Attachment G.9 - BEAST_For_Responder_Members.pdf

Benefits Eligibility Assessment Screening Tool for Responders

WTC Health Program

Table of Contents

Section 1: Introduction and 9/11 Responder Type Screening 3

Section 2: NYC Law Enforcement Officers and FDNY Firefighters and Fire Officers 5

Section 3: DSNY Sanitation Workers and Officers 6

Section 4: FDNY EMTs, Paramedics, and Officers 7

Section 5: NYC Department of Corrections Officers 8

Section 6: NYC and NYS Workers 9

Section 7: Nonmunicipal Workers and Volunteers 10

Section 8: Federal Workers 11

Section 9: Assessment of Benefits Registration for Members with No Health Conditions 12

Section 10: Cancer/Transplant Care Assistance 17

Section 11: Care for Noncovered Conditions Assistance 18

Section 12: Social Services Assistance 19

Section 1

Introduction to Benefits Assessment Questionnaire and 9/11 Responder Type Screening

“In addition to providing medical monitoring and medical and mental health treatment services, the WTC Health Program also offers benefits counseling services to our members. Benefits counseling is a service provided by a benefits counselor, social worker, or other designated staff person, who helps a member to identify the benefits he or she may be eligible for and explains how to apply for those benefits. Benefits counselors also refer members to external benefits experts as needed to help the member access benefits.

Benefits counseling services cover several areas of service, including program benefits counseling, workers’ compensation counseling, September 11th Victim Compensation Fund assistance, external work-related and disability benefits counseling, cancer and transplant care assistance, social services assistance, and care for non-covered conditions assistance.

Today, I am going to ask you some questions to determine how the program might best help you in terms of your benefits counseling needs and interests. In order to do so, I’m first going to ask some questions about your health conditions and WTC-related work so that I better know which specific benefits to ask you about today.”

1.1 Are you currently a member of a union?

• Yes (Proceed to next question)

• No (Skip to question 1.4)

1.2 Which labor union? (Select union via drop down options, or “if other,” type in labor union; Proceed to next question)

1.3 Which local? (Select local via drop down options, or “if other,” type in local; Proceed to next question)

1.4 Were you a member of a union at the time of your work on the WTC effort?

• No (Skip to question 1.7)

1.5 Which labor union? (Select union via drop down options, or “if other,” type in labor union; Proceed to next question)

1.6 Which local? (Select local via drop down options, or “if other,” type in local; Proceed to next question)

1.7 Have you been diagnosed with a physical and/or mental health condition related to your 9/11 rescue, recovery, or clean-up work?

• No (Skip to Section 9 on page 12)

1.8 When you were doing 9/11 rescue, recovery, or clean-up work, were you working as an employee of

New York City?

• Yes (Skip to question 1.11)

• No (Proceed to next question)

1.9 When you were doing 9/11 rescue, recovery, or clean-up work, were you working as an employee of

New York State?

• Yes (Skip to Section 6 on page 9)

1.10 When you were doing 9/11 rescue, recovery, or clean-up work, were you working as an employee of the federal government?

• Yes (Skip to Section 8 on page 11)

• No (Skip to Section 7 on page 10)

1.11 Were you employed by the City of New York Police Department?

• No (Skip to question 1.13)

1.12 Were you working as an NYPD law enforcement officer?

• Yes (Skip to Section 2 on page 5)

• No (Skip to Section 6 on page 9)

1.13 Were you employed by the Fire Department of the City of New York?

• No (Skip to question 1.16)

1.14 Were you working as an FDNY firefighter or fire officer?

• Yes (Skip to Section 2 on page 5)

1.15 Were you working as an FDNY EMT, paramedic, or EMS officer?

• Yes (Skip to Section 4 on page 7)

1.16 Were you employed by the New York City Department of Sanitation?

• No (Skip to question 1.18)

1.17 Were you working as a sanitation worker or officer?

• Yes (Skip to Section 3 on page 6)

1.18 Were you employed by the New York City Department of Corrections?

1.19 Were you working as a corrections officer?

• Yes (Skip to Section 5 on page 8)

Section 2

NYPD Law Enforcement Officers and FDNY Firefighters and Fire Officers

WTC-Related Illness and Related Benefits

2.1 Do you have a WTC Health Program certified physical health condition?

• Yes (Populate VCF Registration; Populate VCF Application, into plan; Proceed to next question)

• No (Populate VCF Registration; Populate VCF Education, into plan; Proceed to next question)

2.2 In addition to your employment as a New York City [police officer, firefighter, fire officer], did you also perform 9/11 rescue, recovery, or clean-up work as an unpaid volunteer?

