March 2016 Group A Payment Issues: Missing Information-Loss Calculation letters ( MILC ) - deficiency resolutions: Outstanding appeals:

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1 The fllwing tpics were discussed in the March 24, 2016 meeting with law firms representing VCF claimants. Grup A Payment Issues: We cntinue t fcus n paying Grup A claims in full and are meeting the schedule shwn in ur timeline. Hwever, we cntinue t identify claims we cannt pay due t utstanding issues. Listed belw are the mst cmmn issues and the steps we are taking t reslve them: Missing Infrmatin-Lss Calculatin letters ( MILC ) - deficiency reslutins: One f the biggest hurdles t finishing Grup A payments has been that there are utstanding missing items n claims that are therwise ready t be paid. In ur review f these claims, we have determined that sme can be paid withut the missing item. If we determine we can reslve the issue internally (meaning we n lnger need the dcument listed in the MILC), we will reslve it in ur system and send a lss calculatin letter that states the issue has been reslved. This nly applies t select Grup A claims and this plicy will nt apply t any Grup B claims. Yu shuld cntinue t respnd t all missing infrmatin requests immediately t avid Grup A claims ptentially being marked as abandned. Outstanding appeals: We are wrking t hld all Grup A hearings and render pst-appeal determinatins as quickly as pssible. If yu appealed a Grup A claim, yu shuld have been ntified f the hearing date by nw. If yu submitted a timely appeal and have nt been ntified f a scheduled hearing date, please let Clleen knw. Deceased claims: Grup A claimants wh have passed away since their Persnal Injury claim was decided are anther cncern as we try t finish Grup A payments. If a Grup A Persnal Injury claimant has passed away, we need the death certificate, curt rder, and Exhibit F in rder t verify a Persnal Representative t receive payment. We knw the law firms have been wrking t prvide this infrmatin and we need t institute a cutff date in rder t allw us time t review and verify the Persnal Representative, and prcess the payment s we can cmplete the Grup A claims. The cutff date t submit these dcuments fr Grup A claims is April 30, We als cannt pay these claims if the letters f administratin cntain limitatins. We have prepared a dcument yu can prvide t Surrgates r ther prbate curts with additinal infrmatin regarding the need fr LOAs withut such limitatins (especially mnetary limitatins) in rder t pay these claims as sn as pssible. The dcument has been psted t ur website and is available n the Infrmatin fr Law Firms page. If there is a claim where the restrictins are nt lifted by April 30, 2015, we will knw the amunt t be paid n the claim and can place the funds int an accunt fr future distributin. This will allw us t cnsider all Grup A payments t be cmplete s we d nt hld up Grup B claims. Captive crrectin letters: As discussed n ur call in January, arund the time f the reauthrizatin, we became aware f a supplemental Captive settlement payment that had been made t many claimants. Yu may recall that ur plan fr Grup A payments nted that claims with any lawsuit settlements wuld be paid later than ther claims, as we need t g thrugh each claim t cnfirm there was n additinal payment that needs t be treated as an ffset. Claimants shuld understand that if they received ne f these payments, their awards will be lwered t accunt fr the additinal ffset. We have been wrking thrugh this prcess and have been either mving claims t payment nce we cnfirm the claimant did nt receive a supplemental payment r updating lss calculatins and then issuing revised lss calculatin letters. Yu shuld see updated lss calculatin letters reflecting these changes in the cming weeks. Page 1

