*These Frequently Asked Questions and Answers (FAQs) were prepared by the Parties and the Claims Administrator to assist claimants who might submit claims to the Court Supervised Settlement Program. The information contained in these FAQs is based on the Medical Benefits Settlement Agreement, which was granted Final Approval on January 11, 2013. However, these FAQs are not a substitute for and do not constitute the official Class Notice, and they are not approved by the Court. Any term or information in these FAQs that is found in the Medical Benefits Settlement Agreement will have the meaning set forth in the Medical Benefits Settlement Agreement. If there is any conflict between these FAQs and the Medical Benefits Settlement Agreement, the Medical Benefits Settlement Agreement controls.
IV. POST DETERMINATION PAYMENT COMPLICATIONS
1. What are Payment Complications?
“Payment Complications” refers to all liens and other issues that must be resolved under the Medical Benefits Class Action Settlement Agreement (“MSA”) before the Claims Administrator may pay a claim for compensation for a Specified Physical Condition (“SPC”). Here is a list of all payment complications addressed by the Claims Administrator:
Healthcare Liens and Complications:
- Medicare Parts A and B
- Medicaid
- Medicare Parts C and D
- Veterans Administration
- TRICARE
- Indian Health Services
- Private Health Insurance
Non-Healthcare Liens and Complications:
- Audit
- Authorized Representatives
- Bankruptcy
- Child Support
- Legal Liens
- Third Party Liens
- Workers’ Compensation
- Dual Representation Issues
- Financial Hardship Waiver request
- Request for Review
2. Why is my payment being held up? How long will it take to receive payment after I receive a Notice of Determination for compensation for an SPC?
The time between determination and payment will depend on several factors. Under the MSA, the Claims Administrator is required to resolve any liens and subrogation interests (see Section XXIX of MSA). We must also resolve any other complications relating to payment (such as dual representation issues, audit, and bankruptcy). The time required to resolve these complications is dependent on the number and nature of those complications. The Claims Administrator pays all claims that do not have any outstanding payment complications during regularly-scheduled pay sweeps that occur every two (2) weeks. As soon as all complications and liens relating to your claim are resolved, your claim will be included in the next pay sweep. Where possible, the Claims Administrator will make partial payments, as allowed under Section XXIX.H of the MSA.
3. What are liens?
Liens are a legal right to your settlement funds acquired by a third party creditor or lien holder. The most common type of lien seen with this settlement is a healthcare lien.
4. What is a healthcare lien?
If a government healthcare payer (such as Medicare, Medicaid, the Department of Veterans Affairs, and others) or a private insurer pays for medical treatments received by you for your Specified Physical Condition resulting from the Deepwater Horizon Oil Spill, and if you are awarded a settlement because of that Specified Physical Condition, your insurer may be entitled to recoup some or all of the healthcare payments from that award. You agreed to reimburse your insurance company when you signed the policy forms and began using the coverage.
5. Do I Have To Resolve My Lien?
Yes. Federal law and the terms of the MSA require all plaintiffs who receive a settlement award to identify and resolve any repayment obligations owed to Medicare, Medicaid, VA/Tricare, and Indian Health Services. State laws and the terms of the MSA require the same procedure for private liens and workers' compensation obligations. If healthcare liens are not resolved properly, your future benefits could come under scrutiny. The Claims Administrator will determine what, if any, repayment obligations exist against your settlement award. If no repayment obligation exists, the Claims Administrator will clear your settlement funds of any healthcare lien holds.
6. I only received treatment at the clean-up site (not from any other medical provider). Why is all or part of my settlement being withheld?
The MSA requires the Claims Administrator to affirmatively identify and resolve certain potential liens. At the beginning of the lien resolution process, when obligations are unknown or when liens have not yet been cleared, the initial holdback could be 100%. As we identify and resolve obligations, the holdback may be reduced, allowing for partial disbursements. A lien holdback does not necessarily mean that a lien exists. As mentioned above, the settlement funds must be withheld until we are able to confirm whether a lien exists and what amount should be withheld.
7. What are the different types of liens that could hold up my payment?
See the list above for the different categories of liens that must be resolved prior to paying your claim. Some examples of liens that could hold up your payment are healthcare liens, attorney liens, and delinquent child support payments. Any third party lien submitted to the Claims Administrator can delay payment.
8. What is a lien holdback?
A lien holdback is the percentage of a gross settlement award that is placed in reserve until the Medical Settlement Agreement’s lien requirements are satisfied.
9. What is the finalized lien process?
Medicare Parts A and B:
The Claims Administrator will affirmatively verify whether claimants in the program are (or have been) entitled to Medicare Part A and/or Part B benefits. We will then facilitate a global resolution strategy to satisfy and resolve Medicare’s Part A and/or Part B recovery claims for all Medicare enrolled participating claimants. The term “global resolution” refers to an agreement with the Centers for Medicare and Medicaid Services (CMS) to resolve Medicare Part A and/or Part B reimbursement claims on an aggregate basis (as opposed to a claim-by-claim approach) based on values derived from compensable injury categories. Global repayment values are based on the routine costs associated with the medically accepted standard of care for the treatment and management of each specified injury category.
Medicaid:
The Claims Administrator will affirmatively verify whether claimants in the program are (or have been) entitled to Medicaid benefits in their current state of residence and any other state the Class Member identifies in Section IX of the Proof of Claim Form. If the Class Member is entitled, Medicaid will submit claims. The Claims Administrator will then audit those claims to determine the lien amount owed by the Class Member. The Claims Administrator audits each individual’s claims to ensure that the agencies are compensated only for injury related medical care. The Claims Administrator also presents the state Medicaid agencies with a standard protocol agreement. The protocol proposes that Medicaid’s recovery claim is “capped” at a certain percentage of a claimant’s gross settlement award. In past programs, most caps are 20% to 30%.
Class Members cannot dispute these lien amounts. Under Section XXIX.F, the Claims Administrator shall identify and then satisfy any liens of governmental payors before the Claims Administrator is authorized to make payment to the Class Member. Once these liens are resolved, we make payment to the agencies prior to disbursing the remaining funds to you. You will be notified of the amount of the liens on the Explanation of Payment that accompanies the payment of your remaining settlement funds.
TRICARE, Veterans Administration and Indian Health Services:
Class Members are required to inform the Claims Administrator if they have been entitled to TRICARE, Veterans Administration, or Indian Health Services health care or prescription drug benefits at any time since April 20, 2010 in Section IX.C of the Proof of Claim Form.
If you are receiving A1 compensation and indicated you were entitled to any of these benefits, the Claims Administrator will first ask you to provide additional information via declaration (if pro se) or attorney certification (if represented) executed under penalty of perjury as to whether or not you (or your client) actually received treatment. If you were entitled to any of these benefits, and are receiving compensation greater than A1, the Claims Administrator will send you an authorization packet for you to complete and sign. Upon receipt of the signed authorization packet, the Claims Administrator will contact the agency to request claims and determine whether there is a lien against your settlement funds. As Indian Health Services, Tricare and Veterans Administration are government payor, Class Members cannot dispute these lien amounts under the MSA. Once these liens are resolved, we make payment to the agency prior to disbursing the remaining funds to you. You will be notified of the amount of the liens on the Explanation of Payment that accompanies the payment of your remaining settlement funds.
