More information about Non-Economic Loss, Economic Loss, and Collateral Offsets can be found in the sections below. If SSA or another entity found you disabled based on a condition that is not eligible for compensation by the VCF, please do not contact SSA or the other entity to request that they change your disability determination solely for the purpose of obtaining VCF compensation. If you have a defined benefit pension that was or will be reduced because you retired early due to an eligible condition, the VCF may compensate you for that loss. Economic loss is pecuniary loss caused by an eligible condition: loss of earnings or other benefits related to employment, the cost to replace household services previously provided by the victim, certain past medical expenses, and expenses associated with a burial or memorial service in the case of a deceased victim. If you do not promptly notify the VCF of the pending disability application, and the VCF processes your claim and issues only a non-economic loss award, the claim for economic loss will be reviewed in priority order based on the date of submission of the amendment advising the VCF of the completed disability determination. This generally includes the final Medical Board report that identifies the final diagnosis and recommends approval of a WTC disability, as well as any prior Medical Board reports issued that address the claimants conditions and recommend approval, disapproval, or deferral on the claimants disability application. The Special Master is required under the VCF Actto offset Social Security survivor and dependent benefits as compensation paid to the surviving spouse or dependents of a disabled or deceased wage earner because of the eligible injury. First, you need to show that you actually lost compensation. payments under the September 11th Victim Compensation Fund of 2001 . Examples of the types of tasks that are considered for replacement services compensation are services that the victim provided to the family, such as cleaning, cooking, child care, home maintenance and repairs, and financial services. As of the end of 2021, the September 11th Victim Compensation Fund has paid out almost $9.4 billion dollars to 9/11 victims and their families. [8] The tax rate used to determine after-tax interest rates is the computed combined Federal, State and local income tax rate of 15.1% for New York for the $70,000 earnings bracket. A significant increase (more than a cost of living adjustment) in the amount of a previously reported collateral offset may constitute an additional payment that should be reported. Upper Respiratory Diseases are those affecting the nose, sinuses, or throat. Evidence that you are or were unable to work as a result of an eligible condition. Application of statutory limitation on annual gross income: In accordance withthe VCF Act, for each year of loss, the methodology limits the annual loss of earnings and other benefits related to employment that fall under the definition of gross income in section 61 of the Internal Revenue Code of 1986 to $200,000. In some cases,the VCF may estimate your benefits using presumptive values. The amendment may be filed at any time following receipt of your initial award determination, but no later than October 1, 2090. The VCF does not premise their award amounts solely on financial losses. Please read this letter carefully. The WTC Victim Compensation Fund has a long historyafter several reauthorizations, the Fund got permanent financing when the Senate almost unanimously voted for its permanent authorization. These claimants might require lung transplants (sometimes double lung transplants), or significant mechanical respiratory assistance on a daily basis. If you received $125,000 of non-economic loss in VCF1 for asthma, and you amend in VCF2 for additional non-economic loss for newly certified interstitial lung disease and emphysema that have progressively worsened, the VCF will consider you to be fully compensated for your eligible conditions and will not award additional non-economic loss. For example, many people with respiratory injuries have pulmonary function tests. In certain, very limited circumstances for example, if your claim qualifies for expedited processing due to terminal illness or significant financial hardship (see Section 8),and the Special Master determines it appropriate the VCF may issue an award that deducts a presumptive offset amount assuming that your disability application was decided favorably, and you will be able to amend your claim once the disability process is concluded for any necessary correction to your award. For more information on the WTC Health Program List of Covered Conditions and 9/11 Victim Compensation, please contact Pitta & Baione at 844-982-2667 or info@pittabaione.com. When filing your amendment, you must identify the specific type(s) of economic loss claim(s) you are withdrawing: past lost earnings, future lost earnings, replacement services, and/or medical expenses. If you are requesting economic loss but you have a disability application pending, and if your application for disability is based on a condition that is eligible for the VCF, or if you intend to file for a disability based on your VCF-eligible condition, you should wait to submit your claim until the application is decided. ), If you receive a disability pension, documents showing the injuries or conditions that the pension is based upon. Our review includes: determining non-economic loss based on the severity of physical harm; calculating economic loss, including past and future lost earnings (if claimed); and confirming collateral offsets, including payments