2 Grup B Claim Prcessing: Our secnd pririty is the review f Grup B claims submitted prir t the reauthrizatin. Claims filed between December 18, 2015 and January 29, 2016 (when the nline system became read nly ) will nt be reviewed until we are able t begin accepting new claims again. Listed belw are several updates and reminders: Timeline t prcess existing Grup B claims: We have set aggressive targets t prcess the majrity f Grup B claims that were submitted prir t reauthrizatin. These claims are being prcessed in first in, first ut rder, meaning that nce we are able t begin issuing lss determinatins again, yu shuld see lss calculatin letters fr yur ldest claims first. Please respnd t missing infrmatin letters prmptly t help us in ur effrts. When the time cmes that we can pay Grup B claims, they will be paid in full in ne payment. Grup B Cmplete : Even thugh we are currently evaluating and making lss determinatins n Grup B claims, we cannt finalize these determinatins until the regulatins are final and the Grup B funding becmes available. Fr this reasn, we are marking these claims internally as Grup B Cmplete when we are dne with them this means we have cmpleted review f the claim, and calculated the lss amunt. Yu will receive a letter when a claim reaches this pint, but the status f the claim will nt change in the nline system. In rder t make sure this prcess ges smthly, it is extremely imprtant that yu nt submit additinal dcuments n any claims that reach the Grup B Cmplete stage. Yu shuld nt be submitting ANY dcuments n ANY claims unless yu receive a missing infrmatin request; hwever, this directin is particularly imprtant fr Grup B Cmplete claims. If yu uplad additinal dcuments t a Grup B Cmplete claim, the infrmatin will nt be reviewed and yu may need t resubmit it as an amendment nce the lss calculatin letter is issued. Ecnmic lss denials: Our current practice fr cmpensatin claims is that when we lack the dcumentatin we need t apprve ecnmic lss, we will deny ecnmic lss but issue a nnecnmic award. This generally happens either when there is n indicatin f a disability, r if there is an ffset we knw was received and we may be required t deduct if it is related t an eligible cnditin in which case, we need t clarify the nature/basis f the ffset befre ecnmic lss can be issued. As part give f ur Grup B prcessing plan, we are cntinuing this practice and will render decisins n claims based n the infrmatin in the file at the time the decisin is made. If a claim fr ecnmic lss is denied and nly a nn-ecnmic lss is issued, yu can always amend the claim in the future nce yu receive the Grup B lss calculatin letter n the claim. Changes t nn-ecnmic grid and ecnmic lss calculatins: The reauthrizatin statute requires a number f changes t hw we make cmpensatin determinatins. Mst ntably, the law des the fllwing: Caps aggregate grss incme ( AGI ) at $200,000 per year nte this is based n the IRS definitin f what is included in AGI Caps nn-ecnmic lss fr a cancer at $250,000 Caps nn-ecnmic lss fr a nn-cancer cnditin at $90,000 Instructs us t priritize the mst debilitating cnditins this is interpreted t mean that claimants with the mst debilitating cnditins will receive larger awards than thse with less severe cnditins and the nn-ecnmic awards will be adjusted t reflect this (i.e. the less serius injuries will receive lwer awards than in the past) Remves the $10,000 minimum award we expect a number f Grup B claims t result in $0.00 lss calculatins where they previusly may have received the $10,000 lss New Exhibit C guidance: Ging frward, we will require ne Exhibit C per law firm, rather than per claim. This dcument is signed nly by the law firm, nt the individual claimant. If yu have already submitted at least ne sufficient Exhibit C, we will be able t use that fr all f yur claims. Page 2

3 Eligibility appeals: Eligibility determinatins are being issued n Grup B claims. If yu receive an eligibility denial and yu wish t appeal, yu must file yur appeal befre the 30 day deadline. We are currently priritizing Grup A cmpensatin hearings, s nce we receive yur Grup B eligibility appeal, we will schedule the hearing, but it will likely be several mnths away. We will schedule eligibility hearings sner if we are able t, but yu shuld be aware that mst will be held later. The fact that we are hlding these hearings later des nt change the 30 day deadline t appeal the decisin nce yu receive the denial letter. Expedite claims: Our expedite prcess is prceeding as we previusly discussed during ur call in January. As a reminder, we cannt issue Grup B payments, even t expedites, at this time. We will issue expedited eligibility decisins when pssible. Please see the ntes frm the January call fr specific details n Grup B expedited claims. Grup B Claim Submissins and Prcessing after June: Belw are several updates related t future new claim submissins: Regulatin prcess and timeline: There is a statutry mandate that we update the regulatins n later than June 15, 2016 (180 days after enactment). The draft regulatins are currently under review within DOJ and will then be sent t OMB fr review. Once OMB apprves the regulatins, they will be published in the Federal Register. Fllwing publicatin, there will be a public cmment perid. After the public cmment perid, the VCF will cnsider and evaluate any cmments, and publish the Final Rule with clarificatins r changes t address the issues raised, as apprpriate. Nearly all f the changes we have made t the previus regulatins are mandated by the statute. There are few discretinary changes and they all benefit the claimant and/r minimize the burden f filing certain dcuments in supprt f a claim. CMS changes: We are currently updating the claims management system t receive the new claim frm. We are als explring ptins fr enhancements t the system and will keep yu updated as we have additinal infrmatin. New claim frm: We are wrking n a new claim frm that will becme available nce the regulatins are finalized and the new frm is apprved. The new frm cmbines the existing eligibility and cmpensatin frms int ne cmprehensive frm. It als includes addendums fr claimants submitting a private physician packet, persnal representatives filing n behalf f a deceased claimant, and ther cmmn circumstances. Our gal has been t streamline ur prcess and include everything we need in ne frm. We have als made significant changes t ur Attestatins, Certificatins, and Exhibits t make them easier t understand and t cmplete prperly. As a reminder, we will nt accept the ld claim frms fr any new claim submissins. Yu can cntinue submitting the ld frms in respnse t missing infrmatin requests that yu are receiving nw, but yu shuld nt have new clients prepare claims using the ld frms. The burden f prf fr presence, cnditins, and lss remains the same. If yu have claimants wh are eager t wrk n claims that they intend t submit nce the frms becme available, yu can instruct them t begin cllecting prf f presence, medical recrds fr a private physician packet (r certificatin frm the WTC Health Prgram), and dcumentatin f ecnmic lss. Please nte that the actual private physician frm will change, but the diagnstic essentials (i.e. required medical recrds) remain the same. Miscellaneus Items: Private Physician Prcess: As nted abve, we are changing the PP frms and including them in the claim frm s they can be mre easily filed with the initial claim submissin. Yu will still be able t cmplete and submit them as an amendment, as well. We have been finding that the expsure statement prvided n the frm ften cnflicts with data cntained in the claim and we will therefre be asking fr mre supprt specific t expsure as part f the updated frm. Page 3