Private Health Insurance and Medicare Parts C and D:
In Section IX.D of the Proof of Claim Form, Class Members are required to inform the Claims Administrator if they were entitled to receive, at any time since April 20, 2010, medical items, services, and/or prescription drugs from any type of person or entity not previously listed in Section IX of the Proof of Claim Form (ex. private health insurance). If you were entitled to any of these benefits, the Claims Administrator will send you an authorization packet for you to complete and sign. Upon receipt of the signed authorization packet, the Claims Administrator will contact the private health insurer to determine whether there is a lien. Class Members will be provided the opportunity to dispute the lien amounts, if any lien is asserted.
Workers’ Compensation:
In Section IX.E of the Proof of Claim Form, Class Members must notify the Claims Administrator if they made a claim for workers’ compensation benefits for any conditions related to the Class Member’s claims or symptoms at any time after April 20, 2010, and if the Class Member received workers’ compensation benefits. If you did make a claim and received workers’ compensation benefits, the Claims Administrator will contact the employer or state agency that provided the benefits to determine whether there is a lien. Class Members will be provided the opportunity to dispute the lien amounts, if any lien is asserted.
Legal Liens, Child Support, and Other Third Party Liens:
Class Members must inform the Claims Administrator in Section IX.F of the Proof of Claim Form of any liens or rights to be paid out of your compensation that have been or may be asserted by any third party, such as a state child support agency or an attorney who does not currently represent you in your claim for compensation for a Specified Physical Condition. In addition, third parties may contact the Claims Administrator directly to assert a lien against a Class Member’s compensation. If any third party has asserted or may assert a lien or a right to be paid out of your compensation, the Claims Administrator will contact the third party to determine the amount of the lien and whether the lien is valid. Depending on the information provided by the third party, the Class Member may have the opportunity to dispute the validity and/or amount of the lien. For all third party liens, the Claims Administrator will notify you of the amount of the lien that is being asserted, and will notify you whether the lien has been determined by the Claims Administrator to be valid. If you are able to dispute the lien, the Claims Administrator will also notify you in writing of the process to dispute the lien. If the lien is disputed, the Claims Administrator will not pay the lien holder until the dispute is resolved. The final amount of the lien will be reflected on the Explanation of Payment that accompanies the payment of your remaining settlement funds.
10. How are child support liens resolved and paid?
The Claims Administrator identifies child support obligations in the state of Louisiana with a database provided by the state. If the Class Member appears in the database, the Claims Administrator will contact the state of Louisiana to provide a Notice of Income Assignment order. The Class Member will be notified of the lien and receive a copy of the order. If the Class Member is represented, their attorney will be contacted for cost and fee information, which will be paid prior to payment of the child support lien.
For all other liens, state law will determine lien priority, and attorneys will be contacted for fee information as needed.
11. Other than liens, what other complications might hold up payment of my claim, and how are these complications resolved?
In addition to the liens addressed above, the following issues must be resolved prior to payment, as they relate to your claim: audit, Authorized Representatives, bankruptcy, dual representation, financial hardship waivers, and Request for Review. Each of these is addressed below:
Audit:
Under the Medical Settlement Agreement, the Claims Administrator is required to audit a certain percentage of qualified claims. If your claim is selected for audit, the Claims Administrator will notify you in writing of the steps you need to take. You may need to provide additional materials to the Claims Administrator in connection with the audit. The Claims Administrator may select additional qualifying claims for audit if, based on the experience with the claim administration process, the Claims Administrator determines the Proof of Claim form or documents submitted in support may contain intentional misrepresentation, omission, or concealment of material facts.
Authorized Representative:
If you are filing a claim for compensation for a Specified Physical Condition on behalf of a Class Member as that Class Member’s Authorized Representative, the Claims Administrator must verify your authority to act as the Authorized Representative under state law. In addition, pursuant to the Court’s Order on October 17, 2012, the Claims Administrator and the Authorized Representative must file a joint motion with the Court requesting the Court to approve the settlement before the Claims Administrator may pay the claim to the Authorized Representative. The Claims Administrator will contact you to request the required documentation under state law to prove your authority to act as the Authorized Representative and will provide you the joint motion to sign once your authority has been verified.
Bankruptcy:
Class Members are required to notify the Claims Administrator of any bankruptcy filed by the Class Member since April 20, 2010 in Section IX.G of the Proof of Claim Form. If the Class Member has filed bankruptcy within the relevant time periods (since April 20, 2010 for Chapter 7 and since April 20, 2007 for Chapter 13), the bankruptcy trustee may have an interest in your claim. You must provide certain documentation relating to your bankruptcy, and the bankruptcy trustee may need to be notified. The Claims Administrator will provide you a detailed explanation of the documents that are required in order to resolve your bankruptcy complication. Depending on the documentation provided, the Claims Administrator may be required to pay some or all of your claim to the bankruptcy trustee.
Dual Representation:
If you have more than one attorney representing you in connection with your claim for compensation for a Specified Physical Condition, we must resolve this dual representation before we can pay your claim. The Claims Administrator will first contact your attorneys to determine which attorney should receive correspondence and which attorney should receive payment of your claim. If the attorneys do not agree or do not respond to the Claims Administrator within 30 days, the Claims Administrator will contact you for the sole purpose of asking you which attorney should receive correspondence and payment on your claim.
Financial Hardship Waivers:
If a Class Member not represented by an attorney requests the Claims Administrator to obtain medical records in connection with their claim for compensation for a Specified Physical Condition, the Claims Administrator may waive the costs of retrieving those medical records if the Class Member provides evidence of financial hardship. Class Members who would like to request a financial hardship waiver must select the box requesting the waiver in Section VII of the Proof of Claim Form. If a financial hardship waiver is requested, the Claims Administrator will not pay your claim until the Claims Administrator determines your eligibility for a financial hardship waiver. The Claims Administrator may request additional documentation supporting your claim for financial hardship.
Request for Review:
If the Class Member disagrees with any determination or denial issued by the Claims Administrator on the Notice of Determination, the Class Member may file a Request for Review under Section V.M of the Medical Settlement Agreement within 14 days of receipt of the Notice of Determination. If a timely and valid Request for Review is filed, the claim will not be paid until the Request for Review process has been completed and the one-time reviewer has determined whether the Claims Administrator made a clearly erroneous factual determination in connection with your claim for compensation for a Specified Physical Condition. You will be notified of the outcome of this review when it is complete. If the Request for Review is denied, your claim will be paid in accordance with the Notice of Determination. If the Request for Review is approved, the Claims Administrator will reprocess your claim and issue a new Notice of Determination, and your claim will not be paid until the new Notice of Determination has been issued.
12. Are any liens automatically taken out of my award? Will I receive formal notification that a lien is present?
Medicare Parts A and B, Medicaid, Veterans Administration, TRICARE, and Indian Health Services liens are automatically taken out of your award, and other liens subject to a court order or garnishment order may be automatically taken out of your award. However, we will always notify you of the lien and amount.