received from pension funds, life insurance, SSA, Workers Compensation, and settlements from 9/11-related lawsuits. Sections 2.2.f-i contain information specific to victims who worked for New York City (including FDNY and NYPD) and the Federal government (including military and military reserve); and. If your claim is missing documentation that we need in order to calculate your award, you will receive a missing information letter. How Does the VCF Calculate Awards for Multiple Certified Conditions? If the WTC Health Program has certified your condition, no further documentation is necessary to support a claim for non-economic loss; the VCF will award non-economic loss at the lowest end of the range for the applicable condition based solely on the WTC Health Program certification. . The latter figures $100,000 on account ofthe spouse and each dependent include a non-economic component of "replacement services loss.". 2. The VCF will evaluate these types of payments on a case-by-case basis. Claimants who receive disability benefits under the federal Supplemental Security Income (SSI) program: If you receive disability benefits under the federal Supplemental Security Income (SSI) program (administered by Social Security) as opposed to under the regular Social Security Disability Income (SSDI) program, please indicate that you are receiving SSI benefits when you file the claim and file an Exhibit 1, making sure to select the box requesting release of Current monthly Supplemental Security Income payment amount. The information that the VCF receives from the SSAwill include information about SSI benefits if applicable. A personal statement discussing the impact of the eligible conditions on your life. Employer-provided benefits: Add the value of employer-provided benefits (or other benefits received through employment, such as from a union or government pension program). service, disability), if applicable, Date of retirement from the military, if applicable, Most recent pay statement showing various allowances, benefits, and special pay, If receiving military retired pay: start date and benefit amount. Likewise, if you are disabled due to an Obstructive Airways Disease and you have been deemed eligible by the VCF only for Interstitial Lung Disease, the disability determination is not a basis for awarding lost earnings. Employment- related benefits include pension programs, retirement contribution programs, and health benefits. However, the VCF requires that claimants be enrolled in and have their physical condition (s) certified for treatment by the WTC Health Program in order to process a VCF claim and award compensation. It is not an appropriate use of SSAs resources to request re-evaluation for this purpose. Although CPS and other data used to study lifetime earnings profiles indicate that peak real earnings typically decline at some point, in calculating life-cycle earnings growth in excess of inflation and overall productivity adjustments for victims, the Special Master has assumed that peak earnings are maintained. VCF Policies and Procedures Section 3: Awards and Payment Date effective November 16, 2022 When the VCF has made an award determination for your claim, you will receive a letter notifying you of the amount of your award. Once you receive your award determination, you will need to determine if the out-of-pocket medical expenses you incurred meet the $5,000 minimum threshold and other criteria noted above and are acceptable expenses as described in Acceptable Medical Expenses Claims below. If you have insurance, the VCF will not compensate for any expenses that have not yet been evaluated by your insurance company or any applicable secondary payer. In addition, the victims consumption is determined as a share of the victims own earnings only, rather than the standard share of total household earnings. You will need to submit two types of information: The VCF provides a Temporary Past Lost Earnings worksheet to help support your VCF claim. If, however, the certified condition significantly impairs activities of daily living or if the certification does not reflect the severity of the condition, additional documentation of the types described below can help the VCF evaluate whether an increased non- economic loss award within the appropriate range is warranted. An additional $9 million was provided by the State of New York in 2016. In addition, compensation may include other military benefits or allowances if the appropriate documentation of the amount and duration of the benefits is submitted. As required by the VCF Act, your final award will be calculated using this basic formula: Non-Economic Loss plus Economic Loss, minus Collateral Offsets. Do not hesitate to contact us toll-free at 844-982-2667 if we may be of service. Suffering from constant nasal inflammation, stuffy nose, pain and swelling around your nose and in your sinuses, and reduced taste or smell are common indicators. Our claim analysis therefore always begins with three essential questions: was there a demonstrable loss, can we reasonably conclude the loss was caused by a WTC-related eligible condition, and what makes sense in the context of this claimant and the individual circumstances of this claim? The lower the after-tax discount rate, the higher the present value of presumed economic loss. Assumptions: The computation methodology adopts a number of assumptions implemented to facilitate analysis on a large scale. If, as a benefit of your employment, you are a member of a defined benefit pension plan, and you submit documentation of all information required to calculate a pension benefit under your plan, the VCF