Is the Private Physician Process Available Only to Deceased Individuals?

For most individuals who got sick with a 9/11 cancer or other condition because of exposure to the toxins released by the September 11th terrorist attack sites, obtaining medical treatment and monitoring through the WTC Health Program for their eligible condition is directly related to  seeking compensation through the other federally funded 9/11 benefit program, the September 11th Victim Compensation Fund.

What happens if you have a 9/11 eligible condition, but cannot obtain treatment through a WTC Health program Metro area Clinical Center of Excellence or with one of the doctors in the Nationwide Network of Providers?  What happens if your loved one died of a 9/11-related cancer or other medical condition before having their 9/11 cancer or other 9/11 illness evaluated by the WTC Health program or their condition certified?

For the families who lost loved ones who did not participate in the WTC Health Program, the private physician process takes the place of examination and treatment in the WTC Health Program for the purpose of making the finding that the environmental exposure in the 9/11 Crash Site Area was a cause of the later condition that resulted in the person’s demise. Contrary to popular belief, this process isn’t just available in deceased claims but is open to many individuals. Read on for more information about who should use the private physician process when seeking compensation for the expenses and impacts of your 9/11-related illness.

If you have questions about the private physician process or any other matter related to obtaining medical monitoring and treatment or compensation from the federal 9/11 benefits programs, an experienced 9/11 benefits attorney can provide answers.

What Is the Private Physician Process?

When an individual seeks compensation from the September 11th Victim Compensation Fund (VCF), the administrators of the fund use certification information from the WTC Health Program to determine if the individual has an eligible 9/11-related medical condition that qualifies him or her for compensation.

In some cases, however, the individual can’t have their condition certified by the WTC Health Program, as that requires evaluation and treatment through one of the program’s designated medical centers. The private physician process is used to determine eligibility for these individuals instead.

The private physician process requires a physician of the claimant’s choosing to meet certain diagnostic criteria. Claimants and their physicians must fill out the documents and provide the necessary documentation for VCF consideration,

Who Can Use the Private Physician Process?

Only those who meet the following criteria are permitted to use the private physician process to obtain compensation for a 9/11-related medical condition:

• Individuals whom a VCF representative instructed to download and complete the private physician process forms.
• Individuals filing a death claim on behalf of a deceased individual who was already approved for an eligible condition by the WTC Health Program, but was diagnosed with an uncertified eligible condition before death.
• Foreign residents currently living outside the U.S. who have not previously obtained WTC Health Program certification of a claimed eligible condition.
• You formerly obtained compensation from the VCF for an eligible condition, and now you want to add cancer as an additional claimed condition.
• You were present at the Pentagon during the 9/11 attack, but not as a responder, so the VCF does not certify your condition.
• You can’t go to one of the WTC Health Program designated medical centers or a networked provider for certification or treatment without significant hardship.

Why Would Someone Want to Add a Condition to the Claim through the Private Physician Process?

The exposure to the toxic dust plume at ground zero in lower Manhattan created the potential for many catastrophic cancers and other illnesses. Many individuals did not merely suffer one type of devastating disease, but two or even more.

However, because the latency periods on different types of 9/11-related cancers vary greatly (from 146 days for blood cancer to 11 years for mesothelioma), it is not unusual for many years to pass between one cancer diagnosis and another.

If an individual already received compensation for the expenses and impacts of one 9/11-related cancer and subsequently received a new diagnosis, he or she can obtain compensation for the additional condition by either having the WTC Health Program certify the condition, or—if that is not an option—through the private physician process.

The private physician process is also helpful for personal representatives filing deceased claims, as a deceased individual can’t seek either the initial certification or the certification of any new death-causing condition. Therefore, the private physician must be followed, using the diagnostic test results that discovered the new condition.

How to Complete the Private Physician Process Forms

If you were asked to complete the private physician process forms or you have a condition that qualifies you to use the physician process, you can complete the package following these steps:

• Review the physician process forms and associated literature thoroughly to understand the types of information you need to provide.
• Complete the appropriate form for your claim, using one form if you were present at the terrorist attack site in New York City, or a different form if you were at the Pentagon or the site of the plane crash in Shanksville, PA.
• Review the WTC Health Program’s document on the diagnostic tests that you need to confirm your diagnosis.
• Fill out a “Treating Physician Information Form” for each physician who treats your 9/11-related medical condition, or have your treating physician fill out this form. Be sure to list all of the 9/11-related conditions you receive treatment for on the form, along with the earliest date on which you were diagnosed or began experiencing symptoms of the condition. You must provide related medical records to support the diagnosis.
• Complete an authorization to release your medical records for every treating physician you have listed. You must provide an original copy of the release to both the physician and the VCF to authorize your doctor to discuss your condition with VCF administrators. You must use the right release form, as there is a form for personal injury claims and one for claims involving deceased individuals.
• Gather all of the forms and necessary documentation. Complete the cover sheet, and send the packet to September 11th Victim Compensation Fund, PO Box 34500, Washington, DC 20043.