• Yes (Populate NYS WTC Volunteer Workers’ Compensation Application; Populate WTC12

Registration, into plan; Proceed to next question)

• No (Rule out NYS WTC Volunteer Workers’ Compensation Application; Rule out WTC12

Registration; Proceed to next question)

2.3 Which of the following best describes your current employment status with [NYPD or FDNY]?

• Active duty (Populate LODI into plan; Proceed to next question)

• Retired (Rule out LODI; Proceed to next question)

• Vested, but not active duty or retired (Rule out LODI; Proceed to next question)

• Other (Rule out LODI; Rule out Accidental Disability Benefits via the WTC Disability Law; Skip to question 2.5)

2.4. Do your WTC-related health conditions disable you from performing normal work duties? [active duty, retired, and vested officers]

• Yes (Populate Accidental Disability Benefits via the WTC Disability Law; Populate Notice of

Participation Registration; SSD/SSI, Union Disability Benefits; and Public Safety Officer Benefit into plan; Skip to Section 10 on page 17)

• No (Populate Notice of Participation Registration into plan; Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 17)

2.5 Do your WTC-related health conditions disable you from performing normal work duties?

[“other” officers, per question 2.3]

• Yes (Populate SSD/SSI, Union Disability Benefits, and Public Safety Officer Benefit into plan;

Skip to Section 10 on page 17)

• No (Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer

Benefit; Skip to Section 10 on page 17)

Section 3

DSNY Sanitation Workers and Officers

WTC-Related Illness and Related Benefits

3.1 Do you have a WTC Health Program certified physical health condition?

• Yes (Populate VCF Registration; Populate VCF Application, into plan; Proceed to next question)

• No (Populate VCF Registration; Populate VCF Education; Proceed to next question)

3.2 In addition to your employment as a New York City [sanitation worker, officer], did you also perform 9/11 rescue, recovery, or clean-up work as an unpaid volunteer?

• Yes (Populate NYS WTC Volunteer Workers’ Compensation Application; Populate WTC12

Registration, into plan; Proceed to next question)

• No (Rule out NYS WTC Volunteer Workers’ Compensation Application; Rule out WTC12

Registration; Proceed to next question)

3.3 Which of the following best describes your current employment status with DSNY?

• Active duty (Populate LODI into plan; Proceed to next question)

• Retired (Rule out LODI; Proceed to next question)

• Vested, but not active duty or retired (Rule out LODI; Proceed to next question) to question 3.5)

3.4 Do your WTC-related health conditions disable you from performing normal work duties? [active duty, retired, and vested workers and officers]

• Yes (Populate Accidental Disability Benefits via the WTC Disability Law; Populate Notice of

Participation Registration; SSD/SSI, and Union Disability Benefits, into plan; Skip to Section 10 on page 17)

• No (Populate Notice of Participation Registration into plan; Rule out Accidental Disability Benefits via the WTC Disability Law; Rule out SSD/SSI; Rule out Union Disability Benefits;

Skip to Section 10 on page 17)

3.5 Do your WTC-related health conditions disable you from performing normal work duties?

[“other” workers and officers, per question 3.3]

• Yes (Populate SSD/SSI and Union Disability Benefits into plan; Skip to Section 10 on page 17)

• No (Rule out SSD/SSI; Rule out Union Disability Benefits; Skip to Section 10 on page 17)

Section 4 FDNY EMTs, Paramedics, and Officers

WTC-Related Illness and Related Benefits

** Populate NYS Workers’ Compensation Application into plan. No additional questions need to be asked in this section to screen for workers’ compensation eligibility.

4.1 Do you have a WTC Health Program certified physical health condition?

• Yes (Populate VCF Registration; Populate VCF Application, into plan; Proceed to next question)

• No (Populate VCF Registration; Populate VCF Education, into plan; Proceed to next question)

4.2 Which of the following best describes your current employment status with FDNY?

• Active duty (Populate LODI; Populate 9/11 Unlimited Sick Leave, into plan; Proceed to next question)

• Retired (Rule out LODI; Rule out 9/11 Unlimited Sick Leave; Proceed to next question)

• Vested, but not active duty or retired (Rule out LODI; Rule out 9/11 Unlimited Sick Leave;

Proceed to next question)

• Other (Rule out LODI; Rule out 9/11 Unlimited Sick Leave; Rule out Accidental Disability

Benefits via the WTC Disability Law; Skip to question 4.4)

4.3 Do your WTC-related health conditions disable you from performing normal work duties? [active duty, retired, and vested EMTs]

• Yes (Populate Accidental Disability Benefits via the WTC Disability Law; Populate Notice of

Participation Registration; SSD/SSI, Union Disability Benefits; and Public Safety Officer Benefit into plan; Skip to Section 10 on page 17)

• No (Populate Notice of Participation Registration into plan; Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 17)

4.4 Do your WTC-related health conditions disable you from performing normal work duties?

[“other” EMTs, per question 4.2]

• Yes (Populate SSD/SSI, Union Disability Benefits, and Public Safety Officer Benefit into plan;

Skip to Section 10 on page 17)

Section 5 NYC Department of Corrections Officers WTC-Related Illness and Related Benefits

** Populate NYS Workers’ Compensation Application into plan. No additional questions need to be asked in this section to screen for workers’ compensation eligibility.

5.1 Do you have a WTC Health Program certified physical health condition?

• Yes (Populate VCF Registration; Populate VCF Application, into plan; Proceed to next question)

• No (Populate VCF Registration; Populate VCF Education, into plan; Proceed to next question)

5.2 Which of the following best describes your current employment status with NYC Department of Corrections?

• Active duty (Populate LODI into plan; Proceed to next question)

• Retired (Rule out LODI; Proceed to next question)

• Vested, but not active duty or retired (Rule out LODI; Proceed to next question) to question 5.4)

5.3 Do your WTC-related health conditions disable you from performing normal work duties? [active duty, retired, and vested Corrections Officers]

• Yes (Populate Accidental Disability Benefits via the WTC Disability Law; Populate Notice of

Participation Registration; SSD/SSI, Union Disability Benefits; and Public Safety Officer Benefit into plan; Skip to Section 10 on page 17)

• No (Populate Notice of Participation Registration into plan; Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 17)

5.4 Do your WTC-related health conditions disable you from performing normal work duties?

[“other” Corrections officers, per question 5.2]

• Yes (Populate SSD/SSI, Union Disability Benefits, and Public Safety Officer Benefit into plan;

Skip to Section 10 on page 17)

Section 6 NYC and NYS Workers

WTC-Related Illness and Related Benefits

** Populate NYS Workers’ Compensation Application into plan. No additional questions need to be asked in this section to screen for workers’ compensation eligibility.