13. If I do have a lien, how long does it take to process the lien so that I can receive payment?
The amount of time required to process a lien will depend on the type of lien. For Medicare Parts A and B and Medicaid, the Claims Administrator must first identify if there is a lien. This process generally takes up to 90 days to complete. If a lien is identified, the Claims Administrator must then resolve the lien. For most cases, this requires an additional 90 days to complete. However, some cases may require more time to resolve the lien based on certain factors. For other types of liens, the amount of time required to process will depend on whether you choose to dispute the lien and the documentation provided by the lienholder.
14. Can I get my payment liens waived or “forgiven”?
We cannot forgive or waive valid liens without formal authorization (final satisfaction) from the lien holder. Any reduction of payments would need to be the result of negotiations with the lender or lienholder following the dispute process, and would require the submission of a joint agreement.
15. Can I question the validity of a lien?
You may question the validity of certain liens. The Claims Administrator will notify you if you have the right to dispute a lien.
16. Will I be afforded the opportunity to dispute any alleged lien? How would I dispute an alleged lien?
You will not have the opportunity to dispute Medicare Parts A and B, Medicaid, Veterans Administration, TRICARE, and Indian Health Services liens, and some liens that are subject to a court or garnishment order. For other liens, the Claims Administrator will notify you of the lien and include information on the dispute process.
17. What if my lien amount exceeds my award amount?
It is possible for the amount of valid liens to surpass your compensation amount. You will receive a separate notification providing you with a breakdown of any/all liens affecting your compensation. If the amount of the liens asserted exceeds the award amount, the liens will be paid according to state priority laws. Some liens may not be paid or may not be paid in full. Please note that your obligation with respect to these unpaid liens may not be extinguished.
18. Am I required to disclose a lien or subrogation right related to any potential recovery I may receive?
Yes. In Section IX of the Proof of Claim Form, you must disclose any parties, whether governmental or private, who you suspect may hold a lien or subrogation right related to any potential recovery you may receive.
19. As an Authorized Representative, what issues can arise that would hold up payment of a claim?
As an Authorized Representative, certain documentation is required to prove your authority to settle a claim on behalf of the Class Member. This documentation varies by state. The Claims Administrator will notify you of any missing required documentation. We cannot move forward with payment of the claim until the proper documentation is received.
20. What if I have filed for bankruptcy in the past and/or currently have a bankruptcy in process?
If you have filed bankruptcy in the past, the Claims Administrator will examine the date of filing to determine if your settlement may be part of the bankruptcy estate. If your bankruptcy is currently pending, or falls within the relevant dates, the Claims Administrator will notify you of the documentation required to be submitted before the claim can be paid.
21. Workers’ Compensation – why would it apply when it has nothing to do with my medical settlement claim?
If you filed a Worker’s Compensation claim for the Specified Physical Condition you are receiving settlement funds for, you may be required to reimburse Worker’s Compensation for amounts paid for that same condition.
22. What if I do not claim a lien, I receive compensation, and then a lien holder wants to later collect on my payment?
If you do not notify the Claims Administrator of a lien and receive compensation, the lien holder could initiate any collection proceedings allowed under the relevant state law against you.
Attorney Lien Issues
23. What paperwork needs to be completed to file an attorney lien?
The Claims Administrator will pay all funds owed to the Class Member to the attorney representing the Class Member. Therefore, the attorney representing the Class Member in connection with the claim for compensation for a Specified Physical Condition does not need to file an attorney lien with the Claims Administrator, except in certain situations. If a lien must be asserted by the current attorney, the Claims Administrator will notify the attorney in advance.
Otherwise, an attorney lien only arises if a lien is asserted by an attorney other than the attorney currently representing the Class Member on the Class Member’s claim for compensation for a Specified Physical Condition. In order to file an attorney lien, an attorney must notify the Claims Administrator of the lien amount and provide proof of representation. The Class Member will be provided an opportunity to dispute the lien.
24. Does the attorney’s lien take precedence over all other liens? How are the attorney fee liens going to be protected in light of all other liens, including government liens?
Priority of liens is a state law issue, and the priority of the attorney’s lien will be determined by the laws of the relevant state. Medicare allows a certain amount of attorneys’ fees and expenses to be paid prior to Medicare. In this case there is a Global resolution, and a percentage of these fees have already been considered in determining the Medicare reimbursement amounts for claimants.
25. Would an attorney claiming entitlement to reimbursement of attorney’s fees against my claim hold up my payment? Will the claim be put on hold until the dispute is resolved?
Yes, a lien complication will be set on the award, and you will be notified and given an opportunity to respond. If you choose to dispute the lien, that portion of the payment will be held until the dispute is resolved.
Payments to Attorneys and Dual Representation Issues
26. Where does my money go when I’m represented? Will I receive it directly, or do I have to get it from my attorney?
If you are represented by an attorney, your settlement funds will be sent to your attorney, who will then disburse the funds to you after deducting the fees and expenses you agreed to pay to your attorney.
27. Can a payment be held due to dual representation? How can this issue be resolved?
Payment will be held until a dual representation conflict is resolved. The Claims Administrator will contact the attorneys to resolve the issue and request the information necessary to resolve the complication. If the attorneys cannot resolve the issue, you will be sent a form allowing you to designate the attorney that should receive correspondence and payment. Once you or your attorneys submit documentation that clears the complication, and any terminating attorney is provided the opportunity to assert a lien, payment can be made.
28. How is the cap on attorney’s fees handled among more than one attorney?
Attorney fees are capped by court order at 25%, and that 25% must be split among co-counsel if a co-counsel relationship exists. The Court’s order can be viewed at http://www.laed.uscourts.gov/OilSpill/Orders/06152012Order(FeeCap).pdf. If there is a dispute, the attorneys will have to come to an agreement. The Claims Administrator will not step in to resolve the disagreement.
Healthcare Lien Issues
29. I received documents in the mail regarding TRICARE liens. How do I fill out these documents? How do I fill out that information if I do not have the information?
Fill out these documents as you would the Proof of Claim Form, entering the appropriate information in each field. If you do not have the information, please contact your provider.
30. What does “sponsor” mean on the TRICARE lien documents?
The sponsor is the same as the patient if the patient is the military member. The sponsor is always the member or Veteran.
31. I received documents in the mail regarding Indian Health Services liens. How do I fill out these documents? How do I fill out that information if I do not have the information?
Fill out these documents as you would the Proof of Claim Form, entering the appropriate information in each field. If you do not have the information, please contact your provider.
32. I received documents in the mail regarding Veterans Administration liens. How do I fill out these documents? How do I fill out that information if I do not have the information?
Fill out these documents as you would the Proof of Claim Form, entering the appropriate information in each field. If you do not have the information, please contact your provider.
33. I received documents in the mail regarding private healthcare liens. How do I fill out these documents? How do I fill out that information if I do not have the information?
Fill out these documents as you would the Proof of Claim Form, entering the appropriate information in each field. If you do not have the information, please contact your provider.
34. Can you explain Medicare/Medicaid liens? Can I dispute them?
If Medicare or Medicaid paid for medical treatment for your Specified Physical Condition those entities have a right to reimbursement from your settlement proceeds. These liens cannot be disputed.
35. What if I only receive A1 compensation – will a lien still be taken out by Medicaid?
All states in the Gulf region, except Texas, have agreed to waive Medicaid liens for claimants who received A1 compensation.
