ATT014_BEAST_Responders.docx

Benefits Eligibility Assessment Screening Tool [BEAST] for Responders WTC Health Program

0.1 Benefits survey administered by phone?

· Yes (Proceed to next question)

· No (Proceed to next question)

0.2 Member declined benefits survey?

· Yes (Stop survey here)

· No (Proceed to next question)

0.3 Are you currently a member of a union?

· Yes (Proceed to next question)

· No (Skip to question 0.6)

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

· Yes (Proceed to next question)

· No (Skip to question 0.9)

0.9 Do you have one or more WTC Health Program-certified physical health conditions?

· 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)

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

· Yes (Proceed to Section 1 on page 3)

· No (Proceed to Section 1 on page 3) Click on “Proceed” to administer the rest of the screening tool.

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 WTC-related work so that I better know which specific benefits to ask you about today.”

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

· Yes (Proceed to next question)

· No (Skip to question 1.11)

1.2 When you were performing 9/11 rescue, recovery, or clean-up work, were you employed by the City of New York Police Department?

· Yes (Proceed to next question)

· No (Skip to question 1.4)

1.3 When you were performing 9/11 rescue, recovery, or clean-up work, were you working as an NYPD law enforcement officer?

· Yes (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 2 on page 5; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9A, Question 9.1 on page 12)

· No (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 6 on page 9; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9B, Question 9.4 on page 13)

1.4 When you were performing 9/11 rescue, recovery, or clean-up work, were you employed by the Fire Department of the City of New York?

· Yes (Proceed to next question)

· No (Skip to question 1.7)

1.5 When you were performing 9/11 rescue, recovery, or clean-up work, were you working as an FDNY firefighter or fire officer?

· Yes (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 2 on page 5; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9A, Question 9.1 on page 12)

· No (Proceed to question 1.6)

1.6 When you were performing 9/11 rescue, recovery, or clean-up work, were you working an as FDNY EMT, paramedic, or EMS officer?

· Yes (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 4 on page 7; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9B, Question 9.4 on page 13)

· No (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 6 on page 9; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9B, Question 9.4 on page 13)

1.7 When you were performing 9/11 rescue, recovery, or clean-up work, were you employed by the New York City Department of Sanitation?

· Yes (Proceed to next question)

· No (Skip to question 1.9)

1.8 When you were performing 9/11 rescue, recovery, or clean-up work, were you working as a uniformed sanitation worker or officer?

· Yes (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 3 on page 6; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9A, Question 9.1 on page 12)

· No (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 6 on page 9; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9B, Question 9.4 on page 13)

1.9 When you were performing 9/11 rescue, recovery, or clean-up work, were you employed by the New York City Department of Corrections?

· Yes (Proceed to next question)

· No (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 6 on page 9; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9B, Question 9.4 on page 13)

1.10 Were you working as a corrections officer?

· Yes (+certified condition AND/OR physical or mental health diagnosis, Skip to Section 5 on page 8; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9B, Question 9.4 on page 13)

· No (+certified condition AND/OR physical or mental health diagnosis, Skip to Section 6 on page 9; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9B, Question 9.4 on page 13)

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

· Yes (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 6 on page 9; + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9C, Question 9.6 on page 14)

· No (Proceed to next question)

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

· Yes (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 8 on page 11); + NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9D, Question 9.8 on page 15)

· No (+ certified condition AND/OR physical or mental health diagnosis, Skip to Section 7 on page 10;+ NO certified condition AND NO physical or mental health diagnosis, Skip to Section 9E, Question 9.10 on page 15)

Section 2 NYPD Law Enforcement Officers and FDNY Firefighters and Fire Officers WTC-Related Illness and Related Benefits

2.1 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)

2.2 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 2.4)

2.3 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 16)

· No (Populate Notice of Participation Registration into plan; Rule out SSD/SSI; Rule out Public Safety Officer Benefit; Rule out Union Disability Benefits; Skip to Section 10 on page 16)

2.4 Do your WTC-related health conditions disable you from performing normal work duties? [“other” officers, per question 2.2]

· Yes (Populate SSD/SSI; Union Disability Benefits, and Public Safety Officer Benefit into plan; Skip to Section 10 on page 16)

· No (Rule out SSD/SSI; Rule out Public Safety Officer Benefit; Rule out Union Disability Benefits; Skip to Section 10 on page 16)