6.1 Do you have a WTC Health Program certified physical health condition?

• Yes (Populate VCF Registration; Populate VCF Application, into plan; Proceed to next question)

• No (Populate VCF Registration; Populate VCF Education, into plan; Proceed to next question)

6.2 Which of the following best describes your current employment status with [NYC or NYS]?

• Active duty (Populate 9/11 Unlimited Sick Leave; Proceed to next question)

• Retired (Rule out 9/11 Unlimited Sick Leave; Proceed to next question)

• Vested, but not active duty or retired (Rule out 9/11 Unlimited Sick Leave; Proceed to next question)

• Other (Rule out 9/11 Unlimited Sick Leave; Rule out Accidental Disability Benefits via the WTC

Disability Law; Skip to question 6.4)

6.3 Do your WTC-related health conditions disable you from performing normal work duties? [active duty, retired and vested workers and officers]

• Yes (+ CURRENT or 9/11 UNION MEMBERSHIP--Populate Accidental Disability Benefits via the WTC Disability Law; Populate Notice of Participation Registration; SSD/SSI; and Union Disability Benefits into plan; Skip to question 6.5; NO CURRENT or 9/11 UNION MEMBERSHIP—Populate Accidental Disability Benefits via the WTC Disability Law; Populate Notice of Participation Registration and SSD/SSI into plan; Rule out Union Disability Benefits;

Skip to question 6.5)

• No (Populate Notice of Participation Registration into plan; Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 17)

6.4 Do your WTC-related health conditions disable you from performing normal work duties?

[“other” workers, per question 6.2]

• Yes (+ CURRENT or 9/11 UNION MEMBERSHIP--Populate SSD/SSI and Union Disability

Benefits into plan; Proceed to next question; NO CURRENT or 9/11 UNION MEMBERSHIP— Populate SSD/SSI into plan; Rule out Union Disability Benefits; Proceed to next question)

• No (Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 17)

6.5 At the 9/11 site, were you working as an employee of a state or local emergency management or civil defense agency performing duties in cooperation with FEMA?

• Yes (Populate Public Safety Officer Benefit into plan; Proceed to Section 10 on page 17)

6.6 During the 9/11 effort, were you serving a public agency in an official capacity, paid or unpaid, as a law enforcement officer, including in corrections, parole, as a judicial/court officer, or as a chaplain?

• Yes (Populate Public Safety Officer Benefit into plan; Skip to Section 10 on page 17)

• No (Rule out Public Safety Officer Benefit; Skip to Section 10 on page 17)

Section 7 Nonmunicipal Workers and Volunteers

WTC-Related Illness and Related Benefits

** Populate NYS Workers’ Compensation Application into plan. No additional questions need to be asked in this section to screen for workers’ compensation eligibility.

7.1 Do you currently work in New York State?

• Yes (Populate NYS Paid Family Leave into plan; Proceed to next question)

• No (Proceed to next question)

7.2 Do you have a WTC Health Program certified physical health condition?

• Yes (Populate VCF Registration; Populate VCF application, into plan; Proceed to next question)

• No (Populate VCF Registration; Populate VCF Education, into plan; Proceed to next question)

7.3 Do your WTC-related health conditions disable you from performing normal work duties?

• Yes (+ CURRENT or 9/11 UNION MEMBERSHIP--Populate SSD/SSI and Union Disability

Benefits, into plan; Proceed to next question; NO CURRENT or 9/11 UNION MEMBERSHIP— Rule out Union Disability Benefits; Populate SSD/SSI into plan; Proceed to next question)

• No (Rule out Union Disability Benefits; Rule out SSD/SSI; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 17)

7.4 During the 9/11 effort, were you working as a member of a private, not-for-profit rescue squad or ambulance crew?

• Yes (Populate Public Safety Officer Benefit into plan; Skip to Section 10 on page 17)

• No (Rule out Public Safety Officer Benefit; Skip to Section 10 on page 17)

Section 8 Federal and “Federalized” Workers

WTC-Related Illness and Related Benefits

** Populate Federal Workers’ Compensation into plan. No additional questions need to be asked in this section to screen for workers’ compensation eligibility.

8.1 Do you have a WTC Health Program certified physical health condition?

• Yes (Populate VCF Registration; Populate VCF Application, into plan; Proceed to next question)

• No (Populate VCF Registration; Populate VCF Education, into plan; Proceed to next question)

8.2 In addition to your employment as a federal worker, did you also perform 9/11 rescue, recovery, or clean-up work as an unpaid volunteer?

