The September 11th Victim Compensation Fund (“VCF”) works closely with the World Trade Center (“WTC”) Health Program to determine whether a claimant’s medical condition(s) can be certified as eligible for compensation from the VCF. Last month, the VCF updated the criteria for claimants to seek verification of their conditions through the Private Physician Process.
The new Private Physician forms should only be used by claimants who meet one of the following criteria:
- You received specific direction from the VCF to complete the forms; or
- You are filing a claim for a deceased individual who was not certified for treatment by the WTC Health Program for the claimed condition; or
- You were previously deemed eligible for compensation from the VCF based on a certified condition, and you are now seeking to add a non-certified cancer as a claimed condition.
Claimants who do not meet the criteria above should not complete the Private Physician forms.
The VCF provides instructions on gathering and submitting information from private physicians on its website. Claimants should follow the instructions below to gather the information the VCF needs in order to verify the claimed condition is eligible for compensation.
- Review the Private Physician Process forms to understand the type of information that is needed. The forms can be found on the www.vcf.gov website under “Forms and Resources”. The website also has Frequently Asked Questions (“FAQs”) about the Private Physician process.
- Complete the “Assessing Exposure to the September 11th, 2001 Attacks” form, being careful to use the appropriate version based on the claimant’s specific circumstances. There is one form for those present at the New York City site and a second version for those at the Pentagon and Shanksville, PA sites. Each form has two sections: one applicable to Responders and one for Non-Responders.
- Review the WTC Health Program “Diagnostic Essentials: Physical Health Conditions” document. These guidelines outline the specific documentation that is required in order to verify a condition for compensation from the VCF. Review the required documents for the specific injury being claimed to confirm you will be able to provide the requested information.
- Complete the 2-page “Treating Physician Information Form” using a separate form for each treating physician. This form can be completed by the claimant or the physician. List the conditions for which the claimant is being treated and the year of earliest diagnosis/symptom and provide relevant medical records (as outlined in the “Diagnostic Essentials” document) that support the diagnosis. If the claimant completes the form, please be sure the physician is notified that the form has been submitted to the VCF.
- Complete an “Authorization for Release of Medical Records Form” for each physician whose information is included in a “Treating Physician Information Form.” Provide one original version of the Authorization Form to the individual physician and send a second original version to the VCF. The Authorization Form authorizes the physician(s) to speak with the VCF about the claimant’s treatment. Please note there is one version of the form for Personal Injury claimants and one version for those filing a claim on behalf of a Deceased Individual.
- Gather the completed forms and relevant records and write the claimant’s name and VCF claim number on the first page of each form or document. Finally, complete the “Cover Sheet for Return of Completed Private Physician Forms” and upload the cover sheet and documents to the online claim or mail them in a single package to the VCF to the appropriate address listed on the form.
Claimants are also strongly encouraged to review the WTC Health Program materials discussed here before completing the Private Physician forms.
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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