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Section 5: Amendments

Date effective
December 26, 2019

5.1  Personal Injury Claims 

You may amend your personal injury claim if you have already filed a claim and meet one of the following circumstances:

  1. The WTC Health Program certifies you for a condition not previously certified, or you are diagnosed with a new 9/11 related injury or condition that qualifies for verification through the VCF Private Physician process.
  2. Your claim was denied or deemed inactive because you did not respond to the VCF’s request for missing information and you are now ready to provide the requested documents.
  3. You need to add, change, or remove the Personal Representative or parent/guardian on an existing claim.    
  4. Your injury or condition substantially worsens, resulting in loss that was not previously compensated, or you have incurred new or additional economic losses due to your eligible injury or condition.
  5. You have new information in support of your claim that was not submitted to the VCF when your award was determined and that you believe would affect the amount of your calculated loss.
  6. You have received the initial award determination on your claim and are seeking reimbursement for out-of-pocket medical expenses that total more than $5,000.
  7. You previously submitted a claim for one or more components of economic loss and now want to withdraw that portion of your claim.
  8. You meet the criteria for the WTC Health Program Disability Evaluation Process and want to request consideration for that process, or you have received your WTC Health Program disability evaluation report and need to submit it for VCF review.
  9. You responded to a “Missing Information” request from the VCF after the time period stated in the letter and the information you submitted was not considered by the VCF when calculating your award.  Or, your online claim status is “Determination Made: Processing” and you have new documents you would like the VCF to review.  After you receive the letter notifying you of your award, you will need to file an amendment to have the new documents reviewed.  Note: If you submit documents after the VCF finalizes substantive review of your compensation claim, but before your award letter is issued, we will notify you in the award letter that the documents have not been reviewed and will instruct you to submit an amendment if you still want the VCF to review the documents.

 

5.2  Deceased Claims 

In a deceased claim (i.e., claims filed on behalf of a victim who died as a result of his or her 9/11-related eligible condition), you will not be permitted to amend your claim after the VCF finalizes substantive review of the compensation claim (with limited exceptions, as explained in the “Exceptions” section below).  A claim has reached the final stages of “substantive review” when the status in the online system moves to “Determination Made: Processing.”  This means that when filing a new deceased claim, you must claim all losses and submit all supporting documentation before the VCF finalizes substantive review of the compensation claim.  You can amend your claim at any time before the VCF finalizes substantive review of the compensation claim, but the best way to ensure complete review of a claim filed on behalf of a deceased victim is to claim all losses and submit all supporting documentation when you file your claim form.

Exceptions: 

The VCF will permit amendments on deceased claims after the VCF has finalized substantive review of the compensation claim in the following limited circumstances:  

  1. You received an award on a deceased claim and then filed an amendment before December 9, 2019.  The VCF will review your amendment in the ordinary course.  If you previously received an award on a deceased claim but failed to seek all compensable losses prior to payment of your award, you may file an amendment to your claim on or before March 9, 2020.  After that date, you will not be able to amend your deceased claim, except in the limited circumstances listed below.
  2. You previously claimed wrongful death losses but the VCF found that there was not enough evidence to show that the victim’s death was related to an eligible condition.  In this situation, you may file an amendment to submit additional information showing that the victim’s death was related to an eligible condition;
  3. The victim had a 9/11-related physical health condition that was not on the list of presumptively covered conditions when the VCF finalized substantive review of the claim, the VCF therefore did not award compensation relating to that condition, and that condition has since been added by the WTC Health Program to the list of presumptively covered conditions.  In this situation, you may file an amendment to seek compensation for losses relating to the newly added condition;
  4. You want to request reimbursement for past out-of-pocket medical expenses the victim paid as a result of eligible conditions. Please see Section 2.4(a) for more information about filing a medical expenses claim;
  5. You need to add, change, or remove the Personal Representative on your claim, including to add a Personal Representative when a victim passes away after filing a  personal injury claim and the death is not due to an eligible 9/11-related condition; or
  6. The Special Master determines that not permitting the amendment would result in substantial injustice.    

All Claims:

There are certain situations when amending your claim will not result in a change to your award.  Listed below are examples to consider before filing an amendment.

  • Amendments seeking additional non-economic loss:

Except in limited circumstances, if you already received a non-economic loss award at the statutory cap ($90,000 for non-cancer conditions and $250,000 for cancer), claiming a new condition will not change your non-economic loss award.  You may file an eligibility amendment to add the new condition and the VCF will determine if it is considered eligible, but you should not file a compensation amendment to seek additional non-economic loss.  The limited circumstances in which the VCF may award additional non-economic loss include if you are claiming a cancer where one was not previously considered in the award or if you are were previously compensated for a cancer and are claiming a non-cancer condition that the Special Master has identified as presumptively severe and debilitating (see Section 2.1(a)).  

  • Amendments on claims with large collateral offsets:

If your initial award determination was reduced by collateral offsets, you should consider whether these offsets will exceed the new loss you are seeking.  If your offsets are substantially higher than the loss you are claiming through the amendment, the amendment will not result in a change to your net total award.  For example, if you received a $350,000 settlement payment from a 9/11-related lawsuit, and are only seeking additional non-economic loss, you should not file an amendment as the non-economic loss awarded will not exceed the amount of this offset.

If you are represented by an attorney and are unsure whether your amendment will result in a substantial change in your award, we encourage you to discuss the amendment with your attorney.  If you are not represented, the VCF Helpline can assist you in deciding whether to submit the amendment.

You may file an amendment online or in hard copy. Follow the instructions in "How to File an Amendment" to amend your claim. The instructions are also available on the "Resources" tab, under “Forms and Resources” on the www.vcf.gov website.

The VCF will review the new information you submit with your amendment and will notify you of the outcome of our review. Each amendment will be reviewed; however, an amendment may not necessarily result in a change in your award.

If you believe your claim warrants an expedited review at the amendment phase, please submit another request for expedited status following the guidelines in Section 3.9.  If your claim was previously approved for expedited review based on financial hardship, your amendment will not automatically be reviewed on an expedited basis.