• Yes (Populate NYS-WTC Volunteer Workers’ Compensation Application; Populate WTC12

Registration, into plan; Proceed to next question)

• No (Rule out NYS-WTC Volunteer Workers’ Compensation Application; Rule out WTC12

Registration; Proceed to next question)

8.3 Do your WTC-related health conditions disable you from performing normal work duties?

• Yes (+ CURRENT or 9/11 UNION MEMBERSHIP--Populate SSD/SSI and Union Disability

Benefits, into plan; Proceed to next question; NO CURRENT or 9/11 UNION MEMBERSHIP— Rule out Union Disability Benefits; Populate SSD/SSI, into plan; Proceed to next question)

• No (Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Proceed to Section 10 on page 17)

8.4 Were you a FEMA employee when working at the 9/11 site?

• Yes (Populate Public Safety Officer Benefit into plan; Proceed to Section 10 on page 17)

• No (Rule out Public Safety Officer Benefit; Proceed to Section 10 on page 17)

Section 9

Assessment of Benefits Registration for Members with No Health Conditions

“I am now going to ask you a few questions about benefits you might be eligible for if you were diagnosed with a 9/11-related mental or physical health condition in the future. Please keep in mind that, if you are diagnosed with a 9/11-related physical or mental health condition in the future, it is important to see a benefits counselor or social worker who could inform you about the benefits you could be eligible for at that time.”

“In order to best understand which benefits might be applicable to you, I will also ask you some questions about the type of paid or volunteer work you were doing in response to 9/11.”

9.1 When you were doing 9/11 rescue, recovery, or clean-up work, were you working as an employee of New York City?

• Yes (Skip to Registration Questions: NYC Workers Section [question 9.4])

• No (Proceed to next question)

9.2 When you were doing 9/11 rescue, recovery, or clean-up work, were you working as an employee of New York State?

• Yes (Skip to Registration Questions: NYS Workers Section [question 9.14])

• No (Proceed to next question)

9.3 When you were doing 9/11 rescue, recovery, or clean-up work, were you working as an employee of the federal government?

• Yes (Skip to Registration Questions: Federal Workers [question 9.16])

• No (Skip to Registration Questions: Nonmunicipal Workers Section [question 9.18])

Registration Questions: New York City Workers Accidental Disability Benefits via the World Trade Center Disability Law

“In 2005, the World Trade Center Disability Law took effect in New York State. The law established a presumption that certain disabilities for certain New York City workers were caused by rescue, recovery, or clean-up operations at the World Trade Center and other qualifying sites. The law entitles covered employees to accidental disability benefits if the individual meets other eligibility criteria.”

“In order to be eligible for these benefits, the law requires that active and retired New York City employees file a notice of participation, or statement including dates and locations of 9/11-related employment, with their appropriately retirement system by September 11, 2022.”

9.4 Have you filed a notice of participation of your 9/11 rescue, recovery, or clean-up work with your retirement system? (Retirement system could be Police Pension Fund (NYPD); Fire Department Pension Fund (FDNY); New York City Employees Retirement System, or NYCERS)

• Yes (Rule out Notice of Participation Registration; Proceed to New York State Workers’

Compensation Section [question 9.5])

• No (Populate Notice of Participation Registration into plan; Proceed to New York State Workers’

Compensation Section [question 9.5])

• Don’t Know (“Our members have been asked to complete and submit a lot of forms and paperwork for various 9/11-related programs and benefits. It might be of benefit to you to call your retirement system simply to confirm whether or not you ever did submit notice of participation form. If you would like to do so, you can reach your retirement system at XXX-XXX-XXXX.”; Refer to Benefits Counseling Handbook Section XX for contact information for all retirement systems; Proceed to New York State Workers’ Compensation Section [question 9.5])

New York State Workers’ Compensation

9.5 Were you employed by the City of New York Police Department?

• Yes (Proceed to next question)

• No (Skip to question 9.7)

9.6 Were you working as an NYPD law enforcement officer?

• Yes (Skip to question 9.12)

• No (Skip to below NYS Workers’ Compensation script, then question 9.13)

9.7 Were you employed by the Fire Department of the City of New York?

• No (Skip to question 9.10)

9.8 Were you working as an FDNY firefighter or fire officer?

• Yes (Proceed to question 9.12)

• No (Proceed to next question)

9.9 Were you working as an FDNY EMT, paramedic, or EMS officer?

• Yes (Skip to below NYS Workers’ Compensation script, then question 9.13)

9.10 Were you employed by the New York City Department of Sanitation?

9.11 Were you working as a sanitation worker or officer?

9.12 In addition to your employment as a New York City [police officer, firefighter, sanitation worker], did you also perform 9/11 rescue, recovery, or clean-up work as an unpaid volunteer?

• Yes (Proceed to below script, then question 9.13)

• No (Skip to Section 10 on page 17)

“In August, 2006, Workers’ Compensation Law Article 8-A was enacted to expand the time for a participant in World Trade Center rescue, recovery, or clean-up operations to file a claim for workers’ compensation benefits if diagnosed with specific qualifying health conditions. It also included a provision to allow claimants to reopen WTC-related workers’ compensation claims that had previously been denied as untimely.”

“In order for a claimant’s previous, current, or future cases to be considered under Article 8-A, the WTC rescue, recovery, or clean-up worker or volunteer must have registered their WTC participation with the Workers’ Compensation Board via the completion and submission of a form called the “WTC-12” form.

The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.’”

9.13 Have you filed a “WTC-12 form”, or “Registration of Participation in World Trade Center Rescue, Recovery, or Clean-Up Operations,” with the New York State Workers’ Compensation Board?