generally will calculate your benefits using that data. Note that, in all cases, even though the conditions may be treated as equivalent when deciding whether a disabling condition is the same as your eligible conditions, these conditions are NOT equivalent for the purposes of determining the appropriate non-economic loss award amount, as discussed in Section 2.1 above. First, the VCF strives to be fair to all claimants. When viewed in total, these assumptions are designed to benefit the victim and are more favorable than the standard assumptions typically applied in litigation. The Special Master has the discretion to exclude from consideration life insurance proceeds that are distributed to persons other than the beneficiaries of the VCF award. The start date and amount of the victims pension. In such cases, the non-economic award may be greater than $250,000, with a maximum award, under current VCF policy guidelines, of $340,000 for multiple severe conditions. You are not required to amend your claim if you decide you no longer want to seek reimbursement for medical expenses. The $7.3 billion fund has already paid out about $5 billion. Moreover, computation of the after-tax discount rate using a relatively high combined New York income tax rate, compared to other states, results in a lower after-tax discount rate. If you believe that your SSA earnings history does not fully account for future earnings potential, then you must provide documentation supporting any argument that the VCF should take into consideration other information in determining future earnings. This includes determining the types of loss being claimed. For example, a victim who has a respiratory condition that significantly restricts the victims ability to participate in activities of daily living and recreation, or that is progressive and not effectively treated, may have a higher non-economic award than a victim who has a mild respiratory condition and another mild condition which have not had a significant effect on their activities of daily living. We urge you (and your attorney, when applicable) to consider the collateral offsets that may be applicable to your claim before submission, and consider submitting a non-economic loss only claim in those cases where your earnings-related offsets are likely to exceed your economic loss. award benefits without considering the benefits' total cost. If you are not receiving a pension, submit a letter from your union/Con Edison/Verizon stating that you are not receiving a pension. Similarly, if the victim has cancer and severe non-cancer conditions, the Special Master may issue an award that makes an adjustment above $250,000 to account for multiple conditions. It was determined that the net effect of these and other facilitating assumptions was to increase the potential amount of presumed economic loss to the benefit of the victim. Where there is a finding of partial disability or if there are multiple disability determinations, some for eligible conditions and some for ineligible conditions, the VCF will compute the percentage of income lost based on the percentage of disability attributable to eligible conditions. To maintain the privacy of individual claimants and beneficiaries, the Fund will not list names or any other identifying information that might easily lead to the identification of individuals who have received or been notified of awards. There is no requirement for a member of the WTC Health Program to have registered for or filed a claim with the VCF. If you are an employee of Con Edison or Verizon, pension calculation statements from Con Edison or Verizon. Please note, however, that this presumption of an offset will be used sparingly as the VCF does not want to place claimants in a position where it overpays an award and then is required to recoup funds already paid. If you are receiving a pension (either directly or as a beneficiary of a decedent), you will be required to submit: In general, the VCF will use the following procedures and assumptions for determining future lost earnings for both deceased and injured victims: 1. 1. Add this amount to the total computed above. The Special Master may reduce the amount of the offset for a pension to take account of self-contributions to that plan over the injured victims or decedents lifetime. Consumption rates calculated using alternative techniques were considered but found to produce higher personal consumption rates and were not ultimately used to determine the decedents household consumption adjustment. 42 U.S.C. Below are some illustrative examples of how VCF1 awards are considered: As part of the economic loss component of your claim, you can request reimbursement for past out-of-pocket medical expenses you have paid as a result of your eligible condition(s). Thus, there is a possibility in those states that payments to a victim or family member of a decedent might ultimately be subject to repayment from the VCF award. The letter will explain the next steps to take on your claim. He was earning about $100,000 per year at the time of his disability. The methodology accounts for the loss of employer-provided health plans after application of the limit because such costs are exempted from gross income. For example, the victim may suffer from multiple types of cancer or may have a severe non-cancer eligible condition along with an eligible cancer. Depending on their circumstances, FDNY victims should submit either two, three, or five documents (depending on their specific situation as explained below) to demonstrate that they have been found disabled as a result of a VCF-eligible condition or injury. Thus, for example, the