, and my appointment with the WTC Health Program is not scheduled for several months?

No. For those claims that have already been submitted and are impacted by the change in the Private Physician process, your claim’s priority order will not be impacted as it is established based on the submission of your compensation claim. This means that waiting for the certification will not change the order in which your claim is processed. Once your certification is received, your claim will be prioritized for processing based on the date on which your compensation claim was submitted.

  1. Should I still complete the online Private Physician forms based on answers to questions in the claim form?

No. You should only complete the online Private Physician forms if you meet the new criteria for certification of the condition through the Private Physician process. It will take time for the changes to be made to the online system and this may create some confusion. In the interim, if you do not meet the new criteria, you should answer “No” to any questions that ask about treatment by a physician not affiliated with the WTC Health Program. You should also answer “No” if the system displays the question that asks if you are ready to provide information regarding the Private Physician process. Answering “No” to these questions will prevent the Private Physician questions from being displayed in the system.

  1. Is the Private Physician process available to victims who died of an ineligible condition and are claiming personal injury losses? For example, if a WTC survivor died of a heart attack, yet had suffered asthma and GERD while living, had treated with private doctors only, and had never been a member of the WTC Health Program, does the change mean the estate cannot seek verification of an eligible condition through the Private Physician process and has no way of becoming eligible for a VCF personal injury award?

The Private Physician process would be available in this situation so that the claimant could pursue a personal injury claim. The process remains available for deceased individuals who were not certified for treatment for the claimed condition prior to death.

  1. Is the Private Physician process available only to deceased individuals who were previously certified by the WTC Health Program and now claim a cancer, or is it also available to personal injury victims who were previously certified for a non-cancer and are now seeking compensation for a cancer?

The Private Physician process will remain available for all claims – deceased or personal injury – where the victim has already been certified for a condition by the WTC Health Program and is now seeking to add a cancer. Please note that the individual must have been previously certified for at least one eligible condition in order to seek verification of a cancer through the Private Physician process. For individuals claiming cancer who are not currently certified for treatment of any condition by the WTC Health Program, they must go to the WTC Health Program for certification of the cancer, although they can, of course, continue to be treated by their treating physician.

  1. Should I wait to receive a letter from the VCF explaining next steps on my claim or should I initiate the application/enrollment process at the WTC Health Program?

No – don’t wait! If you know you are seeking compensation for a condition that has not been certified for treatment by the WTC Health Program, please begin the certification process. You do not need to wait for the VCF to notify you if you are already aware you will need to seek certification based on the revised Private Physician criteria.

  1. I scheduled my appointment with the WTC Health Program but they told me it may take several months to be seen and to then receive a certification letter. Should I submit my claim even though I have not yet been certified?

As long as you have timely registered your claim, it is best to wait to submit your claim until you have been certified by the WTC Health Program. If you submit your claim without first being certified, the VCF will place your claim in Inactive status and it will remain in that status and will not be reviewed until you submit your certification letter.

  1. How do I request consideration for an exception to the Private Physician criteria? What do I need to submit if I want to claim a substantial hardship exception?

The VCF is considering various options for submitting these requests and will notify you once it has decided on the process it will use.

The deadline for filing a VCF claim is December 18, 2020. If you need assistance with the Private Physician Process, reach out to Sullivan Papain Block McManus Coffinas & Cannavo at (800) 962-9954 and via SPBMC’s contact page.

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