• Yes (Rule out WTC12 Registration; Proceed to Section 10 on page 17)

• No (Populate WTC12 Registration; Proceed to Section 10 on page 17)

• Don’t Know (“It might be of benefit to you to call the New York State Workers’

Compensation Board simply to confirm whether or not you ever did submit a WTC-12 form. If you would like to do so, you can reach the Workers’ Compensation Board at 1-877- 632-4996.”; Proceed to Section 10 on page 17)

Registration Questions: New York State Workers Accidental Disability Benefits via the World Trade Center Disability Law

“In 2005, the World Trade Center Disability Law took effect in New York State. The law established a presumption that certain disabilities for certain New York State workers were caused by rescue, recovery, or clean-up operations at the World Trade Center and other qualifying sites. The law entitles covered employees to accidental disability benefits if the individual meets other eligibility criteria.”

“In order to be eligible for these benefits, the law requires that active and retired New York State employees file a notice of participation, or statement including dates and locations of 9/11-related employment, with their appropriately retirement system by September 1, 2022.”

9.14 Have you filed a notice of participation of your 9/11 rescue, recovery, or clean-up work with your retirement system? (Retirement system could be the New York State and Local Retirement System

[NYSLRS])

• Yes (Rule out Notice of Participation Registration; Proceed to New York State Workers’

Compensation Section [question 9.15])

• No (Populate Notice of Participation Registration into plan; Proceed to New York State Workers’

Compensation Section [question 9.15])

• Don’t Know (“Our members have been asked to complete and submit a lot of forms and paperwork for various 9/11-related programs and benefits. It might be of benefit to you to call your retirement system simply to confirm whether or not you ever did submit notice of participation form. If you would like to do so, you can reach your retirement system at XXX-XXX-XXXX.”; Refer to Benefits Counseling Handbook Section XX for contact information for all retirement systems; Proceed to New York State Workers’ Compensation Section [question 9.15]).

New York State Workers’ Compensation participant in World Trade Center rescue, recovery, or clean-up operations to file a claim for workers’ compensation benefits if diagnosed with specific qualifying health conditions. It also included a provision to allow claimants to reopen WTC-related workers’ compensation claims that had previously been denied as untimely.”

“In order for a claimant’s previous, current, or future cases to be considered under Article 8-A, the WTC rescue, recovery, or clean-up worker or volunteer must have registered their WTC participation with the Workers’ Compensation Board via the completion and submission of a form called the “WTC-12” form.

The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.’”

9.15 Have you filed a “WTC-12 form”, or “Registration of Participation in World Trade Center Rescue, Recovery, or Clean-Up Operations”, with the New York State Workers’ Compensation Board?

• Yes (Rule out WTC12 Registration; Proceed to Section 10 on page 17)

• No (Populate WTC12 Registration into plan; Proceed to Section 10 on page 17)

• Don’t Know (“It might be of benefit to you to call the New York State Workers’

Compensation Board simply to confirm whether or not you ever did submit a WTC-12

Registration Questions: Federal Workers

9.16 In addition to your to your employment as a federal worker, did you also perform 9/11 rescue, recovery, or clean-up work as an unpaid volunteer?

• Yes (Proceed to below script, then question 9.17)

• No (Skip to Section 10 on page 17) participant in World Trade Center rescue, recovery, or clean-up operations to file a claim for workers’ compensation benefits if diagnosed with specific qualifying health conditions. It also included a provision to allow claimants to reopen WTC-related workers’ compensation claims that had previously been denied as untimely.”

“In order for a claimant’s previous, current, or future cases to be considered under Article 8-A, the WTC rescue, recovery, or clean-up worker or volunteer must have registered their WTC participation with the Workers’ Compensation Board via the completion and submission of a form called the “WTC-12” form.

The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.’”

9.17 Have you filed a “WTC-12 form”, or “Registration of Participation in World Trade Center Rescue, Recovery, or Clean-Up Operations”, with the New York State Workers’ Compensation Board?

• Yes (Rule out WTC12 Registration; Proceed to Section 10 on page 17)

• No (Populate WTC12 Registration; Proceed to Section 10 on page 17)

• Don’t Know (“It might be of benefit to you to call the New York State Workers’

Compensation Board simply to confirm whether or not you ever did submit a WTC-12

Registration Questions: Nonmunicipal Workers and Volunteers

“In August, 2006, Workers’ Compensation Law Article 8-A was enacted to expand the time for a participant in World Trade Center rescue, recovery, or clean-up operations to file a claim for workers’ compensation benefits if diagnosed with specific qualifying health conditions. It also included a provision to allow claimants to reopen WTC-related workers’ compensation claims that had previously been denied as untimely.”

“In order for a claimant’s previous, current, or future cases to be considered under Article 8-A, the WTC rescue, recovery, or clean-up worker or volunteer must have registered their WTC participation with the Workers’ Compensation Board via the completion and submission of a form called the “WTC-12” form.

The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.’”

9.18 Have you filed a “WTC-12 form”, or “Registration of Participation in World Trade Center Rescue, Recovery, or Clean-Up Operations”, with the New York State Workers’ Compensation Board?