How the Private Physician Process Works with Claims for the Deceased

To complete the private physician process to add an eligible condition to a deceased person’s claim, you must be the personal representative for the deceased’s estate (usually appointed by the local Surrogate’s Court). You must provide a listing of all doctors and health providers who diagnosed and treated the deceased’s injury. You will also need to list all insurance companies, worker’s compensation programs, or pension programs that may have information about the deceased’s medical condition.

When you sign the authorization releasing medical records, you allow the deceased person’s healthcare providers to discuss his or her medical conditions with several individuals, including representatives from the VCF, the WTC Health Program, and the U.S. Department of Justice.

You may revoke this authorization at any time by making a written request to each of the authorized entities. If you do not revoke this authorization, the release remains in effect for six years from the date of the signature on the release.

About the WTC Health Program and the September 11th Victim Compensation Fund

In late 2001, Congress established the original VCF program to bring financial relief to those most impacted by the terrorist attacks on September 11th, 2001. The original program ran until 2004.

In 2011, President Barack Obama signed into law the James Zadroga 9/11 Health and Compensation Act, which reauthorized and reopened the VCF and also created the WTC Health Program.

The government reauthorized the programs in 2015, with changes to the VCF policies that included caps on non-economic claims and the prioritization of claims involving the most seriously ill claimants. Despite these changes, the VCF Special Master warned in 2019 that the money that remained in the VCF fund was insufficient to cover all pending and projected claims.

In 2019, President Donald Trump signed into law The Never Forget the Heroes: James Zadroga, Ray Pfeifer, and Luis Alvarez Permanent Authorization of the September 11th Victim Compensation Fund. This extended the deadline for filing a claim for compensation through the VCF until October 1, 2090, for all claimants who registered their certified 9/11 medical condition with the VCF within two years of receiving certification of the condition through the WTC Health Program.

The National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control and Prevention (CDC), and the U.S. Department of Health and Human Services administer the WTC Health Program. The program provides no-cost monitoring and treatment of certified medical conditions related to the participant’s exposure as a responder, worker, or individual living, working, or attending school near one of the 9/11 crash sites during the terrorist attack or who participated in the cleanup efforts at those sites.

Diagnostic procedures at one of the designated WTC Health Program medical centers or a networked provider in the continental U.S. certify a medical condition through the WTC Health Program.

Certification of an eligible condition not only provides continued monitoring and treatment through the program, but this certification also determines eligibility for compensation through the VCF.

If the individual can’t go to one of the program’s medical facilities or one of the program’s networked providers located throughout the continental U.S., the VCF allows the claimant to use the private physician process to ensure eligibility for an award from the VCF.

An Attorney Can Help You Obtain 9/11 Benefits

When the terrorist attacks occurred on September 11, 2001, nearly 3,000 people died and another 25,000 were injured. These sites exposed an estimated 500,000 more people to toxins either on the day of the attacks or during the many months afterwards (into mid-2002) during the rescue, recovery, and cleanup efforts. It was impossible to know at that time just how dangerous this exposure would be, but it has resulted in an endless battle for a number of those exposed.

A law firm dedicated to helping those who were exposed to harmful materials as a result of the 9/11 attacks to obtain the 9/11 benefits can help you obtain the benefits you need and deserve. A 9/11 benefits attorney can:

• Establish a value for your VCF claim based on the expenses and impacts you incurred because of your 9/11-related medical condition.
• Assist with the application process for the WTC Health Program and the filing a successful claim with the VCF.
• Ensure that all required documentation needed to prove exposure and eligibility through a certified condition has been gathered and submitted along with the claim.
• Assist with appealing decisions or awards from either of these programs.
• Examine your case to determine if you qualify for other benefit programs and to see if the compensation you receive from the VCF affects the benefits you already receive from other programs.