Date: June 7, 2013
The Workers' Compensation Board (Board) will transition the management of the World Trade Center (WTC) Volunteer Fund claims to the Triad Group effective June 24, 2013. This is part of a larger effort to shift management of claims from the Board to professional third party administrators (TPAs). The Board will pay the TPA costs directly from its own budget so that all of the WTC Volunteer Fund is available to pay for medical and indemnity benefits for the volunteers. All claimants who have active WTC Volunteer claims, their health care providers, and their legal representatives will receive written notice about the change in claim administrator. Additional information is available at WTC Volunteer Fund Overview.
The transition of claim management should have no impact on WTC volunteers receiving Fund benefits. Claimants will continue receiving their biweekly indemnity benefits on the same schedule in place today. While health providers should begin sending new medical reports and bills to the Triad Group for services provided after June 24, they will continue to operate under the same flexible rules that have governed the WTC Volunteer Fund since its creation. Volunteers with new claims should continue submitting them directly to the Board. The Triad Group will assume responsibility for the claim only after the Board determines the claimant is eligible for the Fund.
The Triad Group has designated a WTC administrator, Gretchen Finch, to address any issues that arise during the transition. Gretchen will serve as the claimants' and providers' first point of contact for all claim administration issues. She can be reached via email at email@example.com and/or by phone at 1-800-337-7419 extension 112. Documents, including medical reports and bills, should be sent to her c/o Triad Group, LLC; 185 Jordan Road, Troy, NY 12180 or by fax to 1-866-617-7585. She will have direct access to Board staff to address individual questions or problems as they arise.
The transition of claim management responsibilities to professional TPAs is driven by the Board's focus on its core competencies as primary regulator of the workers' compensation system and adjudicator of disputes in individual claims. It rarely is responsible for claim management and payment of benefits. As a result, the Board's IT systems are not designed for the activities associated with managing claims. In contrast, the Triad Group and other TPAs handle claims for hundreds of employers and insurers and therefore have a much larger claim management staff that includes medical, legal, and insurance professionals and the software necessary to address the ever changing workers' compensation claim environment.
The Board is extremely proud of the staff in both the No Insurance Unit and the Office of the Advocate for Injured Workers for their tireless dedication to the needs of the heroes who volunteered in the aftermath of 9/11 and became ill, as a result.
On January 2, 2011, President Obama signed the James Zadroga 9/11 Health and Compensation Act to provide continued funding for health care programs treating those affected by the 9/11 events and to reopen the Victims Compensation Fund for those who suffered physical injuries or death as a result of the events of 9/11, including the subsequent rescue, recovery, and clean-up efforts.
The Zadroga Act establishes the WTC Health Program, which funds networks of specialized medical programs. These programs are designed to monitor and treat those with 9/11 related conditions. The four programs are:
These programs provide free medical services by health care professionals who specialize in 9/11-related conditions. These professionals are very familiar with the administrative processes relating to workers' compensation and the 9/11 Victim Compensation Fund. More information about the WTC Health Program is available on the WTC Centers for Excellence website, or by contacting the WTC Health Program at 1-888-WTC-HP4U (1-888-982-4748), or at the Centers for Disease Control and Prevention: World Trade Center Health Effects.
Volunteers, and other WTC-related claimants, are strongly encouraged to apply for benefits under the WTC Health Program. Unless Congress authorizes a new appropriation, the WTC Volunteer Fund will likely be exhausted over the next five years. Volunteers who apply for the WTC Health Program will benefit from secure funding for their health care needs, while helping preserve and extend the life of the limited Volunteer Fund for indemnity benefits not covered by the WTC Health Program.
The Zadroga Act also reopened the September 11th Victim Compensation Fund of 2001 (VCF) to new applications. The Zadroga Act expands eligibility allowing more people, who suffered physical harm or death as a result of the events of 9/11 or its aftermath, to collect compensation from the VCF. The Act provides that those who collect from the VCF must waive their right to pursue litigation to recover damages for the same physical injuries or conditions. Recipients are not barred from receiving workers' compensation benefits.
Information regarding eligibility requirements and the process for filing a claim with the reopened VCF is available on the VCF website, or by calling the VCF help line at 1-855-885-1555 (or 1-855-885-1558 for the hearing impaired). The deadline to register, for those individuals who knew (or reasonably should have known) that they had a WTC-related physical injury or condition, is October 3, 2013. Individuals who learned of their WTC-related physical injury or condition after October 3, 2011 must register within 2 years of the date they learned or reasonably should have known this information for the first time. As long as one registers within the relevant two-year window, one can submit the eligibility form online at any point during the VCF's existence (i.e., through October 3, 2016).
The New York City Bar Justice Center and certain law schools in the New York metropolitan area are offering free legal clinics for individuals who need assistance in filing a VCF claim. Those attending will be able to meet with an attorney who will provide information on the eligibility process and will assist in filling out the eligibility form. To register or request more information on available clinics, please call the VCF Helpline at 1-855-885-1555.
Robert E. Beloten