• Yes (Rule out WTC12 Registration; Proceed to Section 10 on page 17)

• No (Populate WTC12 Registration; Proceed to Section 10 on page 17)

• Don’t Know (“It might be of benefit to you to call the New York State Workers’

Compensation Board simply to confirm whether or not you ever did submit a WTC-12

Section 10

Cancer/Transplant Care Assistance

10.1 Since 9/11, have you been diagnosed with cancer?

• Yes (Populate Cancer Care Assistance into plan; Proceed to next question)

• No (Rule out Cancer Care Assistance; Proceed to next question)

10.2 Are you awaiting or have you had an organ transplant since 9/11?

• Yes (Populate Transplant Care Assistance; Proceed to Section 11 on page 18)

• No (Rule out Transplant Care Assistance; Proceed to Section 11 on page 18)

Section 11

Care for Non-Covered Conditions Assistance

Interviewer: “I am now going to ask you some questions about medical insurance coverage and access to medical care for health conditions that are not covered by the WTC Health Program.”

11.1 Do you have health insurance?

• Yes (Rule out Health Insurance Assistance; Proceed to next question)

• No (Populate Health Insurance Assistance; Proceed to next question)

11.2 Do you currently have a primary care doctor?

• Yes (Rule out Help Finding a Primary Care Doctor; Proceed to next question)

• No (Populate Help Finding a Primary Care Doctor; Proceed to next question)

11.3 At this time, are you having any problems accessing the medical care you need for conditions that are not covered by the WTC Health Program?

• Yes (Populate Care for Noncovered Conditions Assistance; Proceed to Section 12 on page 19)

• No (Rule out Care for Noncovered Conditions Assistance; Proceed to Section 12 on page 19)

Section 12

Social Services Assistance

Interviewer: “Due to disabling 9/11 health conditions, some program members have had trouble paying rent, mortgage, or utility bills; buying food; or securing transportation. I am now going to ask you some questions about basic needs assistance.”

12.1 As of today, are you having trouble paying your basic needs expenses, specifically shelter, utilities, food, or transportation?

• Yes (Populate Social Services Assistance; Conclude interview)

• No (Rule out Social Services Assistance; Conclude interview)

9/11 Unlimited Sick Leave Based on the member’s BEAST responses, he or she is a NYC or NYS worker who is likely eligible for 9/11 Unlimited Sick Leave benefits through their employer.

1. Educate the member about 9/11 Unlimited Sick Leave benefits.

NYC 9/11 Unlimited Sick Leave Info:

https://www1.nyc.gov/assets/dcas/downloads/pdf/reports/440_17.pdf NYS 9/11 Unlimited Sick Leave Info:

https://legislation.nysenate.gov/pdf/bills/2017/S6398A

2. Refer the member to their union representative or employer to find out more about their eligibility for such benefits and how to access them.

Accidental Disability Benefits via the WTC Disability Law:

Based on the member’s BEAST responses, he or she is a NYC or NYS worker who might be eligible for Accidental Disability Benefits via the WTC Disability Law.

1. Educate the member about Accidental Disability Benefits via the WTC Disability

Law and how it might be helpful to them. [Link to BC Handbook Section 6.3]

2. Refer the member to their appropriate union representative to find out more about

Accidental Disability Benefits and how to apply. [Link to BC Handbook Section 6.6.2]

3. Refer the member to their appropriate retirement system to find out more about Accidental Disability Benefits and how to apply. [Link to BC Handbook Section 6.3.9]

Cancer Care Assistance:

Based on the member’s cancer diagnosis, he or she might need help identifying resources to help with the financial, legal, occupational, emotional, or other aspects of cancer. He or she might also need help fully understanding the cancer-related benefits offered by the WTC Health Program.

1. Further assess the member’s need for financial, legal, occupational, emotional or other cancer-related resources.

2. Refer to appropriate resources as needed. [Link to BC Handbook: Cancer Resources

Section]

3. Educate the member about the WTC Health Program’s cancer-related benefits as needed. [Link to BC Handbook Section 7.2] [Link to WTC HP Cancer Fact Sheets]

4. Ensure the member is connected with an oncology social worker at his or her treatment center.

Care for Noncovered Conditions Assistance:

The member is having trouble finding care for noncovered conditions and might need help identifying an affordable and appropriate care option for these conditions.

1. Work in partnership with the member’s WTC Health Program healthcare provider to identify appropriate and affordable health care referrals for the member’s noncovered health conditions.

2. Consult the benefits counseling handbook for information about community health centers, federally qualified health centers, and other healthcare options that offer care https://www1.nyc.gov/assets/dcas/downloads/pdf/reports/440_17.pdf https://legislation.nysenate.gov/pdf/bills/2017/S6398A on a sliding fee scale basis and/or offer culturally competent care. [Link to BC Handbook Section 8.6.7]

3. Refer the member as appropriate and needed.

4. After referral, follow-up with the member to confirm completion of the referral.

Federal Workers’ Compensation:

Based on the member’s BEAST responses, he or she may be eligible for federal workers’ compensation benefits.

1. Educate the member about federal workers’ compensation benefits, what it is, and how it might be helpful to them. [Link to BC Handbook Section 4]

2. Refer the member to the Office of Workers’ Compensation Programs for more information. [OWCP website:

https://www.dol.gov/agencies/owcp/dfec/regs/compliance/Basic-Information-on- New-Claims]

3. Advise the member to speak to their union representative or employer for more details about how to file and securing legal representation.

Health Insurance Assistance:

Health Insurance Assistance shows up in a member’s plan only if the member is currently uninsured.