Special Master has determined that Workers Compensation benefits that are payable only if the spouse does not remarry will be offset throughout the period of compensated loss unless evidence is submitted that the spouse in fact remarried and the benefits in fact terminated. You will need to submit documents to show the benefits you received before the eligible injury/death and any claimed losses associated with employer-provided benefits. For example, if you received a promotion before becoming disabled and if the earnings history did not reflect that promotion, then you must provide proof of the promotion and any earnings adjustment resulting from the promotion. The total amount of the claimed medical expenses incurred due to eligible conditions exceeds $5,000. This adjustment is made because work-life expectancies are based on years of expected workforce participation, which, as defined by the Bureau of Labor Statistics, include periods an individual is either working or seeking work. This subtraction is a standard adjustment in evaluating loss of earnings in wrongful death claims because some amount of the income the decedent would have contributed to the household would have been consumed personally by the decedent and not available to other household members. The type of survivor option selected (e.g., 100% joint and survivor). Age, start of loss and compensable income: Establish the victims age and compensable income at death or at the time the victim was determined to be unable to work by a governmental entity, or had to reduce work, and suffered a loss of income as a result of eligible conditions. 24. Personal consumption adjustment for decedents: For claims for deceased victims whose death was related to an eligible condition, the VCF subtracts from annual projected compensable income and benefits the decedents share of household expenditures or consumption as a percentage of income, using expenditure data by income level obtained from Table 2. These rates of increase are consistent with the long- term relationship between economy-wide wage growth and risk-free interest rates, which currently reflect lowered inflationary expectations. Recent documentation of the medications required to manage your condition and how often you take those medications. Please be sure to refer to the most recent chartprior to filing your amendment for medical expenses. The VCF (which stands for "Victim Compensation Fund") provides financial compensation for those who were physically injured or died as a result of an eligible 9/11-related illness (these include cancer claims ). World Trade Center Health Program: Approach Used to Add Cancers to List of Covered Conditions was Reasonable but Could be Improved, GAO-14-606, July 2014. According to the Eighth Annual Status Report, in 2019, the VCF made victim compensation payouts to nearly 26,000 claimants in the amount of $6 billion. Work-life expectancies are based on actual experiences and behavior of the general population and measure the estimated time in years an individual of a given age will remain in the labor force (either employed or actively seeking work), allowing for age-specific mortality risks and rates of workforce transitions. A New York firefighter amid the rubble of the World Trade Center after the September 11, 2001 attacks. Other expenses that are not eligible for reimbursement include insurance premiums, expenses related to replacement services, investigational and holistic treatment, home health care or in-home aides, nursing home/live-in rehabilitation facilities, wigs, household items such as vacuum cleaners, air filters, and water filters, or home modifications. [2] Effective income tax rates derived from IRS data for New York are shown in Table 1 below. CNN Editorial Research Here is a look at the September 11th Victim Compensation Fund (VCF) and the James Zadroga 9/11 Health and Compensation Act of 2010. Specifically, the NY Workers Compensation law, Section 29(1-b) provides as follows: 1-b. Second, everything we do must be faithful to the statute that authorizes our work, the VCFAct (codified at 49 USC 40101 Note, Title IV). If you filed a claim for more than one type of economic loss, you may choose to withdraw some or all of your economic loss claims. The VCF also refers to non-economic loss as a "pain and suffering" award. You do not need to resubmit documents in support of your medical expenses claim if you already submitted them with your claim form, although you may submit additional documentation. The appropriate amount of the compensation that should be offset, taking into account the time value of money and contributions made by the injured victim or decedent in the nature of investment or savings. There are three types of economic loss: loss of earnings/benefits, out-of-pocket medical expenses, and replacement services loss. We will not process your claim until a determination on your disability application is made. In addition, the legislation created the WTC Health Program, which provides monitoring and treatment for 9/11-related conditions and can certify such illnesses for a VCF claim. To determine the amount, the VCF will consider how the injury affects your daily life, what kind of condition you have, and the severity. Income will be determined based on the documents submitted with the claim and on data obtained from SSA earnings reports. Exceptions may be considered if the victim (or his or her authorized representative) submits evidence to support the assumption of additional years of workforce participation after age 65, such as the victims need to support minor children. The expenses are acceptable expenses as