4 Tax relief fr disabled respnders: As a reminder, there is tax relief available fr sme disabled 9/11 respnders, survivrs and the families f thse wh have died frm their 9/11 injuries. There is a link t infrmatin n this prgram n the hme page f ur website. We ask that if yu have clients wh may be eligible, yu remind them that this prgram exists. Pensins: As a reminder, if a claimant is emplyed by an entity that ffers a pensin, we cnsider that when calculating lss and it generally increases the lss amunt. We have standard default values we use r yu can prvide dcumentatin f the pensin plan. If yu d nt submit the pensin dcumentatin, we will nt calculate a pensin lss but we will incrprate ur default values fr defined cntributin plans t reflect the fact that emplyers in many cases prvide cntributins t retirement accunts. Wrkers Cmpensatin Vlunteer Fund: It is widely expected this fund will run ut f mney. If a claimant received a payment frm this fund, we treat it as an ffset. We determine the amunt f the ffset based n what the claimant has already received frm the Wrkers Cmpensatin Vlunteer Fund. There is n future cmpnent r calculatin fr this ffset. Amendments/supprting dcuments: We have seen claims where it appears yu are trying t file an amendment by uplading supprting dcuments t the claim nw. Please d nt d this. Yu cannt submit amendments until we begin accepting new claims and ding this causes delays as it pulls resurces frm Grup A payments and Grup B claim prcessing. At this pint, yu shuld nly be submitting dcuments in respnse t missing infrmatin requests frm the VCF. Questins: The fllwing questins and answers were discussed: Des the VCF anticipate that all Grup B claims submitted prir t December 18, 2015 if cmplete claims will be paid by the end f 2016? Our timeline shws that we expect t begin paying Grup B claims in September. When the regulatins are published and we begin issuing Grup B lss calculatin letters, we need t stagger the mailing f thse letters s as nt t create a situatin where we have thusands f claims all reaching appeal deadlines r payment prcessing deadlines at the same time. Our gal is t issue letters and pay claims as quickly as pssible nce we knw the claimant des nt intend t appeal the award. If a claimant receives a new ffset after having received a lss calculatin letter and after the claim has been paid what is the claimant required t d? Suggest yu pst this infrmatin n the website s ur claimants can see it in print. Every lss calculatin letter includes the fllwing language: In accrdance with the requirements f the Zadrga Act, yu must infrm the VCF f any new cllateral surce payments yu receive, such as an update t the amunt f yur 9/11-related lawsuit settlement r a change t yur disability benefits, as this may change the amunt f yur lss calculatin. We will wrk t get smething psted t the website that clarifies this bligatin. Yu can als refer yur clients t these ntes r their lss calculatin letter. Will the VCF be expanding the list f eligible cnditins r the deadlines fr filing claims? We fllw the WTC Health Prgram s list f cnditins. If they change their list, we will adpt the change. Our registratin deadlines remain the same and must be met fr the claim t be cnsidered timely. If a claimant passes away after receiving payment n a Persnal Injury claim, is there a deadline fr filing the amendment and new deceased claim? The nly deadline is the deadline t file a claim which is December 18, Hwever, yu shuld ntify us f the claimant s death as sn as pssible, even if yu d nt have infrmatin n the Persnal Representative. If a claimant passes away frm an eligible 9/11-related injury, des the lss calculatin include pain and suffering and ecnmic lss assciated with the death? Yes. The lss wuld include bth ecnmic and nn-ecnmic lss. There can als be a lss assciated with the claimant s illness befre death. Page 4

5 The lss letters d nt include in the details an explanatin fr the VCF s basis f disability and start date fr lss f earnings. It is smetimes hard t determine what was used when trying t decide whether r nt the claimant shuld appeal. At a minimum, culd the letters indicate when the standard default is used vs. what has been claimed? If yu are trying t figure ut hw we decided specific cmpnent f the lss, please call us s we can talk thrugh the details with yu. There are a variety f ways in which these calculatins are dne and it wuld be difficult t try and incrprate these nuances int ur letter templates. We will lk at what it might take t add at least a reference in the letter r addendum when default values are used. Page 5

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