36. Can I contact Medicare/my insurer to speed up the lien process?
The Claims Administrator is already working with Medicare and your insurer in the most efficient manner. Contacting your insurer regarding a lien may result in multiple recovery attempts and delay processing time.
V. FREQUENTLY ASKED QUESTIONS REGARDING LATER-MANIFESTED PHYSICAL CONDITIONS AND NOTICES OF INTENT TO SUE
SUBMITTING A CLAIM FOR A LATER-MANIFESTED PHYSICAL CONDITION
1. How do I submit a claim for a Later-Manifested Physical Condition?
You must mail a Notice of Intent to Sue and all of the required supporting documentation to the Claims Administrator. You can find a copy of the Notice of Intent to Sue on the Claims Administrator’s website at www.deepwaterhorizonmedicalsettlement.com, or you can contact the Claims Administrator at 1-877-545-5111 or info@deepwaterhorizonmedicalsettlement.com to request a copy.
Effective Monday, February 26, 2018, your Notice of Intent to Sue and all of the required supporting documentation should be mailed to:
Deepwater Horizon Claims Administrator
600 Vine Street, Suite 2006
Cincinnati, Ohio 45202
2.How long do I have to submit a Notice of Intent to Sue?
You must mail your Notice of Intent to Sue and supporting documentation to the Claims Administrator either (a) within four years after the date of first diagnosis of the Later-Manifested Physical Condition you are claiming in the Notice of Intent to Sue or (b) by February 12, 2018, whichever is later.
The following examples illustrate how this rule works:
a. Example 1: John Doe was first diagnosed with Condition A on November 1, 2012. John Doe’s deadline to file a Notice of Intent to Sue for this condition is February 12, 2018.
b.Example 2: John Doe was first diagnosed with Condition A on November 1, 2014. John Doe’s deadline to file a Notice of Intent to Sue for this condition is November 1, 2018.
3.What happens if I do not submit a Notice of Intent to Sue by the deadline?
Under Section XVI.B.1 of the Medical Settlement Agreement, any and all claims of a Medical Benefits Settlement Class Member relating to, arising from, or as a result of a Later-Manifested Physical Condition will be released and forever discharged as to the Released Parties if the Class Member fails to properly submit a Notice of Intent to Sue for that Later-Manifested Physical Condition by the deadline described in FAQ Number 2.
4.What information and documentation do I have to submit with the Notice of Intent to Sue?
You must complete the Notice of Intent to Sue in its entirety. You must also provide the documentation identified in the Notice of Intent to Sue. Among other things, every claimant must submit the following documentation:
a. either (i) a completed Physician’s Certification Form, which is attached to the Notice of Intent to Sue as Appendix D, or (ii) medical records containing the diagnosis and date of first diagnosis of the Later-Manifested Physical Condition you are claiming; and
b. a completed HIPAA Authorization for Disclosure of Medical Records and Disclosure of Protected Health Information Pursuant to 45 C.F.R. § 164.508, which is attached to the Notice of Intent to Sue as Exhibit B.
In addition, depending on your specific circumstances, you may also need to submit the following documentation:
a. documents establishing that you are a Medical Benefits Settlement Class Member, as described in more detail in Sections IV and V of the Notice of Intent to Sue;
b. an Authorized Representative Form, which is attached to the Notice of Intent to Sue as Appendix A; and
c. an Authorization and Release of Employee/Personnel Records (for Clean-Up Workers Without Sufficient Information in the Database or Documentation Provided by BP to the Claims Administrator), which is attached to the Notice of Intent to Sue as Appendix C.
You should carefully review the directions in the Notice of Intent to Sue and its appendices to see which documents you need to submit with your Notice of Intent to Sue. If you have questions, you can contact the Claims Administrator at 1-877-545-5111 or info@deepwaterhorizonmedicalsettlement.com.
5.What will happen if I submit a Notice of Intent to Sue on or before the deadline but without all of the required information and/or supporting documentation?
You will receive a Notice of Defect from the Claims Administrator. The Notice of Defect will identify the missing or incomplete information and/or documentation for each Later-Manifested Physical Condition you are claiming and will describe the action you need to take to cure those Defects.
NOTICE OF DEFECT PROCESS – GENERALLY
6.How long do I have to cure the Defects identified in a Notice of Defect?
In general, you must submit all of the information and/or documentation identified in the Notice of Defect by the deadline for filing a Notice of Intent to Sue for your Later-Manifested Physical Condition. That deadline is described in FAQ Number 2, above. However, if you would have less than 120 days before the filing deadline for a given Later-Manifested Physical Condition at the time the Claims Administrator mails the first Notice of Defect for that Later-Manifested Physical Condition, then you would have 120 days from the date of the first Notice of Defect for that Later-Manifested Physical Condition to submit the required information and documentation to cure all Defects.
The following examples illustrate how these rules work:
a. Example 1: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe’s deadline to file a Notice of Intent to Sue for that condition is November 1, 2018. John Doe files a Notice of Intent to Sue for this condition on March 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue, determines it is missing required information, and issues a Notice of Defect to John Doe on April 1, 2018. Because John Doe has 120 days or more before the deadline for submitting a Notice of Intent to Sue for his Condition A claim at the time the Claims Administrator issued the Notice of Defect, John Doe has until November 1, 2018 — the deadline for filing his Notice of Intent to Sue — to submit information to cure all of the Defects identified in the Notice of Defect.
b.Example 2: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe’s deadline to file a Notice of Intent to Sue for that condition is November 1, 2018. John Doe files a Notice of Intent to Sue for this condition on September 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue, determines it is missing required information, and issues a Notice of Defect to John Doe on October 1, 2018. Because John Doe has less than 120 days before the deadline for submitting a Notice of Intent to Sue for his Condition A claim at the time the Claims Administrator issued the Notice of Defect, John Doe would have until January 29, 2019 — i.e., 120 days from the date the Claims Administrator issued the Notice of Defect on October 1, 2018 — to cure all of the Defects identified in the Notice of Defect.
7.Can I get an extension of time to cure the Defects in my Notice of Intent to Sue?
No. You must submit all of the required information and/or documentation to cure all of the Defects by the submission deadline. See FAQs 6, 8, 9, 10 and 11.
8.Will I receive more than one Notice of Defect per Notice of Intent to Sue and/or Later-Manifested Physical Condition claim?
It is possible. If the information and documentation you submit in response to a Notice of Defect does not cure all of the Defects in your claim for a Later-Manifested Physical Condition, and if there is enough time for the Claims Administrator to review the materials you submitted in response to the Notice of Defect and issue another Notice of Defect before your deadline to cure expires, then the Claims Administrator will issue another Notice of Defect. There is no guarantee, however, that you will receive more than one Notice of Defect per Later-Manifested Physical Condition claim, so you should be sure to submit all of the required information and documentation to cure all Defects when you respond to the first Notice of Defect.
9.Do I get additional time to cure the Defects identified in a second or subsequent Notice of Defect?
