PRIVATE PHYSICIAN PROCESS FORMS

Updated: August 28, 2018


These Private Physician forms should only be used if you 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 are a foreign resident, living outside the continental United States, who has not been 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.
  • You are not able to go to a WTC Health Program center (either in the New York City metropolitan area or through the Nationwide Provider Network) to have your condition evaluated and certified for treatment without suffering significant hardship. If you believe that you will suffer significant hardship in seeking certification by the WTC Health Program, you should upload a statement or letter to the claim explaining the circumstances and why you should be considered for the Private Physician process and call the VCF Helpline to alert us to the request.

If you do not meet the criteria above, you should not complete the Private Physician forms.


You can review Frequently Asked Questions ("FAQs") specific to the Private Physician process in Section 7 of our FAQs.


Individual Forms:



WTC HEALTH PROGRAM GUIDANCE


The WTC Health Program has published the following materials related to the VCF Private Physician process. Claimants are strongly encouraged to review these materials before completing the Private Physician forms.


Click here to visit the WTC Health Program website.



IMPORTANT REMINDERS