Section 3 DSNY Sanitation Workers and Officers WTC-Related Illness and Related Benefits

3.1 In addition to your employment as a New York City [uniformed 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)

3.2 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)

· Other (Rule out LODI; Rule out Accidental Disability Benefits via the WTC Disability Law; Skip to question 3.4)

3.3 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 16)

· No (Populate Notice of Participation Registration into plan; Rule out SSD/SSI; Rule out Union Disability Benefits; Skip to Section 10 on page 16)

3.4 Do your WTC-related health conditions disable you from performing normal work duties? [“other” workers and officers, per question 3.2]

· Yes (Populate SSD/SSI; and Union Disability Benefits into plan; Skip to Section 10 on page 16)

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

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 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 4.3)

4.2 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; Union Disability Benefits, and Public Safety Officer Benefit, into plan; Skip to Section 10 on page 16)

· 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 16)

4.3 Do your WTC-related health conditions disable you from performing normal work duties? [“other” workers and officers, per question 4.1]

· Yes (Populate SSD/SSI; Union Disability Benefits, and Public Safety Officer Benefit into plan; Skip to Section 10 on page 16)

· No (Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 16)

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

· Active duty (Populate LODI; 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 5.3)

5.2 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 16)

· 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 16)

5.3 Do your WTC-related health conditions disable you from performing normal work duties? [“other” Corrections officers, per question 5.1]

· Yes (Populate SSD/SSI; Union Disability Benefits, and Public Safety Officer Benefit into plan; Skip to Section 10 on page 16)

· No (Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 16)

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 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 6.3)

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

· 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 6.4; 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 6.4)

· No (Populate Notice of Participation Registration into plan; Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefits; Skip to Section 10 on page 16) Comment by Hill, Elizabeth (CDC/NIOSH/WTCHP) (CTR): If a member answers no to the disability question, he or she is not asked questions 6.4 or 6.5. Questions 6.4 and 6.6 assess for Public Safety Officer Benefit eligibility, which is irrelevant if the member is not disabled. That said, we need to make sure the disability questions are asked at subsequent visits so that these questions ARE asked and PSOB is not incorrectly ruled out, in the event that a member becomes disabled between visits and administrations of the BEAST.

6.3 Do your WTC-related health conditions disable you from performing normal work duties? [“other” workers, per question 6.1]

· 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 16) Comment by Hill, Elizabeth (CDC/NIOSH/WTCHP) (CTR): Same comment as above.

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

· Yes (Populate Public Safety Officer Benefit into plan; Skip to Section 10 on page 16)

· No (Proceed to next question)

6.5 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 16)

· No (Rule out Public Safety Officer Benefit; Skip to Section 10 on page 16) Section 7

Nonmunicipal Workers and Volunteers WTC-Related Illness and Related Benefits ** Populate NYS Workers’ Compensation Application; Populate WTC12 Registration, into plan. No additional questions need to be asked in this section to screen for workers’ compensation eligibility.

6.1 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)

6.2 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—Populate SSD/SSI into plan; Rule out Union Disability Benefits)

· No (Rule out SSD/SSI; Rule out Union Disability Benefits; Proceed to section 10 on page 16)

6.3 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 16)

· No (Rule out Public Safety Officer Benefit; Skip to Section 10 on page 16)

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 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)

8.2 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—Populate SSD/SSI into plan, Rule out Union Disability Benefits; Proceed to Section 10 on page 16)

· No (Rule out SSD/SSI; Rule out Union Disability Benefits; Rule out Public Safety Officer Benefit; Skip to Section 10 on page 16)

8.3 Were you a FEMA employee when working on the 9/11 effort?

· Yes (Populate Public Safety Officer Benefit into plan; Skip to Section 10 on page 16)

· No (Rule out Public Safety Officer Benefit; Skip to Section 10 on page 16)

Section 9 Assessment of Benefits Registration for Members with No Health Conditions Section 9(A): NYPD Law Enforcement Officers; FDNY Firefighters and Fire Officers; DSNY Sanitation Workers and Officers ONLY “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 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 and 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 City and New York State workers file a notice of participation, or statement including dates and locations of 9/11 related employment, with their appropriate retirement system by September 11, 2022.”

9.1 Have you filed a notice of participation of your 9/11 rescue, recovery or clean-up work with your retirement system?

· Yes (Rule out Notice of Participation Registration; Proceed to next question)

· No (Populate Notice of Participation Registration into plan; Proceed to next question)

· 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 a 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 6.3.2 for contact information for all retirement systems; Proceed to next question.)