No. The deadline by which you must respond to a second or subsequent Notice of Defect is the same as the deadline to respond to the first Notice of Defect. Consequently, if you had 120 days or more before the filing deadline for a given Later-Manifested Physical Condition at the time the Claims Administrator sent the first Notice of Defect for that Later-Manifested Physical Condition, then your deadline for responding to the second or subsequent Notice of Defect is the deadline for filing a Notice of Intent to Sue for that Later-Manifested Physical Condition, as described in FAQ Number 2, above. Conversely, if you had less than 120 days before the filing deadline for a given Later-Manifested Physical Condition at the time the Claims Administrator sent your first Notice of Defect for that Later-Manifested Physical Condition, then your deadline for responding to the second or subsequent Notice of Defect is the same 120 days from the date the Claims Administrator mailed the first Notice of Defect for that Later-Manifested Physical Condition.
The following example illustrates how this rule works:
Example: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe’s deadline to file a Notice of Intent to Sue for that condition is November 1, 2018. John Doe files a Notice of Intent to Sue for this condition on September 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue, determines it is missing required information, and issues a Notice of Defect to John Doe on October 1, 2018. Because John Doe has less than 120 days before the deadline for submitting a Notice of Intent to Sue for his Condition A claim at the time the Claims Administrator issued the Notice of Defect, John Doe would have until January 29, 2019 — i.e., 120 days from the date the Claims Administrator issued the Notice of Defect on October 1, 2018 — to cure the Defects identified in the Notice of Defect.
John Doe submits information in response to the Notice of Defect on October 15, 2018. The Claims Administrator reviews the information, determines that it does not cure all of the Defects identified in the first Notice of Defect, and issues a second Notice of Defect on November 15, 2018. John Doe’s deadline to cure the Defects in his Notice of Intent to Sue for his Condition A claim is still January 29, 2019.
10. What will happen if I do not cure all of the Defects in my claim for a Later-Manifested Physical Condition by the applicable deadline?
If you do not cure all of the Defects in your claim for a Later-Manifested Physical Condition by the applicable deadline, then you will not be able to pursue your claim for that Later-Manifested Physical Condition against BP, and under Section XVI.B.1 of the Medical Settlement Agreement, you will have released and forever discharged any and all claims relating to, arising from, or as a result of that Later-Manifested Physical Condition as to the Released Parties.
11. What will happen if I submit a complete Notice of Intent to Sue, or cure all of the Defects in my Notice of Intent to Sue, for a Later-Manifested Physical Condition by the applicable deadline?
Within 10 days of determining that you have submitted a complete and timely Notice of Intent to Sue for a Later-Manifested Physical Condition, the Claims Administrator will submit your Notice of Intent to Sue for that Later-Manifested Physical Condition to BP. The BP Defendant(s) named in your Notice of Intent to Sue will then decide whether to mediate your claim.
NOTICE OF DEFECT PROCESS – MULTIPLE LATER-MANIFESTED PHYSICAL CONDITIONS LISTED IN A SINGLE NOTICE OF INTENT TO SUE
12. May I list multiple Later-Manifested Physical Conditions in a single Notice of Intent to Sue?
Yes, you may list multiple Later-Manifested Physical Conditions in a single Notice of Intent to Sue. There are some considerations you should keep in mind, however. First, in Section VI.A.2 of the Notice of Intent to Sue, you must provide the date of first diagnosis for each of the Later-Manifested Physical Conditions you are claiming. Second, in Section VI.B of the Notice of Intent to Sue, you must provide a Physician’s Certification Form or supporting medical records for each of the Later-Manifested Physical Conditions you are claiming. Third, the deadline by which you must submit the Notice of Intent to Sue may be different for each of the Later-Manifested Physical Conditions you are claiming. Fourth, the deadline by which you must cure any Defects in the Notice of Intent to Sue may be different for each of the Later-Manifested Physical Conditions you are claiming. Fifth, the Claims Administrator will not be able to submit the Notice of Intent to Sue to BP for a mediation decision until it determines either that (1) you have timely provided all of the required information and documentation for each of the Later-Manifested Physical Conditions listed in the Notice of Intent to Sue or (2) you have timely provided all of the required information and documentation for one or more of the Later-Manifested Physical Conditions listed in the Notice of Intent to Sue, and the deadline to provide the required information and documentation for the remaining Later-Manifested Physical Conditions has expired, as explained in more detail in FAQ Number 14, below.
13. If I list multiple Later-Manifested Physical Conditions in a single Notice of Intent to Sue, what is my deadline for filing the Notice of Intent to Sue?
Your deadline to file a Notice of Intent to Sue is specific to each Later-Manifested Physical Condition you are claiming. As explained in FAQ Number 2, above, your deadline to file a Notice of Intent to Sue for a Later-Manifested Physical Condition is either four years after the date you were first diagnosed with the Later-Manifested Physical Condition or February 12, 2018, whichever is later. Consequently, if you list multiple Later-Manifested Physical Conditions in a single Notice of Intent to Sue, your deadline for filing the Notice of Intent to Sue may vary for each condition listed in it.
The following examples illustrate how this rule works:
Example 1: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on October 1, 2018. The Notice of Intent to Sue is timely for both claims.
Example 2: Same facts as in Example 1 except that John Doe files the Notice of Intent to Sue on December 1, 2018. The Notice of Intent to Sue is untimely as to his claim for Condition A but timely as to his claim for Condition B.
14. If I list multiple Later-Manifested Physical Conditions in a single Notice of Intent to Sue and I get a Notice of Defect because I did not provide all of the required information and/or documentation for those conditions, how long do I have to respond to the Notice of Defect?
Your deadline to provide the missing information and/or documentation identified in the Notice of Defect is specific to each Later-Manifested Physical Condition you are claiming. As explained in FAQ Number 6, above, you generally must submit all of the information and/or documentation identified in the Notice of Defect by the deadline for filing a Notice of Intent to Sue for your Later-Manifested Physical Condition. However, if you would have less than 120 days before the filing deadline for a given Later-Manifested Physical Condition at the time the Claims Administrator mails the first Notice of Defect for that Later-Manifested Physical Condition, then you would have 120 days from the date of the first Notice of Defect for that Later-Manifested Physical Condition to submit the required information and documentation. Because your deadline to cure is specific to each Later-Manifested Physical Condition listed in the Notice of Defect, it is possible that you will have a different deadline to respond to the Notice of Defect for each Later-Manifested Physical Condition listed in the Notice of Defect.
The following examples illustrate how these rules work:
Example 1: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on March 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue, determines that John Doe did not provide medical records or a Physician Certification Form for either condition, and issues a Notice of Defect on April 1, 2018.
To determine the deadline for responding to the Notice of Defect, you need to look at each Later-Manifested Physical Condition individually. First, consider John Doe’s claim for Condition A. Because John Doe has 120 days or more before the deadline for submitting a Notice of Intent to Sue for Condition B at the time the Claims Administrator issued the Notice of Defect, his deadline to cure the Defect relating to his claim for Condition A is the deadline for filing a Notice of Intent to Sue for that condition. Therefore, John Doe has until November 1, 2018 to cure the Defect relating to his claim for Condition A.
Next, consider John Doe’s claim for Condition B. Because John Doe has 120 days or more before the deadline for submitting a Notice of Intent to Sue for Condition B at the time the Claims Administrator issued the Notice of Defect, his deadline to cure the Defect relating to his claim for Condition B is the deadline for filing a Notice of Intent to Sue for that condition. Therefore, John Doe has until February 1, 2019 to cure the Defect relating to his claim for Condition B.
