Amendments vs. Appeals in Your 9/11 Benefits Claim: What You Need to Know

When should I amend my claim and when should I appeal?

Sometimes, in managing your VCF claim, it becomes necessary to supply new information to the VCF to secure the compensation you deserve. Two formal processes exist for supplying information: amendment and appeal. Let’s take a look at how they work.

The Difference Between Claim Appeals and Claim Amendments

According to the VCF,

• You should appeal if you are challenging the VCF’s determination on your claim.
• You should amend if you are seeking a new determination based on new information.

Here are some key differences between appeals and amendments.

Amendments

An amendment changes the existing information associated with your claim, usually because you have new information to supply about your covered illness. For example, you might need to amend a claim to add information about a newly diagnosed health condition, or to supply supplemental information from your doctor that will help the VCF process your existing claim. An amendment can also supply information to establish additional losses related to your claim, for which you request compensation.

Appeals

An appeal contests a decision made by the VCF about your claim, such as a claim denial. New information that has come to light about your condition can serve as the basis for an appeal. For example, you might need to file an appeal if the VCF denied your claim due to inadequate documentation proving your presence in the 9/11 Crash Site Area or WTC Health Program certification or other proof of your covered 9/11-related cancer or other condition, and you have since obtained that information and want to supply it so that the VCF will reverse its decision and approve your claim.

Why Might You Need to File an Amendment or Appeal?

Your entitlement to VCF benefits depends on your ability to prove:

• Your presence at a 9/11 attack or cleanup site on 9/11 or in the months afterward, which exposed you to the toxic dust and other dangerous materials and substances;
• You suffer from an illness caused by exposure to those toxic materials; and
• That you suffered  non-economic (pain and suffering) and/or economic and damages (such as lost earnings or medical expenses) from that illness.

Filing a claim for VCF benefits involves submitting documentation to establish those facts. The more detailed documentation you can provide, the greater the chances that you will receive the full compensation you deserve from the VCF. The quality of your documents matter, including a properly drafted affidavit by witnesses that establish your presence in lower Manhattan on or after 9/11.

In connection with proving your VCF claim, you might need to file an amendment or appeal for a variety of reasons.

1. You have received a new 9/11-related health condition diagnosis.

The WTC Health Program has identified an extensive list of health conditions that could result from toxic exposure at a 9/11 site. Some individuals who seek compensation from the VCF for one 9/11-related health condition sometimes learn, later, that they also suffer from a second condition that’s also related to 9/11.

This additional diagnosis may entitle you to additional compensation from VCF, and you can seek that compensation by amending an existing or already decided claim to add information about the new diagnosis.

Suppose, for example, that you suffered from low back pain in the immediate aftermath of 9/11, and you sought compensation through the VCF for those ailments through a VCF claim early on. Later, you received a lung cancer or mesothelioma diagnosis related to dust cloud exposure. You may have the right to amend your claim and seek further compensation because these diagnoses may have a much more severe impact on your life as a whole, including both your finances and your daily activities.

To seek additional compensation related to a new diagnosis, you will need to have your new diagnosis certified through the WTC Health Program or alternative means approved by the VCF, such as the private physician process. Without that certification, the VCF will not provide compensation for your losses. An attorney can help you understand the process for having your newly diagnosed condition certified.

2. You have faced additional financial losses due to a condition you have already had certified.

You have already certified your condition through the WTC Health Program and even sought damages through the VCF in the past. However, at some point, you may get a new diagnosis or your cancer or other condition may have worsened so that your ability to work is impaired and you apply and receive Social Security Disability, short- or long-term disability, or workers’ compensation. If you have a new diagnosis or your prior condition worsened, then you may want to submit an amendment seeking additional compensation.

3. You have located additional evidence to support your claim.

To establish your right to compensation through the VCF, you will need to prove your presence at or near a 9/11 attack or cleanup site, such that you were exposed to the toxic dust and other dangerous materials. You may use employment records, property records, or a host of other types of documentation to prove that fact. However, sometimes, you may have a hard time locating that necessary evidence, especially since just about 20 years have passed since 9/11 making it difficult to obtain the required proof or locate the necessary witnesses.

If crucial evidence comes to light late in the process and after the VCF has decided your claim, then you can supply that new information through an amendment. If the VCF has already denied your claim due to the absence of that information, then you may supply that new information by filing an appeal and, in some instances, the VCF will convert the appeal to an amendment.

4. You believe that the information attached to your claim contained incorrect data or an inaccurate assessment of your losses.

