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Breadcrumb

3.2 Does the VCF receive copies of my medical records from the WTC Health Program? Do I need to submit them with my claim?

Question
3.2 Does the VCF receive copies of my medical records from the WTC Health Program? Do I need to submit them with my claim? (Updated: December 26, 2019)
Answer

The VCF does not receive copies of your medical records as part of our information-sharing agreement with the WTC Health Program. The WTC Health Program only provides the VCF with information that is used to determine whether you have an eligible, certified condition. The information we receive from the WTC Health Program includes the name of the condition, the WTC Health Program category under which the condition falls (for example, Cancer or Upper Respiratory Disorder), and the associated medical diagnosis code. If the WTC Health Program notifies us that you have been certified for an eligible physical condition, we accept that certification as proof of your eligible condition.

If the WTC Health Program has certified your condition, you do not need to submit medical records to support a claim for non-economic loss at the lowest end of the range for your eligible condition. Similarly, if you have an eligible condition the VCF has identified as presumptively severe and debilitating, you do not need to submit medical records to qualify for the highest non-economic loss award allowed by the statutory caps. See Section 2.1.a – “Valuation of non-economic loss” – in the VCF Policies and Procedures document for a listing of conditions considered to be presumptively severe.

If, however, your certified condition is not among the list of conditions that the VCF considers to be presumptively severe and it significantly impairs activities of daily living, or if the certification does not reflect the severity of the condition, you may want to submit recent (i.e. within three years of the date your compensation claim was submitted) records related to your condition to help the VCF evaluate the severity and effect of the condition in order to determine whether an increased non-economic loss award within the appropriate range is warranted. This may include medical documents showing hospitalization, surgery, emergency treatment, and/or treatment for side effects of the condition; test results and treatment prescribed that show the severity of your condition; or medical records documenting severity and/or effect of the condition on your daily life. For a listing of the types of documents that can assist the VCF in the evaluation of your claim, see Section 2.1.b – “Documentation of non-economic loss” – in the VCF Policies and Procedures document. Please only submit documents that are related to your 9/11-related eligible physical conditions. It is very helpful and will speed the review of your claim if you highlight the relevant information in the records so the VCF can easily find the pertinent information.

If you submit medical records in support of your claim, you do not have to submit all of your medical records. A document from your physician summarizing the medical history of your condition and treatment will often be sufficient to prove the extent of your non-economic loss.

Question Number
2