Should I File My Claim if the WTC Health Plan Has Not Certified My 9/11-Related Condition?

One common question asked by victims of the 9/11 attacks is, “I scheduled my appointment with the WTC Health Program, but they told me it may take several months to be seen and to then receive a certification letter. Should I file my claim even though I have not yet been certified?”

The VCF FAQ answers the question simply: “It is best to aim has been certified by the WTC Health Program. If you submit your claim without first being certified, the VCF will place your claim in Inactive status, and it will remain in that status and will not be reviewed until you submit your certification letter.”

Consult an experienced 9/11 attorney to learn more about the WTC Health Program, what certification means for your claim, and what type of compensation you can receive through the VCF for a 9/11-related injury or illness.

What Is the Purpose of WTC Health Program Certification?

The September 11th Victim Compensation Fund (VCF) and the WTC Health Program are separate but related federal benefits programs for victims of 9/11 and its aftermath. Initially created to compensate the initial victims of those attacks, many of whom suffered serious traumatic injuries or death on the day of or within 96 hours of the attacks themselves, the programs were broadened to help victims who suffer from serious health conditions because of exposure to toxic materials released during the attacks, building collapses, and subsequent cleanup efforts during the many months after 9/11 into mid-2002.

The WTC Health Program monitors and treats people who suffered toxic exposures linked to the 9/11 attacks. The WTC Health Program recognizes a wide range of eligible 9/11-related health conditions, including airway disorders, digestive disorders, musculoskeletal disorders, and several different types of cancer. Program services are free of charge for eligible individuals.

The VCF separately pays personal injury awards to individuals who suffer from eligible 9/11-related health conditions, and wrongful death awards the estates of victims who die from those conditions.

Individuals who suffer from eligible 9/11-related health conditions, and personal representatives of individuals who have died of those conditions, can apply to the VCF for compensation. In connection with applying, victims can obtain a certification of their condition from the WTC Health Program provider who treats them. That certification serves as proof of the health condition for purposes of establishing eligibility for VCF benefits.

Typically, the WTC Health Program sends a certification of an eligible health condition letter directly to the claimant and then the claimant must provide a copy of the certification letter to the VCF.  There are lots of steps, and it’s easy for a 9/11 claimant to get tripped up on any one of these steps.

Sometimes, 9/11 victims choose to receive medical treatment for an eligible 9/11-related health condition from a provider who is not affiliated with the WTC Health Program. In those cases, the VCF original policy was that it may accept certification from that provider, but that is no longer the case.

However, for purposes of applying to the VCF for benefits, it is usually far more efficient (and actually required) to obtain certification from the WTC Health Program, if a victim can do so. If a claimant has passed away or become incapaciated before being able to obtain a certification letter from the WTCHP, then there a different detailed process that must be followed called the Private Physician Process.

Why It Helps to Wait Until You’re Certified to File a VCF Claim

The VCF recommends waiting to file a claim until you’ve received a WTC Health Program certification because you need certification to establish your eligibility for benefits. The VCF cannot process your claim without having verified that you suffer from an eligible health condition.

Waiting for certification will not affect your chances of receiving VCF benefits. Congress has funded the VCF program until late into this century, ensuring that the money you need will be available if and when you apply to receive it.

In other words, your WTC Health Program certification more-or-less sets the pace for your ability to seek a VCF award. Under the current VCF rules, your application to the VCF will only proceed more slowly if you apply without having first obtained your certification.

How Can I Get Certified Through the WTC Health Program?

To get a 9/11-related health condition certified through the WTC Health Program, you need to establish two basic facts.

1. That you meet the eligibility requirements for the WTC Health Program.

To receive treatment through the WTC Health Program, you must face a recognized risk of suffering from an eligible 9/11-related health condition caused by exposure to toxic materials. You establish that risk by demonstrating your presence at or around Ground Zero, the Pentagon, Shanksville, or a 9/11 cleanup site.

For example:

• You were present at the site of one of the attacks on September 11, 2001. For example, you worked in and escaped the collapse of the World Trade Centers on the day of the attack.
• You were a 9/11 first responder who arrived at the scene of the attacks in their immediate aftermath to render aid and assistance.
• You worked or volunteered in the 9/11 clean-up effort at any of the attack sites, and/or at sites where debris was moved, processed, examined, and disposed of.
• You lived or worked in the lower Manhattan exposure zone at any time from 9/11 through July 31, 2002, and as a result, may have suffered prolonged exposure to environmental toxins that lingered in the area in the months after the attacks.

You can establish your presence at an attack or cleanup site in a variety of ways. Common items of proof include employment records showing that you worked as a first responder, your lease or other documentation reflecting that you resided in lower Manhattan during the eligible period, and photos, videos, or witness statements attesting to your presence at an attack site on September 11th.