outlined in, The claim is submitted with the required documentation and in the required format, as explained in. The lowest compensation amount was $87.02. Chronic rhinosinusitis has typically been awarded . As shown in Table 7 on page 55, PSOB benefits are offset against the total award, including non-economic loss, whether they were awarded for death or disability. In some cases, the VCF will apply a computation of future residual earnings for individuals who are disabled from a specific job but who are otherwise able to perform a different occupation. Recent medical documents that show the type and frequency of medical treatments you have had for your condition. Because your VCF1 non-economic loss exceeds the maximum amount allowed by law for those conditions ($90,000), no additional losses will be awarded. This approach was intended to avoid a penalty to the victim. $340,000 for a downtown office worker with skin cancer and larynx cancer $340,000 for a retired NYPD officer with cancers of the colon and mouth The VCF may also accept a determination of disability made by a private insurer or a treating physician if they are sufficiently detailed as to the effect of the VCF eligible condition, distinguish those effects from those of ineligible conditions, and provide sufficient information from which the onset and severity of the disabling condition may be determined. Since each claim involves reviewing a substantial amount of documentation, and each award is calculated individually, the process can . For single individuals without dependents, Housing, Education and Health are also included. When uploading the Supporting Documentation Packet to your claim, select the document type Medical Expense Supporting Documentation Packet. If you fail to include the required supporting documentation, your claim for medical expenses will be denied. Since the VCF was reauthorized last year, claims for non-cancer conditions have routinely been awarded the lowest possible amount, absent medical records to support the severity of the condition. [6] For lower income categories where total expenditures exceed income, expenditures were scaled to income, so as not to reduce income for expenses potentially met by other forms of support. By law, the VCF can only compensate for losses caused by eligible conditions related to the events of September 11, 2001. This has the effect of decreasing offsets and, thus, increasing the amount of VCF awards. . If you are claiming economic loss, we obtain information and documentation from various third parties, such as the Social Security Administration (SSA), the FDNY, the NYPD, and the New York State Workers Compensation Board, regarding your disability, earnings history, and/or pensions if we have not already done so as part of our preliminary eligibility review. The VCF focuses on recent documentation, from within three years of the claim submission date, when evaluating non-economic loss. longevity raises, overtime, bonuses, differential pay, etc.) Charitable gifts - the final regulations clarify that benefits from charities (privately-funded charitable entities) disbursing private donations will not be treated as collateral source compensation, even if such charities were created or managed by governmental entities. How Much Am I Eligible For? You must be certain any documentation you provide meets the requirements outlined in Documentation Required to Support a Medical Expenses Claim below. 9. Treatment expenses billed to you as a co-payment, after denial of insurance coverage, or that you pay because they fall within your insurance deductible, may be reimbursed if appropriate documentation is submitted. If you were found to be partially disabled due to an eligible condition in VCF1 based on an FDNY disability determination, and the Social Security Administration subsequently determined that you became fully disabled due to the same condition after your VCF1 award was issued, you may be eligible for additional compensation. Only expenses that you have paid out-of-pocket, and that were incurred prior to WTC Health Program certification of the applicable condition, will be reimbursed. This is the bar by which the Special Master will measure the appropriateness of an increase above the cap, and it will be done in consideration of all other circumstances of the claim and the totality of the award. For these claims, it may be necessary to provide additional documentation that explains the relationship between your loss of earnings and benefits and your eligible condition(s). Compensation for military service members and uniformed service members is based on the amount of your basic pay (BPY), which is the largest component of military pay, plus any additional factors influencing military pay (e.g. For this reason, if you are filing a claim on behalf of a deceased individual we strongly urge you to submit your claim only once you can provide all materials needed to support the claim. If balances are insufficient to pay the full amounts awarded, claimants will receive payments in proportion to the fund's balance. Another award is made to a successful applicant for an economic loss, which includes lost benefits, lost earnings, household services, and out of pocket medical expenses. Note that in general, the VCF will need medical records substantiating claims of medical procedures (surgery, etc.). Although it is recognized that a different after-tax interest rate could theoretically be calculated for each age, income, and state combination, such a computation was impracticable for the large-scale valuations to be undertaken here.
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