Example 2: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on August 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue, determines that John Doe did not provide medical records or a Physician Certification Form for either condition, and issues a Notice of Defect on September 1, 2018.
To determine the deadline for responding to the Notice of Defect, you need to look at each Later-Manifested Physical Condition individually. First, consider John Doe’s claim for Condition A. At the time the Claims Administrator issues the Notice of Defect, John Doe has less than 120 days before his deadline to file a Notice of Intent to Sue for Condition A. Therefore, John Doe has 120 days from the date of the Notice of Defect to cure the Defect relating to his claim for Condition A. As mentioned above, the Notice of Defect was dated September 1, 2018. The date that is 120 days after September 1, 2018 is December 30, 2018. Therefore, John Doe has until December 30, 2018 to cure the Defect in his claim for Condition A.
Next, consider John Doe’s claim for Condition B. At the time the Claims Administrator issued the Notice of Defect, John Doe had 120 days or more before his deadline to file a Notice of Intent to Sue for Condition B. Therefore, John Doe has until the deadline for filing a Notice of Intent to Sue for Condition B to cure the Defect relating to his claim for Condition B. As mentioned above, John Doe’s deadline for filing a Notice of Intent to Sue for Condition B is February 1, 2019. Therefore, John Doe has until February 1, 2019 to cure the Defect in his claim for Condition B.
* * *
In sum, although John Doe received one Notice of Defect, his deadline to cure the Defect relating to his Condition A claim is different than his deadline to cure the Defect relating to his Condition B claim. Because your deadline to cure Defects can vary from Later-Manifested Physical Condition to Later-Manifested Physical Condition, it is important that you carefully calculate the cure deadline for each Later-Manifested Physical Condition listed in the Notice of Defect.
15. Let’s say I list multiple Later-Manifested Physical Conditions in a single Notice of Intent to Sue. I then receive a Notice of Defect that identifies Defects relating to each of those conditions, and I cure the Defects for some but not all of the conditions. Will I get another Notice of Defect for the Defects I did not cure?
It is possible. If the information and documentation you submit in response to a Notice of Defect does not cure all of the Defects in your claim for a given Later-Manifested Physical Condition, and if there is enough time for the Claims Administrator to review the materials you submitted in response to the Notice of Defect and issue another Notice of Defect before your deadline to cure for that Later-Manifested Physical Condition expires, then the Claims Administrator will issue another Notice of Defect. There is no guarantee, however, that you will receive more than one Notice of Defect per Later-Manifested Physical Condition claim, so you should be sure to submit all of the required information and documentation to cure all Defects when you respond to the first Notice of Defect.
The following examples illustrate how these rules work:
Example 1: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on March 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue, determines that John Doe did not provide medical records or a Physician Certification Form for either condition, and issues a Notice of Defect on April 1, 2018. John Doe’s deadline to cure the Defect related to his claim for Condition A is November 1, 2018, and his deadline to cure the Defect related to his claim for Condition B is February 1, 2019. (See FAQ Numbers 6 and 14 for information on how to calculate his cure deadline.)
John Doe submits a response to the Notice of Defect on May 1, 2018. In his submission, John Doe includes a Physician Certification Form for his Condition B claim, but he forgets to include a Physician Certification Form or medical records for his Condition A claim. The Claims Administrator reviews the submission on June 1, 2018. It determines that the Physician Certification Form cures the Defect for the Condition B claim but notes that John Doe failed to cure the Defect in his Condition A claim. Because John Doe still has five months left before his deadline to cure the Defect in his Condition A claim expires, there is still a sufficient amount of time for the Claims Administrator to issue another Notice of Defect and for John Doe to respond to it. The Claims Administrator therefore would issue another Notice of Defect to John Doe instructing him to provide a Physician Certification Form or medical records for his Condition A claim.
Example 2: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on March 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue, determines that John Doe did not provide medical records or a Physician Certification Form for either condition, and issues a Notice of Defect on April 1, 2018. John Doe’s deadline to cure the Defect related to his claim for Condition A is November 1, 2018, and his deadline to cure his claim for Condition B is February 1, 2019. (See FAQ Numbers 6 and 14 for information on how to calculate his cure deadline.)
John Doe submits a response to the Notice of Defect on September 15, 2018. In his submission, John Doe includes a Physician Certification Form for his Condition B claim, but he forgets to include a Physician Certification Form or medical records for his Condition A claim. The Claims Administrator reviews the submission on October 15, 2018. It determines that the Physician Certification Form cures the Defect for the Condition B claim, but notes that John Doe failed to cure the Defect in his Condition A claim. Because John Doe only has two weeks left before his deadline to cure the Defect in his Condition A claim expires, there is not a sufficient amount of time for the Claims Administrator to issue another Notice of Defect and for John Doe to respond to it (taking into account mailing times, the number of other claims the Claims Administrator is processing, and other variables). The Claims Administrator therefore would not issue another Notice of Defect to John Doe. However, if John Doe recognizes on his own that his prior response to the Notice of Defect did not cure the Defect in his claim for Condition A, he would still have until November 1, 2018 to submit a Physician Certification Form or medical records to cure the Defect in that claim.
16. Do I get additional time to cure the Defects identified in a second or subsequent Notice of Defect?
No. The deadline by which you must respond to a second or subsequent Notice of Defect for a given Later-Manifested Physical Condition is the same as the deadline for responding to the first Notice of Defect for that Later-Manifested Physical Condition. See FAQ Numbers 10, 14, and 15 for additional information.
17. If I list multiple Later-Manifested Physical Conditions in a single Notice of Intent to Sue, when will the Claims Administrator submit the Notice of Intent to Sue to BP for a mediation decision?
The Claims Administrator will submit a Notice of Intent to Sue to BP for a mediation decision once it has determined either that (1) you have provided all of the required information and documentation for each of the Later-Manifested Physical Conditions listed in the Notice of Intent to Sue by the applicable deadline(s) for those conditions or (2) you have provided all of the required information and documentation for one or more of the Later-Manifested Physical Conditions listed in the Notice of Intent to Sue, and the deadlines to provide the required information and documentation for the remaining Later-Manifested Physical Conditions have expired.
The following examples illustrate how these rules work:
Example 1: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on March 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue on April 1, 2018 and determines that John Doe filed the Notice of Intent to Sue before the applicable deadlines and provided all of the required information and documentation. Within 10 days of making that determination, the Claims Administrator will submit the Notice of Intent to Sue for both the Condition A claim and the Condition B claim to BP for a mediation decision and will send a notice to John Doe informing him of the same.
Example 2: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on March 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue and determines that while John Doe provided all of the required information and documentation for his Condition A claim by the applicable deadline of November 1, 2018, he did not provide a Physician Certification Form or medical records for his Condition B claim. The Claims Administrator issues a Notice of Defect for the missing documentation on April 1, 2018. John Doe’s deadline to respond to the Notice of Defect is February 1, 2019. John Doe submits his response to the Notice of Defect on November 1, 2018. The Claims Administrator reviews his submission on December 1, 2018 and determines that John Doe has provided a Physician Certification Form by the February 1, 2019 deadline, thus curing the Defect and rendering his claim compliant. Within 10 days of making that determination, the Claims Administrator will submit the Notice of Intent to Sue for both the Condition A claim and the Condition B claim to BP for a mediation decision and will send a notice to John Doe informing him of the same.