The VCF may have issued an award decision that does not reflect the amount you believe you deserve. After talking to an attorney, for example, you may have realized that you actually deserve more compensation than you initially applied for, or that the VCF did not receive information that could have impacted your claim and helped you obtain the full compensation you deserve. By submitting additional information in support of your claim, you may amend your claim which can help you ultimately receive more compensation for your losses.

You may have grounds to appeal or amend your claim for a variety of reasons, especially as your circumstances change. Working with a lawyer can help you determine how to move forward with that process.

Should You File an Appeal or an Amendment?

Filing an appeal or an amendment could depend on a variety of factors, including whether the VCF has already issued an award or decision related to your claim, and the type of change you need to make to your claim. How do you know what decision you need to make?

Talk to an experienced 9/11 attorney regarding your VCF claim. An attorney can evaluate the changes you need to make to your claim and let you know whether you need to file an amendment or an appeal.

To either amend or appeal your claim, you should work closely with an attorney to ensure that you have all the necessary paperwork lined up. An attorney can guide you through each step of your appeal or amendment, from determining whether you need to file an appeal or an amendment to helping you sort through all the paperwork you need for your claim. An attorney can:

1. Ensure that you have all the necessary documentation to file an appeal or an amendment.

In addition to filling out the VCF forms related to your claim, you may need to collect the right documentation to show that you have grounds for a VCF claim, including WTC Health Program certification of your condition. Filing an amendment or appeal will always lead to additional paperwork, including the need for further proof of your condition or presence in lower Manhattan. An experienced 9/11 attorney can ensure that you have the correct documentation the first time, which can help your appeal proceed smoothly with the greatest chance of success and avoid any unnecessary delays in obtaining the compensation you deserve.

2. Determine whether you need to move forward with an appeal or amendment.

Sometimes, filing an appeal or amendment may not significantly impact your claim, especially if you already received the maximum compensation provided through the VCF or your changes do not document that your overall quality of life has deteriorated further. An attorney can evaluate your new diagnosis or other changes to your circumstances and determine whether filing an appeal may help you achieve your goals regarding compensation.

3. Keep you informed about all the details associated with your claim.

Tracking the progress of your claim, including an appeal or amendment, can be stressful. An attorney can guide you through the process and keep you informed about all elements of your claim, including how long it will likely take to receive compensation through the VCF, any additional documentation you may need to provide, and any elements of your claim that could extend processing time. An attorney can also update you any time something changes with your claim, which will make it easier for you to manage the stress of waiting for a decision.

What Should You Do if You Have Grounds to Appeal or Amend Your Claim?

You have grounds to file an appeal or amendment on your VCF claim. Now what? If you believe that you may have grounds to file an appeal or amendment, make sure you take the right steps to move forward with the changes to your claim.

There are consequences if you incorrectly choose to appeal a decision as opposed to amending your claim. For example, if you appeal an award amount, the VCF will delay payment until all of the documents for the appeal are submitted, a hearing is scheduled and heard, and a decision is rendered — a process that can take over a year and delay your receiving payment of your award.

1. Get in touch with an experienced 9/11 attorney.

Often, an attorney can go over your claim and give you an idea of whether you should file an appeal or amendment: both which type you may want to file and whether you need to file a change to your claim. Sometimes, you may discover that your changed circumstances will do relatively little to influence the compensation you may receive through the VCF.

Filing an appeal or amendment could, at that point, delay the processing of your claim and receipt of the compensation you need as mentioned above, which could cause unintended complications to the claims process. An attorney can also determine whether your changed circumstances justify changing your claim and how those changes may impact your claim, including the time it may take you to receive compensation.

2. Gather relevant documentation.

To prove that you have grounds for an appeal or amendment, you will likely need to supply additional documentation to the VCF. If you have a new health condition stemming from dust cloud or other exposure, for example, you may need to show your medical records as well as WTC Health Program certification.

If you have new evidence that changes your right to compensation, you may need to include those documents, or copies of those documents, as part of your amendment or appeal. You will need to have all that information on hand to expedite filing your claim. An attorney can identify the documentation you need and can help you collect it.

3. Make changes via the online portal, if you originally filed online.

Filing online keeps your VCF claim fully visible at all times. By filing online, you can keep an eye on the claim progress, and determine easily whether you need to supply additional information to supplement your claim submission. If you used the online portal to file your initial claim, then you can also file amendments and appeals through your account. You can also authorize your attorney to make changes to your online claim on your behalf.

If you did not file your claim online, then you will need to submit an amendment or appeal letter that will show your new evidence and the grounds for your request.

Do you need to file an amendment or appeal of a VCF claim? The sooner you contact an experienced 9/11 claims attorney, the sooner you can move forward. Contact a skilled 9/11 attorney today to learn more about your next steps.