What’s the Difference Between a Certified Condition and an Eligible Condition for the 9/11 VCF Claim?

When applying for 9/11 benefits, it is important to understand the difference between two important terms: “certified condition” and “eligible condition”. While they sound similar, these terms refer to two different parts of the 9/11 health and compensation system.

Understanding the Connection Between the VCF and the WTC Health Program

The WTC Health Program (WTCHP) and the Victim Compensation Fund (VCF) are two distinct but related federal programs that were created under the James Zadroga 9/11 Health and Compensation Act.

Although both programs are designed to help those affected by the September 11, 2001, terrorist attacks, they serve different purposes:

• The WTCHP provides free medical monitoring and treatment for certified 9/11-related health conditions.
• The VCF provides financial compensation for individuals (or their families) who have suffered physical harm or death as a result of an eligible 9/11-related health condition.
  
  

To receive a VCF award, your illness must first be certified by the WTC Health Program as being 9/11-related. Certification is an essential component of eligibility for a VCF award, but the VCF has its own, separate list of conditions it can compensate for.

What Is a “Certified Condition”?

A certified condition means the WTC Health Program has formally determined that your medical condition was caused or worsened by exposure to 9/11 toxins or traumatic events. Once certified, you are entitled to free medical care for that illness through WTCHP-approved providers.

To be certified as having a 9/11-related condition, you must:

1. Show proof of presence in the 9/11 exposure zone (at the World Trade Center site, or at the crash sites at the Pentagon or in Shanksville, PA) between September 11, 2001 and May 30, 2002;
2. Meet the minimum requirement for exposure duration (amount of time present in the exposure zone) for your group; and
3. Receive a qualifying diagnosis that matches one of the WTCHP’s officially recognized “WTC-related health conditions.”

Examples of WTCHP certified conditions include:

• Aerodigestive disorders such as chronic rhinosinusitis, asthma, sleep apnea, or GERD;
• More than 75 types of cancers, including lung, thyroid, prostate, and breast cancer,and/or
• Mental health conditions such as PTSD, anxiety, or depression.
  
  

Once your condition is certified, you’ll receive a WTCHP certification letter, which is a condition for to you be able to submit a claim to the VCF. In cases where a person was exposed to the 9/11 toxins and died from a 9/11 cancer or other illness but did not participate in the WTCHP before their passing, the VCF will follow the “private physician form” process of collecting the medical records of the deceased and then work with the WTCHP to determine if the medical condition would have been eligible to be certified under the rules of the Health Program.

What Is an “Eligible Condition”?

An eligible condition refers to a medical condition that the VCF recognizes for financial compensation.

While the VCF requires WTCHP certification to establish a link between your illness and 9/11 exposure, the VCF does not compensate for all conditions certified by the WTCHP. 

An eligible condition for VCF purposes must meet all of the following:

• It is on the VCF’s list of covered physical conditions.
• It has been certified by the WTCHP as 9/11-related.
• It has resulted in economic or non-economic loss (such as medical costs, lost wages, or pain and suffering).
  
  

Mental health conditions alone, even if certified by the WTCHP, do not qualify for VCF compensation.

Certified vs. Eligible Conditions: The Key Differences You Should Know

Here are the most important differences between certified conditions and eligible conditions. 

In short:

• Certified condition = medical recognition
• Eligible condition = financial compensation
  
  

What About Conditions Not Yet Certified by the WTC Health Program?

Some conditions are still under review by the National Institute for Occupational Safety and Health (NIOSH) and the WTCHP for possible inclusion. These include certain autoimmune diseases, neurological conditions, and emerging cancers. (These reviews are currently experiencing delays.) 

If your illness isn’t currently certified but you believe it is connected to 9/11 exposure, you should:

1. Enroll in the WTCHP and undergo a medical evaluation.
2. Gather documentation of your exposure history and medical diagnosis.
3. Consult an experienced 9/11 attorney to help you petition for inclusion or monitor updates from NIOSH and the WTCHP.

The WTCHP continually reviews scientific evidence and updates its list of covered conditions. Once a condition is added, you may become eligible for both medical care and VCF compensation.

Need Help Determining if Your 9/11 Condition Is Eligible for a VCF Claim?

At Hansen & Rosasco, LLP, our attorneys have guided thousands of responders and survivors through the WTCHP and VCF process, from initial certification to receiving the maximum award available. We can help you:

• Confirm whether your condition is certifiable and eligible
• Register with the VCF and file a timely claim
• Appeal denials or amend claims if new conditions are added
• Maximize awards for both economic and non-economic losses
  
  

If you or a loved one suffers from a 9/11-related illness and is unsure whether it qualifies for compensation or medical coverage, contact Hansen & Rosasco, LLP today for a free consultation. Our experienced 9/11 lawyers are here to help guide you through the process.