Example 3: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on March 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue and determines that while John Doe provided all of the required information and documentation for his Condition A claim by the applicable deadline of November 1, 2018, he did not provide a Physician Certification Form or medical records for his Condition B claim. The Claims Administrator issues a Notice of Defect for the missing documentation on April 1, 2018. John Doe’s deadline to respond to the Notice of Defect is February 1, 2019. John Doe fails to respond to the Notice of Defect by the February 1, 2019 deadline. Within 10 days of determining that John Doe failed to cure the Defect by the deadline, the Claims Administrator will send the Notice of Intent to Sue for the Condition A claim to BP for a mediation decision. The Claims Administrator will also send a notice to John Doe to inform him that his claim for Condition A was sent to BP for a mediation decision but that his claim for Condition B was denied.
18. Let’s say I list multiple Later-Manifested Physical Conditions in a single Notice of Intent to Sue. I later receive a Notice of Defect that shows that some of the Later-Manifested Physical Conditions are valid, but the others suffer from Defects that I have to cure. Is there any way that I can get the Claims Administrator to submit the Notice of Intent to Sue to BP for a mediation decision on the valid Later-Manifested Physical Conditions before I cure the Defects in my claims for the other Later-Manifested Physical Conditions?
In this circumstance, the only way the Claims Administrator would submit the Notice of Intent to Sue to BP for a mediation decision on the valid conditions would be if you were to withdraw your claims for the defective Later-Manifested Physical Conditions. Before deciding whether to withdraw the defective conditions, however, you should carefully consider the consequences. In order to pursue your claims for those conditions again, you would need to file a new Notice of Intent to Sue listing those conditions. If you failed to file the Notice of Intent to Sue by the applicable deadline for each Later-Manifested Physical Condition, then you would be unable to pursue your claim for that condition, even though it would have been timely based on the filing date of the first Notice of Intent to Sue if you had not withdrawn it. You do not get an extension of time in which to re-file your claim for the withdrawn condition.
The following example illustrates how this rule works:
Example: John Doe is first diagnosed with Condition A on November 1, 2014. John Doe is first diagnosed with Condition B on February 1, 2015. John Doe’s deadline to file a Notice of Intent to Sue for Condition A is November 1, 2018. His deadline to file a Notice of Intent to Sue for Condition B is February 1, 2019. John Doe files a Notice of Intent to Sue listing both Condition A and Condition B on March 1, 2018. The Claims Administrator reviews the Notice of Intent to Sue and determines that while John Doe provided all of the required information and documentation for his Condition A claim, he did not provide a Physician Certification Form or medical records for his Condition B claim. The Claims Administrator issues a Notice of Defect for the missing documentation on April 1, 2018. In response to the Notice of Defect, John Doe submits a Notice of Withdrawal for his Condition B claim. (See FAQ Number 51 for information on how to withdraw a claim.) The Claims Administrator reviews the Notice of Withdrawal, and within 10 days of processing it, submits the remaining claim for Condition A to BP for a mediation decision.
John Doe submits a new Notice of Intent to Sue for his Condition B claim on February 2, 2019 and includes a complete Physician Certification Form for that condition. As mentioned above, his deadline to submit all of the required information and documentation for his Condition B claim was February 1, 2019. Therefore, the Claims Administrator would deny John Doe’s claim for Condition B, and he would no longer be able to pursue his claim for that condition.
NOTICES OF DENIAL
19. I received a notice that my claim for a particular Later-Manifested Physical Condition was denied. What does that mean?
This notice informs you that your claim for a given Later-Manifested Physical Condition has been denied. The basis for the denial is explained in the notice. In general, the Claims Administrator will deny a claim for a Later-Manifested Physical Condition if it determines one or more of the following:
1. you failed to prove that you were a Medical Benefits Settlement Class Member;
2. the information you provided in your Notice of Intent to Sue shows that you are excluded from the Medical Benefits Settlement Class;
3. you failed to provide all of the information and/or documentation that you must provide in and with your Notice of Intent to Sue and associated Notice(s) of Defect for that Later-Manifested Physical Condition by the deadline for providing such information and/or documentation;
4. the date you were first diagnosed with the medical condition listed in your Notice of Intent to Sue is on or before April 16, 2012;
5. you previously filed a claim for benefits under a workers’ compensation law or the Longshore and Harbor Workers’ Compensation Act for the Later-Manifested Physical Condition you are claiming; or
6. the Claims Administrator has previously issued a notice of determination concerning the Later-Manifested Physical Condition you are claiming.
20. May I challenge a denial of my claim for a Later-Manifested Physical Condition?
Yes. If the Claims Administrator denied your claim for one of the following reasons, you may contest the determination by filing a challenge with the Court:
1.you failed to prove you were a Medical Benefits Settlement Class Member; or
2.the information you provided in your Notice of Intent to Sue shows that you are excluded from the Medical Benefits Settlement Class.
21. On what basis would I be excluded from the Medical Benefits Settlement Class?
The following individuals are excluded from the Medical Benefits Settlement Class:
1.individuals who opted out of the Medical Benefits Settlement Class;
2.individuals who were employed by a BP Entity between April 20, 2010 and April 16, 2012;
3.individuals who served as a sitting judge on the United States District Court for the Eastern District of Louisiana or who served as a law clerk of that court between April 20, 2010 and April 16, 2012; and
4.individuals who previously released claims against BP relating to any illness or injuries allegedly suffered as a result of exposure to oil, other hydrocarbons, or other substances released from the MC252 Well and/or the Deepwater Horizon and its appurtenances, and/or dispersants and/or decontaminants used in connection with the Response Activities (including those individuals who provided a final release to the Gulf Coast Claims Facility in exchange for payment for such illnesses or injuries).
22. How do I challenge the Claims Administrator’s determination that I am not a Medical Benefits Settlement Class Member?
You must submit a Class Membership Challenge Form to the Claims Administrator within 60 days after you receive the notice informing you of the Claims Administrator’s determination that you are not a class member. You can download a copy of the Class Membership Challenge Form from the Claims Administrator’s website at https://deepwaterhorizonmedicalsettlement.com.
23. How do I challenge the Claims Administrator’s determination that I am a Medical Benefits Settlement Class Member but that I can’t pursue my claim for some other reason?
The Medical Settlement Agreement does not provide a procedure for a Class Member to challenge the Claims Administrator's determination that he is a Class Member but that his Later-Manifested Physical Condition claim has to be denied for some other reason, and we cannot advise you on it. The Court retains jurisdiction over disputes or controversies arising out of or related to the interpretation, implementation, administration, and enforcement of the Medical Settlement Agreement. Therefore, you could seek clarification of this question from the Court if you so choose. Any request for clarification must be made through a motion filed with the Court. If you are not represented, you may wish to consult with an attorney.
24. If the Claims Administrator denies my claim for a Later-Manifested Physical Condition because it determines that I failed to prove that I was a Medical Benefits Settlement Class Member, may I file another Notice of Intent to Sue for that same Later-Manifested Physical Condition?