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

· Yes (Proceed to script below, then next question)

· No (Skip to Section 10 on page 16)

“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 WTC12 form. The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.”

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

· Yes (Rule out WTC12 Registration; Proceed to Section 10 on page 16)

· No (Populate WTC12 Registration into plan; Proceed to Section 10 on page 16)

Section (B): NYPD Civilian Workers; FDNY Civilian Workers; DSNY Civilian Workers; NYC Corrections Officers and Civilian Workers; FDNY EMTS, Paramedics, and Officers; All Other NYC Workers ONLY “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 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 and 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 City and New York State workers file a notice of participation, or statement including dates and locations of 9/11 related employment, with their appropriate 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?

· Yes (Rule out Notice of Participation Registration; Proceed to next question)

· No (Populate Notice of Participation Registration into plan; Proceed to next question)

· 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 a 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 6.3.2 for contact information for all retirement systems; Proceed to next question.)

“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 WTC12 form. The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.”

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

· Yes (Rule out WTC12 Registration; Proceed to Section 10 on page 16)

· No (Populate WTC12 Registration into plan; Proceed to Section 10 on page 16)

Section 9(C): NYS Workers Only “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 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 and 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 City and New York State workers file a notice of participation, or statement including dates and locations of 9/11 related employment, with their appropriate retirement system by September 11, 2022.”

9.6 Have you filed a notice of participation of your 9/11 rescue, recovery or clean-up work with your retirement system?

· Yes (Rule out Notice of Participation Registration; Proceed to next question)

· No (Populate Notice of Participation Registration into plan; Proceed to next question)

· 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 a 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 6.3.2 for contact information for all retirement systems; Proceed to next question.)

“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 WTC12 form. The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.”

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

· Yes (Rule out WTC12 Registration; Proceed to Section 10 on page 16)

· No (Populate WTC12 Registration into plan; Proceed to Section 10 on page 16)

Section 9(D): Federal Workers Only

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

· Yes (Proceed to script below, then next question)

· No (Skip to Section 10 on page 16)

“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 WTC12 form. The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.”

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

· Yes (Rule out WTC12 Registration; Proceed to Section 10 on page 16)

· No (Populate WTC12 Registration into plan; Proceed to Section 10 on page 16)

Section 9(E): Nonmunicipal Workers and Volunteers ONLY

“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 WTC12 form. The formal title of this form is ‘Registration of Participation in World Trade Center Rescue, Recovery, and/or Clean-up Operations.”

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

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

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

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 question 10.2)

· No (Rule out Cancer Care Assistance; Proceed to question 10.2)

10.2 Are you awaiting or have you had an organ transplant?

· Yes (Populate Transplant Care Assistance; Proceed to Section 11)

· No (Rule out Transplant Care Assistance; Proceed to Section 11)

Section 11 Care for Noncovered 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 question 11.2)

· No (Populate Health Insurance Assistance; Proceed to question 11.2)

11.2 Do you currently have a primary care doctor?

· Yes (Rule out Primary Care Doctor Assistance; Proceed to question 11.3)

· No (Populate Primary Care Doctor Assistance; Proceed to question 11.3)

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 Noncovered Conditions Assistance; Proceed to Section 12)

· No (Rule out Noncovered Conditions Assistance; Proceed to Section 12)

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.

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.

2. Refer the member to their appropriate union representative to find out more about Accidental Disability Benefits and how to apply.

3. Refer the member to their appropriate retirement system to find out more about Accidental Disability Benefits and how to apply.

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.

3. Educate the member about the WTC Health Program’s cancer-related benefits as needed. [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 member about community health centers, federally qualified health centers, and other healthcare options that offer care on a sliding fee scale basis and/or offer culturally competent care.

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.

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.

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]

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.

2. Refer the member to their appropriate union representative to find out more about LODI and for assistance with filing a claim.

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 have been completed and submitted to the appropriate retirement system before September 11, 2022.

1. Determine whether or not the member has filed the appropriate Notice of Participation form with the appropriate retirement system.

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.

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.

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]

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.

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.

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. [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.

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.

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:

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.

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.

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.

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.

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.

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.

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.

2. Educate the member about the deadline for filing a WTC12.

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.