1. Refer the member to the CCE institution’s Medicaid or financial counseling office or the member’s local community Medicaid office to be assessed for public health insurance eligibility. [Link to BC Handbook Sections 8.3; 8.6.2; 8.6.3]

2. After referral, follow-up with member to confirm whether or not found eligible for public health insurance.

3. If found not eligible, refer the member to a local health navigator for help finding an affordable health insurance policy available through their state’s marketplace. [Link to find local health navigators: https://localhelp.healthcare.gov/#intro]

4. If member is uninsurable or cannot afford to purchase health insurance through the marketplace, try to identify a discount drug or pharmaceutical assistance program option that might be available to the member. [Link to BC Handbook Section 8.6.8]

Help Finding a Primary Care Doctor:

The member does not currently have a primary care doctor and might need help finding one.

1. Work in partnership with the member’s WTC Health Program healthcare provider to identify appropriate and affordable primary care referrals for the member.

2. Refer the member as appropriate and needed.

3. After referral, follow-up with the member to confirm completion of the referral.

LODI: Line-of-Duty-Injury. Ensure the member knows he or she is eligible to apply for LODI benefits at this time.

1. Educate the member about what LODI is and how it might be helpful to them. [Link to BC Handbook Section 6.2] https://www.dol.gov/agencies/owcp/dfec/regs/compliance/Basic-Information-on-New-Claims https://www.dol.gov/agencies/owcp/dfec/regs/compliance/Basic-Information-on-New-Claims

2. Refer the member to their appropriate union representative to find out more about LODI and for assistance with filing a claim. [Link to BC Handbook Section 6.6.2]

Notice of Participation Registration:

Any worker who applies for accidental disability benefits via the WTC Disability Law must have previously filed a notice of participation form with the appropriate NYC or NYS retirement system. Workers who are not currently disabled should file the notice of participation form to preserve their right to file an application for accidental disability benefits should he or she become disabled in the future. Notice forms must be completed and submitted to the appropriate retirement system on or before September 11, 2022.

1. Determine whether or not the member has filed the appropriate Notice of

Participation form with the appropriate retirement system.

2. Educate the member about the Notice of Participation, why it is important, how it protects their right to file for Accidental Disability Benefits via the WTC Disability Law. [Link to BC Handbook Section 6.3.2]

3. Educate the member about the September 11, 2022 deadline for filing a Notice of Participation form. [Link to BC Handbook Section 6.3.2]

4. Help the member complete the appropriate Notice of Participation form if needed.

5. Ensure the member knows how to submit the Notice of Participation form to the appropriate retirement system. [Link to BC Handbook Section 6.3.2]

NYS Paid Family Leave:

1. Provide the member with a NYS Paid Family Leave fact sheet. [Link to Fact Sheet:

http://docs.paidfamilyleave.ny.gov/content/main/forms/PFLDocs/pfl-at-a-glance- 2021.pdf]

2. Advise the member to speak to their employer if interested in learning more about this benefit.

NYS Workers’ Compensation Application:

Ensure the member knows he or she is eligible to apply for NYS Workers’ Compensation benefits at this time.

1. Educate the member about NYS Workers’ Compensation, what it is, and how it might be helpful to them. [Link to BC Handbook Section 3.2]

2. Help the member to complete and file a C-3 form as needed and timely. [Link to C3 forms in various languages:

http://www.wcb.ny.gov/content/main/forms/Forms_CLAIMANT.jsp#C3]

3. If the member is a union member, advise him or her to ask a union representative if their union works with a law firm to help members apply for workers’ compensation benefits. [Link to BC Handbook Section 6.6.2]

4. If the member is not a union member, advise him to her to contact the Advocate for Injured Workers at NYS Workers’ Compensation Board for assistance in finding a workers’ compensation attorney. [Contact info for Advocate for Injured Workers:

877-632-4996 or advinjwkr@wcb.ny.gov] http://docs.paidfamilyleave.ny.gov/content/main/forms/PFLDocs/pfl-at-a-glance-2021.pdf http://docs.paidfamilyleave.ny.gov/content/main/forms/PFLDocs/pfl-at-a-glance-2021.pdf http://www.wcb.ny.gov/content/main/forms/Forms_CLAIMANT.jsp#C3

NYS-WTC Volunteer Workers’ Compensation Application:

Ensure the member knows he or she is eligible to apply for WTC Volunteer Workers’

Compensation benefits at this time. Help the member to complete and file a WTC-Vol 3 form if needed and timely.

1. Educate the member about NYS WTC Volunteer Workers’ Compensation, what is is, and how it might be helpful to them. [Link to BC Handbook Section 3.2]

2. Help the member to complete and file a WTC-Vol 3 form as needed and timely.

[Link to WTCVol-3 Claim Form:

http://www.wcb.ny.gov/content/main/forms/wtcvol-3.pdf]

3. If the member is a union member, advise him or her to ask a union representative if their union works with a law firm to help members apply for workers’ compensation benefits. [Link to BC Handbook Section 6.6.2]

4. If the member is not a union member, advise him to her to contact the Advocate for Injured Workers at NYS Workers’ Compensation Board for assistance in finding a workers’ compensation attorney. [Contact info for Advocate for Injured Workers:

877-632-4996 or advinjwkr@wcb.ny.gov]

Public Safety Officer Benefit:

Based on the member’s BEAST responses, he or she might be eligible for Public Safety

Officer Benefits at this time.

