WTC Health Program: Appeals Process

Overview of the Appeal Process For Denial of Health Condition Certification

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The Overview of the Appeal Process for Denial of Health Condition Certification provides World Trade Center (WTC) Health Program members with a brief summary of the appeal process; timelines for the appeal process; information about the option to make an oral statement during the appeal review; and Frequently Asked Questions about the appeal process.

If you need help in understanding the appeal process, call:

WTC Health Program Call Center
1.888.982.4748
Monday through Friday
9 a.m. to 5 p.m. (Eastern Time Zone)

The Call Center will refer you to the appeal coordinator who can explain the appeal process and answer any questions you may have.

Brief Summary of Appeal Process for Denial of Health Condition Certification

Members of the WTC Health Program denied certification of a health condition have the right to appeal the denial of certification, including denial of authorization for treatment of a certified health condition.

To appeal, you must mail or fax a written letter to the WTC Health Program’s appeal coordinator within 60 calendar days from the date on the top of the denial letter. Within 14 days of receiving an appeal request, the appeal coordinator will notify you by letter if your appeal request is accepted or not. If your appeal request is accepted, this same letter will provide with the name of the Federal official who will review your appeal. If your appeal letter is not accepted, you will be informed of the reasons why it was not accepted. No further consideration will be given to your appeal request.

All accepted appeal requests will be reviewed promptly by the Federal official. If the appeal review is going to take longer than 60 calendar days from the date of the letter notifying you that your appeal request is accepted, the appeal coordinator will send a letter to you providing a written explanation of the delay and the estimated date the review is expected to be completed. After the review is completed, the appeal coordinator will send you a letter informing you of the Federal official’s final decision on the appeal and any actions taken by the WTC Health Program resulting from the Federal official’s decision. If your appeal is denied, no further consideration will be given to your appeal request by the Program and any further action would have to be pursued legally outside the administrative appeal process of the Program.

Making an Oral Statement. You can request the opportunity to make an oral statement to the Federal official during the appeal review at the time you send your appeal request letter to the appeal coordinator. You can also request to make an oral statement within 14 calendar days of receiving the letter from the appeal coordinator notifying you that your appeal request was accepted. See Frequently Asked Questions for more information about how to make an oral statement to the Federal official.

Using a Representative. You can designate a person to represent your interests during the appeal process. You can designate a representative by sending a letter to the appeals coordinator. See Frequently Asked Questions for more information about how to designate a representative.

Appeal Process Timeline


Notification of Denial of Health Condition Certification
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Request an Appeal No more than 60 calendar days after the date of the denial of health condition certification letter If you want to appeal a denial of health condition certification, you must mail or fax a written letter to the appeal coordinator within 60 calendar days from the date of the denial letter.
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Notification of Appeal Request Accepted or Not Within 14 calendar days after requesting an appeal The appeal coordinator will notify you by letter within 14 calendar days of receiving your appeal request whether your appeal request was accepted for review or not accepted for review.
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Request to Make an Oral Statement [Optional] Within 14 Calendar Days After Receiving Appeal Review Acceptance Letter You can request an opportunity to make an oral statement to the Federal official in your appeal request letter or within 14 calendar days after receiving a letter notifying you of the name of the Federal official who will review your appeal.
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Oral Statement Scheduled [Optional] Within 60 Days After Receiving Appeal Review Acceptance Letter You will have 15 uninterrupted minutes to make your statement. After making your statement, the Federal official may ask you questions for no more than 45 minutes. The maximum commitment of time is 1 hour.
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Transcript Review [Optional] Within 14 Calendar Days of Receiving Transcript of Oral Statement After review of the transcript of the oral statement, return the transcript with corrections within 14 calendar days from the date of the appeal coordinator’s letter accompanying the transcript.
Notification of Outcome of Appeal Review Within 60 Calendar Days After Receiving Appeal Review Acceptance Letter If the appeal review is going to take longer than 60 calendar days from the date of the letter notifying you that your appeal request was accepted, the appeal coordinator will send you a letter and provide you with a written explanation of the delay and an estimated date the review is expected to be completed.

Frequently Asked Questions


Several FAQs are provided on our FAQ page on what to do if you disagree with a decision made by the WTC Health Program.
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