2. That you suffer from a health condition recognized as eligible by the WTC Health Program.

By establishing your potential exposure to 9/11 environmental hazards, you become eligible to have the WTC Health Program monitor you for eligible 9/11-related health conditions. If you develop such a condition, no matter who ultimately diagnoses it, a WTC Health Program-approved provider will also treat you free of charge, and will certify that condition as eligible for treatment.

Facing Delays: Why It Might Take Time to Get an Appointment With the WTC Health Program

Sometimes, it may take several weeks or even several months before you can get an appointment through the WTC Health Program. Several challenges can lead to delays.

1. The doctor or doctors you need to see do not have space in their schedule for an appointment.

Often, doctors end up over-booked quickly. In the aftermath of the COVID-19 pandemic, many programs struggled to find adequate appointment space on their calendars, which led to a host of challenges and backups. Other, similar delays, including weather complications, local illness challenges, and simple lack of physician availability can all make it more challenging to get an appointment with the WTC Health Program.

In some cases, you may need to see a specific specialist to get certified, which may lead to additional delays in the process because of the limited time slots available.

2. You cannot fit that appointment into your schedule.

Sometimes, you may need to juggle your schedule to make an appointment with the WTC Health Program work. Depending on your diagnosis and your location, you may need to travel to that appointment, which isn’t always easy, especially if your health condition limits your ability to get around.

If scheduling an appointment with the WTC Health Program becomes impossible, you may also obtain a diagnosis and certification through a provider who is not affiliated with the WTC Health Program. The VCF allows this exception for people who do not live near a WTC Health Program provider, for example. Still, as we mentioned above, if you can get to an appointment with the WTC Health Program, it’s well worth the effort because it will help streamline the processing of your VCF claim.

How to Manage Appointment Delays

WTC Health Program appointment delays may slow down your treatment or make it harder to get the certification you need to receive compensation through the VCF. For many victims of the 9/11 attacks, the lack of that certification and therefore the lack of the funds you deserve can prove incredibly frustrating and even catastrophic. However, there are several steps you can take in the meantime to help you manage potential delays.

1. Get in touch with the WTC Health Program as soon as possible.

Regardless of whether you plan to seek treatment directly through the WTC Health Program or to use another provider, do not wait to get in touch with the WTC Health Program. Call as soon as possible to get your appointment on the books to avoid potential delays. The sooner you call, the sooner you can have that vital appointment and move forward with the assistance and compensation you deserve.

2. Follow the care program recommended by your physician in the meantime.

Often, you will already have a diagnosis before you contact the WTC Health Program. Your doctor may have caught the signs of cancer, lung disease, or digestive difficulties, then conducted the testing necessary to identify your ailment long before you realized that you might have a 9/11-related diagnosis.

You might also have waited for that diagnosis before determining whether you needed to seek treatment and assistance through the WTC Health Program and the VCF, especially if you live far away from a WTC Health Program provider or have a personal physician that you prefer to work with.

No matter who treats you for your eligible health condition, discuss your care plan with them and follow their instructions as best you can. In the case of some types of cancers, you may have time to wait for diagnosis and certification through the WTC Health Program. In other cases, you may not have time to wait before beginning an aggressive treatment. Do not put off treatment while waiting for the WTC Health Program unless your doctor tells you that you can safely wait.

Also, and importantly, if you go through the WTC Health Program process, you do NOT need to leave your current treating doctor, hospital, or team of medical providers. You can keep treating with your own doctors.

3. Contact an experienced 9/11 attorney.

The initial days after a serious 9/11-related diagnosis can feel like a whirlwind. You likely have a lot of questions, from how your illness will impact your family and what treatment you will need, to what compensation you may deserve for your illness. The VCF provides vitally needed compensation to victims of the 9/11 attacks, including those who did not realize the full extent of the damages they suffered until years afterwards.

An attorney can help you navigate your claim and give you a better idea of what you should expect as you pursue compensation, including how much compensation you may deserve for the illness you faced due to your involvement at Ground Zero or your life in Lower Manhattan after the attacks.

An attorney can also help guide you through the entire process of applying for services and compensation, from collecting evidence related to your presence in Lower Manhattan in the aftermath of the attacks to establishing how best to pursue the compensation you deserve.

If you suffered a serious diagnosis from toxic exposure related to 9/11, obtaining certification through the WTC Health Program is an important step in obtaining the compensation you deserve.

Although you can seek compensation and start working with an experienced 9/11 attorney before receiving your certification, you should not submit your claim to the VCF until you have that certification in hand.

Need help navigating your VCF claim or learning more about your rights? Contact an experienced 9/11 attorney as soon as possible.