1. Educate the member about the Public Safety Officer Benefit and how it might be helpful to them. [Link to BC Handbook Section 6.6][PSOB Fact Sheet:

https://psob.bja.ojp.gov/PSOB_FactSheet2019.pdf]

2. Direct the member to the PSOB website for more information about the benefit and how to apply for it. [Contact info for PSOB: https://www.psob.gov or 1-888-744- 6513]

SSD/SSI: Because the member’s WTC-related health conditions disable him or from working, the member might be eligible for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI).

1. Educate the member about SSD/SSI and how it might be helpful to them. [Link to

BC Handbook Section 6.4 (SSD); 6.5 (SSI)]

2. Refer the member to the Social Security Administration website (www.ssa.gov) for more information on SSI and SSD.

3. If the member is a union member, advise him or her to ask a union representative if their union works with a law firm to help members apply for Social Security benefits.

[Link to BC Handbook Section 6.6.2]

4. For member who need more hands-on assistance, refer to an organization such as Center for the Independent of the Disabled in New York (CIDNY) for assistance.

[Contact info for CIDNY: https://www.cidny.org or 212-674-2300]

Social Services Assistance:

http://www.wcb.ny.gov/content/main/forms/wtcvol-3.pdf https://www.psob.gov/ http://www.ssa.gov/ https://www.cidny.org/

Social Services Assistance appears in the member’s benefits counseling plan only if the member is currently having trouble meeting a basic need, such as food, utilities, housing, or transportation.

1. Assess member’s specific social services need(s) (ie, food, utilities, etc).

2. Refer the member to an external agency that could help to address the need. [Link to

BC Handbook Social Services Resources Section]

3. Follow-up with the member after referral to confirm that basic need was addressed.

Transplant Care Assistance:

The member might need help identifying resources to help with the financial, legal, occupational, emotional, or other aspects of transplant. He or she might also need help fully understanding the transplant-related benefits offered by the WTC Health Program.

1. Further assess the member’s need for financial, legal, occupational, emotional or other transplant-related resources.

2. Refer to appropriate resources as needed. [Link to BC Handbook Transplant

Resources Section]

3. Educate the member about the WTC Health Program’s transplant-related benefits as needed.

4. Ensure the member is connected with a transplant social worker at his or her treatment center.

Union Disability Benefits:

Advise the member to reach out to his or her union about union-specific disability benefits that might be available to members. [Link to BC Handbook Section 6.6.2]

VCF Application: Ensure the member knows he or she is eligible to apply for VCF benefits at this time.

VCF Application only appears in the member’s benefits counseling plan if the member answers “yes” to the question, “Do you have one or more WTC Health Program-certified physical health conditions?” Because the member has a certified physical health condition, he or she is eligible to apply for VCF benefits.

1. Determine whether or not member has already applied for VCF.

2. If not, refer member to VCF website to apply. [Link to VCF website https://www.vcf.gov/]

3. Refer member to VCF HelpLine if he/she would like assistance with initial application, or if member has questions about existing application or claim. [VCF HelpLine: 1-855-885-1555]

4. Educate the member about the VCF, its benefits, and how it might be helpful to the member. [Link to BC Handbook Section 5]

5. Make sure the member knows and understands that VCF will request directly from WTC Health Program all information needed related to certification, medical conditions, and disability.

VCF Education: Ensure the member knows about the VCF so that he or she knows to apply if certified for a physical health condition in the future.

VCF Education only appears in the member’s benefits counseling plan if the member answers “no” to the question, “Do you have one or more WTC Health Program-certified physical health conditions?” Because the member does not have a certified health condition, he or she is not yet ready to apply for benefits. However, the member should be made aware of the VCF so that he or she knows about it if certified for a physical health condition in the future.

1. Educate the member about VCF, its benefits, and how it might be helpful to the member IN THE FUTURE IF CERTIFIED FOR A PHYSICAL HEALTH CONDITION. [Link to BC Handbook Section 5]

2. Refer member to VCF website and HelpLine for more information about VCF.

[Contact info for VCF: https://www.vcf.gov or 1-855-885-1555]

VCF Registration: Ensure the member knows about the VCF Registration deadlines and help them to register if needed and timely.

1. Determine whether or not member has registered with the VCF.

2. If not, refer member to VCF website to register. [Link to VCF Registration Info:

https://www.vcf.gov/how-register]

3. Refer member to VCF HelpLine if he/she would like assistance with registration.

[VCF Helpline: 1-855-885-1555]

4. Educate all members about key VCF deadlines (registration and submission). [Link to VCF Deadlines Info: https://www.vcf.gov/deadlines]

WTC12 Registration: Ensure that the member knows about the WTC12 form and the importance of completing it.

1. Educate the member about the WTC12 form, what it is, and how it protects their right to file for workers’ compensation benefits. [Link to BC Handbook Section 3.2.5]

2. Educate the member about the deadline for filing a WTC12. [Link to BC Handbook

Section 3.2.5]

3. Help the member to complete the WTC12 form if needed. [Link to WTC12 form in various languages: http://www.wcb.ny.gov/WTC/wtc-assistance-programs.jsp]

4. Ensure the member knows how to submit the WTC12 form to the NYS Workers’

Compensation Board.

https://www.vcf.gov/