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How Do I Claim VCF Out-of-Pocket Medical Expenses?

While the WTC Health Program provides survivors and responders with necessary medical care for their 9/11-related conditions, there may still be times when you incur out-of-pocket expenses. The September 11th Victim Compensation Fund allows you to recover compensation for out-of-pocket medical expenses in connection with treatment for your eligible condition as part of your VCF claim.

Filing an Amendment for Out-of-Pocket Medical Expenses

The VCF only allows claims for past out-of-pocket medical expenses after an award has been issued, and only if the claimed expenses amount to $5,000 or more. The claim for out-of-pocket expenses must be made by filing an amendment after your award has been issued, and cannot be included with your initial claim submission.

The VCF allows claims for out-of-pocket expenses to be made only after an award determination has been issued since it can take a significant amount of time to process these types of claims. If the expenses were considered during the initial review of your claim, your award could potentially be delayed.

There is no limit on the amount of time to file an amendment for your out-of-pocket medical expenses after receiving your award determination as long as it is filed by October 1, 2090.

What Kinds of Out-of-Pocket Medical Expenses Are Covered?

Many out-of-pocket costs that you paid related to your eligible condition may be reimbursed, including for doctor visits, testing, surgery, prescriptions, and medical equipment.

The VCF does not provide compensation for travel fees or expenses incurred during travel. For example, gas, mileage, meals, and hotels are not compensable expenses, even if they were incurred while you sought medical treatment. However, there may be extraordinary circumstances under which these expenses might be covered.  

While the VCF reimburses for out-of-pocket medical expenses, it only considers those that have already been paid by you. The VCF is not permitted to compensate for future or anticipated medical treatment. You also can’t be reimbursed if a collateral source such as Medicaid, Medicare, or your private insurance has already covered the expenses.

What Documentation Do I Need to Support My Out-of-Pocket Medical Expenses Claim?

In addition to submitting an amendment to your claim, the VCF requires that you include several other documents when you’re claiming out-of-pocket medical expenses. These documents include the VCF Medical Expense Worksheet and the Medical Expense Supporting Documentation Packet.

The VCF Medical Expense Worksheet requires each medical expense to be itemized and listed. You must also provide information such as:

  • Your primary and secondary medical insurance carrier
  • The name of the medical providers you treated with
  • Dates of service and a description of the procedure
  • The amount you paid
  • Proof of payment

You are also required to demonstrate that your out-of-pocket expenses claim is linked with at least one of your eligible certified conditions.

The Medical Expense Supporting Documentation Packet must include information for each expense that you listed on the Medical Expense Worksheet. You can submit provider billing statements, canceled checks, an EOB, or prescription history to show the amount you paid. If you use a canceled check or pharmacy receipt, you must be sure also to include proof as to the prescription or service. Depending on your eligible condition — and whether the expenses claimed are non-presumptively compensable — you may be required to provide medical records to show how the expenses are related to the treatment of your condition.

It’s crucial to make sure all necessary evidence and forms are submitted to the VCF to avoid your amendment being denied.

Contact a New York City 9/11 Victim Compensation Fund Attorney

If you were a 9/11 responder or survivor and been diagnosed with an eligible 9/11-related health condition or any form cancer, you may have incurred a significant amount of out-of-pocket expenses in connection with treatment for your eligible condition. The September 11th Victim Compensation Fund was set up to ensure that you are compensated for your injuries and the medical expenses associated with your treatment. 

The process of filing an amendment to claim out-of-pocket medical expenses can be confusing, frustrating, and complicated. A 9/11 Victim Compensation Fund attorney who is knowledgeable about the deadlines and regulations involved can guide you through the VCF claims process and help ensure that you receive the compensation to which you are entitled from the VCF. The 9/11 Victim Compensation Fund attorneys at The Dearie Law Firm, P.C. have represented claimants and their families in 9/11 VCF claims for over a decade. For a free consultation, contact us today.

John P. Dearie

John P. Dearie is a graduate of Regis High School, The University of Notre Dame, and St. John’s University School of Law. After working at a corporate law firm in New York City for two years following law school graduation, he joined The Dearie Law Firm in 2011.

John represents injured New Yorkers in third-party negligence litigations, as well as first responders, workers, volunteers and residents in claims to the September 11th Victim Compensation Fund.