Medical Records Fact Sheet
Updated: July 26, 2012
A PDF version of the fact sheet is also available.
As background, there are two steps in the VCF claims process:
- First, you must submit an Eligibility Form and supporting documentation to demonstrate your eligibility to recover from the VCF.
- Second, if you are found eligible, then you must complete a Compensation Form and submit supporting documentation so the VCF can determine the appropriate amount of an award.
First Step: What records do I need to submit with my Eligibility Form to show that I have an eligible presumptively covered injury/condition that was a result of the 9/11 crashes or debris removal?
If you have a presumptively covered condition (such as asthma or GERD) and are not submitting a claim for a traumatic injury (such as a broken ankle), you do not need to submit any medical records with your Eligibility Form to demonstrate that your presumptively covered condition was a result of the 9/11 crashes or debris removal. If the VCF needs medical records after reviewing your Eligibility Form, the VCF will notify you. Once the VCF receives your eligibility form, the VCF will take the following steps to obtain the necessary information directly:
- First, the VCF will request information from NIOSH to determine whether you have an eligible condition. (NIOSH is the entity that oversees the World Trade Center Health Program).
- If NIOSH does not have the necessary information to determine whether you have an eligible condition (for example, if you have not been certified for treatment under the WTC Health Program for a VCF covered condition), the VCF will then send certain data collection forms to physician(s) identified on the claim form. (The Eligibility Form requests that Claimants identify treating physicians if they are being treated or were diagnosed by a physician who is not part of the WTCHP). The VCF anticipates that those physicians will likely provide the medical documentation that is required to support the diagnosis and demonstrate the time of initial treatment that are necessary in order to determine the Claimant’s eligibility.
- After that process is complete, the VCF will notify you if further medical records are still needed for a particular case to demonstrate that your covered condition was a result of the 9/11 crashes or debris removal.
If you have a traumatic injury that you claim was a result of the 9/11 attacks, then the VCF will need medical records to document the specific injury and when that injury was first diagnosed and treated.
Also note: the Eligibility Form requests dates that each injury/condition was discovered, first treated, and first diagnosed. If you do not know the exact date(s) that each injury/condition was discovered, first treated, and/or first diagnosed, and don’t have medical records documenting such date(s), put in the best approximate date(s) you can to the best of your personal knowledge and recollection when answering these questions on the claim form. You do not need to get your medical records to answer these questions. After reviewing your claim, the VCF will notify you if specific records are needed.
Second Step: What records do I need to submit with my Compensation Form to demonstrate my economic loss?
Economic loss consists of two aspects – prior loss and future loss. Your past economic loss will be based on actual documented out-of-pocket expenses resulting from an eligible injury/condition. Any projected future losses will be based on the circumstances of your eligible injury/condition and a showing of the likelihood that you will continue to incur losses or expenses in the future. For example, if you are disabled as a result of the eligible injury/condition and cannot work at all or cannot work as much or in the same capacity as you did before the onset of the eligible injury/condition, then the VCF will compute an economic loss based on the reduced work capacity.
If you are not disabled or you do not claim that you will suffer economic loss in the future as a result of your eligible injury/condition:
- You do not need to submit medical records unless those records are necessary to document your past and future medical expenses and losses.
- It is more likely that there are other documents that will show past lost wages or expenses – such as employer statements, determinations of temporary disability and receipts for expenses.
If you are claiming a disability and believe that you will have lost wages or expenses in the future as a result of your eligible injury/condition:
- You will need to submit documents that show your disability. The types of documents that will help you to show disability are: disability determinations from the Social Security Administration (SSA), a state workers compensation board, an employer (like the FDNY) or a private insurer. The VCF will review these documents and will advise you if additional records or information is required. Please remember that you will be eligible for future economic loss only if that loss is caused by an eligible injury/condition.
- If you are claiming a disability with the VCF but you believe that the disability determination that you have received from another organization does not accurately show your current injury/condition then the VCF will likely need additional records such as an updated disability determination from a treating physician or an organization such as the SSA, workers compensation, or private insurer. The VCF will provide guidance after reviewing your claim.