An appeal can be filed within 30 days after the VCF has notified you of the eligibility or compensation decision on your claim. You can file an appeal if you have been found ineligible to receive compensation from the VCF or if you believe the VCF erroneously calculated the amount of your award. For example, you would file an appeal if you believe that the VCF used an incorrect income amount to calculate lost earnings or did not include in the calculation specific benefits information that you provided in your initial claim submission. You should only appeal the compensation decision if you are challenging the award determination already issued, and think that the VCF did not properly consider certain facts and information you presented in your claim in determining the amount of your loss. You may appeal only if your eligibility denial letter or award letter includes an Appeal Request Form.
If you appeal the award decision on your claim, except in cases where a claim is approved for expedited processing, any payment due will not be processed until your hearing is held and a decision is rendered on your appeal.
Note: Compensation appeals are not permitted in cases involving an award for non-economic loss only, where medical records were not submitted at the initial claim review stage. Because you should have the medical records that are needed at the time you submit your claim, the option to appeal will not be included in your award letter. If you did not submit medical records, and you believe your non-economic loss award does not adequately address the severity of your condition, you must submit the medical records with a compensation amendment.
Filing an appeal vs. amending your claim
You should not appeal, but should instead amend your claim, if you filed a personal injury claim and are seeking a revised determination based on one or more of the following: (1) new information that was not previously submitted with your claim; (2) information previously requested by the VCF in connection with review of your claim that you did not submit within the response timeframe provided; or (3) your circumstances have changed since receiving your decision letter. Section 5 includes more detailed information about amending your claim. Note that amendments will not be permitted in deceased claims, except in limited circumstances as described in Section 5.
For further information concerning when an appeal is appropriate vs. when to amend your claim, see When to Appeal vs. When to Amend, also available under "Resources."
When you receive the letter with your eligibility or compensation decision, it will include an Appeal Request Form with instructions for how to appeal the decision. If you intend to appeal you must follow the instructions in the letter, which are also outlined below.
- Within 30 days of the date of your decision letter: Complete and sign the Appeal Request Form and return it to the VCF. If your completed Appeal Request Form is not uploaded to your online claim or postmarked by the due date in your decision letter, you will have waived your right to an appeal.
- Gather the necessary documents and complete your Appeal Package: Your Appeal Package must include the following:
- Completed Pre-Hearing Questionnaire (enclosed with your decision letter).
- “Explanation of Appeal” as explained below.
- All relevant documentation to support your appeal, along with a listing of the documents and the specific component of your appeal to which each document applies.
- Within 60 days of the date of your decision letter: Submit your complete Appeal Package as one package. Your completed package must be submitted or postmarked by the due date in your decision letter or your request for an appeal will be denied.
Explanation of Appeal
The Explanation of Appeal is a written statement that should clearly explain the following:
- The specific components of your award, or the specific eligibility denial reasons, that you believe were not properly decided or calculated and that you intend to raise on appeal.
- The specific issues you intend to raise at your hearing for each component of your decision being appealed.
- A listing of the documents you are submitting as part of your Appeal Package to support your argument for each component of your decision being appealed.
The goal of the Explanation of Appeal is for you to fully explain the arguments you intend to raise at your hearing, and the reasons why you believe your claim was not properly decided. Please carefully review the information enclosed with your decision letter to ensure you submit a complete Appeal Package.
Once your complete Appeal Package is submitted, the VCF will review the information to confirm that you have a valid appeal, and will notify you of the next steps specific to your appeal and the scheduling of your hearing.
- You should only submit the Pre-Hearing Questionnaire, Explanation of Appeal, and applicable supporting documents once you have all of the information you intend to submit in support of your appeal. All materials should be uploaded to your claim or mailed to the VCF as one package.
- Submit your complete Appeal Package as one package. Your Appeal Package must be submitted to the VCF by the deadline stated on the appeal form included with your decision letter.
- With very limited exceptions, documentation provided to the VCF after your Appeal Package is submitted will not be considered as part of your appeal.
- If the VCF previously requested a document during the review of your claim, and you did not submit it when originally requested, the Special Master may exercise her discretion to exclude that document from the appeal record if you submit it for the first time as part of your Appeal Package.
If the VCF determines that your appeal request is valid (e.g., it is not an amendment and the Appeal Request Form and complete Appeal Package are submitted by the deadlines identified in your decision or award letter), the VCF will send you a letter with your assigned hearing date and time and important details about your hearing. If the VCF determines that your appeal request is not valid, we will notify you in writing that a hearing is not appropriate, explain the next steps that are appropriate, and if applicable, process any pending payment on your claim.
Once the VCF has assigned your hearing date and time, it cannot be changed except in rare circumstances of an urgent nature, as determined by the VCF. Requests to reschedule a hearing must be accompanied by a letter explaining the reason for the request. With very limited exceptions, your appeal will be denied and the prior decision on your claim will be considered final if you miss your scheduled (or rescheduled) hearing. If your appeal request is not valid, the VCF will notify you in writing that a hearing is not appropriate, explain the next steps that are appropriate, and if applicable, will process any pending payment.
If you decide after returning your appeal form that you do not want to appeal the decision on your claim, please notify the VCF so that we can update our records and take the appropriate action.
Although in-person hearings are preferred, the VCF is able to provide accommodations – such as phone or video conference – for individuals who are unable to attend an appeal hearing in person. You should include any requirements on your Pre-Hearing Questionnaire. Although you may participate in your hearing by telephone, your attorney (if you are represented) must be present in person.
If you or one of the individuals you are bringing as a witness at your appeal hearing does not speak English, you should request on your Pre-Hearing Questionnaire form that the VCF provide an interpreter for your hearing. Interpreters are provided at no cost to you. The request for an interpreter needs to be made by checking the appropriate box on the form and indicating the specific language. Please note that these interpreters are for the hearing only. If you need translation services before or after the hearing, you will need to provide your own translator. VCF hearing interpreters may not be used outside of the hearing itself.
What happens at a hearing:
Hearings are held in a non-adversarial manner. Hearings are conducted by the Special Master or a Hearing Officer designee from her office. These Hearing Officers are qualified individuals who have been trained expressly for these proceedings. While hearings vary in length, they rarely last more than one hour.
The objective of the hearing is to give you a chance to present information or evidence that you believe is necessary to support your appeal. You are allowed, but not required, to present witnesses, including expert witnesses. The Hearing Officers will be permitted to examine the credentials of any experts who participate in a hearing. If you are represented by an attorney, your attorney should attend the hearing with you, or, as noted above, should appear in person at a hearing for which you may be participating by telephone. Any individual who provides testimony at a hearing will be sworn in and will provide testimony under oath.
Please note that immigration status has no bearing on your hearing and undocumented individuals can attend a VCF hearing without risk of exposure.
After the hearing:
A new determination is not made on the spot at a hearing. The Hearing Officer will make a recommendation and the Special Master will review the information presented at the hearing, including your testimony, your Explanation of Appeal, and any supporting documentation. You will receive a follow-up letter explaining the decision on your appeal.