There would be no point in submitting a second Notice of Intent to Sue for the same Later-Manifested Physical Condition. The Claims Administrator will only deny a claim for a Later-Manifested Physical Condition on this basis if either (1) you are past your deadline for curing Defects in the information that you provided in your Notice of Intent to Sue to prove your status as a Medical Benefits Settlement Class Member, or (2) the information you disclosed in your Notice of Intent to Sue demonstrates that you are excluded from the Medical Benefits Settlement Class. In either case, the information you would provide in the second Notice of Intent to Sue would not change the Claims Administrator’s determination. In the first circumstance, the information would be untimely. In the second, it would contradict the information you previously submitted.
If you disagree with the Claims Administrator’s determination that you are not a Medical Benefits Settlement Class Member, then you may file a challenge with the Court to contest that determination within 60 days of receiving the Notice of Denial. See FAQ Number 20 for additional information. If the Court affirms the denial, or if you fail to challenge the denial by the deadline, then you will have no further opportunity to pursue your claim for that Later-Manifested Physical Condition.
25. If the Claims Administrator denies my claim for a Later-Manifested Physical Condition because it determines that I failed to prove that I am a Medical Benefits Settlement Class Member, may I file another Notice of Intent to Sue for a different Later-Manifested Physical Condition?
If the Claims Administrator denied your claim because the information you provided in the Notice of Intent to Sue for the first Later-Manifested Physical Condition was simply insufficient to prove that you are a Medical Benefits Settlement Class Member, then you may file a separate Notice of Intent to Sue for the second Later-Manifested Physical Condition and may attempt again to prove that you are a Medical Benefits Settlement Class Member.
26. If the Claims Administrator denies my claim for a Later-Manifested Physical Condition because the information I provided in my Notice of Intent to Sue shows that I am excluded from the Medical Benefits Settlement Class, may I file another Notice of Intent to Sue for a different Later-Manifested Physical Condition?
If the information you provided in a previous Notice of Intent to Sue shows that you are excluded from the Medical Benefits Settlement Class (because, for example, you opted out of the class or because you were employed by a BP Entity between April 20, 2010, and April 16, 2012), the Claims Administrator will automatically deny any later Notice of Intent to Sue that you file, even if it is for a different Later-Manifested Physical Condition than the one you claimed in your previous Notice of Intent to Sue.
27. If the Claims Administrator denies my claim for compensation for a Specified Physical Condition because it determines that I failed to prove that I am a Medical Benefits Settlement Class Member, may I file a Notice of Intent to Sue for a Later-Manifested Physical Condition?
If the Claims Administrator denies your claim for compensation for a Specified Physical Condition because the information you provided in the Proof of Claim Form was simply insufficient to prove that you are a Medical Benefits Settlement Class Member, then you may file a separate Notice of Intent to Sue for your Later-Manifested Physical Condition and may attempt again to prove that you are a Medical Benefits Settlement Class Member.
28. If the Claims Administrator denies my claim for compensation for a Specified Physical Condition because the information I provided in my Proof of Claim Form showed that I am excluded from the Medical Benefits Settlement Class, may I file a Notice of Intent to Sue for a Later-Manifested Physical Condition?
If the information you provided in your Proof of Claim Form showed that you are excluded from the Medical Benefits Settlement Class (because, for example, you opted out of the class or because you were employed by a BP Entity between April 20, 2010, and April 16, 2012), the Claims Administrator will automatically deny any Notice of Intent to Sue that you file.
BP’S DECISION TO MEDIATE OR NOT MEDIATE A COMPLIANT CLAIM
29. How much time does BP have to make a mediation decision after the Claims Administrator submits a compliant Notice of Intent to Sue to BP for its review?
BP has 30 days from the date the Claims Administrator submits a compliant Notice of Intent to Sue to BP to decide whether it wants to mediate the claim. Failure by a BP defendant to timely notify the Claims Administrator whether it chooses to mediate the claim shall be deemed to be a decision by that BP defendant not to mediate.
30. What happens if BP decides it wants to mediate my claim?
Within 10 days of receiving a BP defendant’s notification of its decision to mediate, the Claims Administrator will send you a notice that one or more of the BP defendants that you listed in your Notice of Intent to Sue has exercised the mediation option. In that event, you will not have the right to file a Back-End Litigation Option Lawsuit until the conclusion of the mediation process. See FAQ Numbers 32-43 for additional information on the mediation process.
31. What happens if no BP defendant decides it wants to mediate my claim?
If no BP defendant named in your Notice of Intent to Sue exercises its option to mediate your claim for a given Later-Manifested Physical Condition, the Claims Administrator will notify you of that information. You will then have the right to file a Back-End Litigation Option Lawsuit, but only in accordance with the provisions of Section VIII.G of the Medical Settlement Agreement.
THE MEDIATION PROCESS
32. What happens after the Claims Administrator notifies me that a BP defendant has elected to mediate my claim for a Later-Manifested Physical Condition?
Within 60 days of the Claims Administrator’s notice that one or more BP defendants have elected mediation, you must submit a Mediation Information Form and the applicable authorizations mentioned in it to the Claims Administrator.
33. What happens after I submit my Mediation Information Form and required authorizations to the Claims Administrator?
The Claims Administrator will review your Mediation Information Form to determine whether you submitted it on time and with all of the required information and documentation. One of two things will then occur:
a. if the Claims Administrator determines that the Mediation Information Form is complete and that you have submitted the required authorizations, the Claims Administrator will send the materials to BP within 10 days of making that determination; or
b.if the Claims Administrator determines that the Mediation Information Form is incomplete and/or is missing one of the required authorizations, it will send you a Notice of Defect identifying the missing information and/or documentation.
34. What happens if I don’t submit a Mediation Information Form to the Claims Administrator within 60 days of the Claims Administrator’s notice that a BP defendant has elected mediation?
The Claims Administrator will send you a Notice of Defect identifying the missing Mediation Information Form as a Defect.
35. How long do I have to cure the Defects in my Mediation Information Form?
You have 30 days from the date of the Notice of Defect to submit additional information and/or documentation to cure the Defects in your Mediation Information Form and/or authorizations.
36. Can I get an extension of time to cure the Defects in my Mediation Information Form?
The Claims Administrator cannot grant extensions of time to cure the Defects in your Mediation Information Form. You must submit the additional information and/or documentation to cure those Defects within 30 days of the date of the Notice of Defect.
37. What happens if I don’t cure the Defects in my Mediation Information Form by the deadline?
You will be deemed to have failed to file a timely Notice of Intent to Sue, and your claim for the Later-Manifested Physical Condition in question will be released in accordance with Section XVI.B.1 of the Medical Settlement Agreement.
38. Let’s say that I submit a compliant Notice of Intent to Sue for multiple Later-Manifested and BP decides to mediate all of them. I then submit a Mediation Information Form that provides complete information and documentation for some of the Later-Manifested Physical Conditions but not others, and I fail to cure the Defects in the claims with incomplete information by the deadline. What will happen?
With respect to the Later-Manifested Physical Conditions for which you provided complete information and documentation, you will proceed with the mediation process. With respect to the Later-Manifested Physical Conditions for which you provided incomplete information and/or documentation, you will be deemed to have failed to file a timely Notice of Intent to Sue, and your claims for the Later-Manifested Physical Conditions in question will be released in accordance with Section XVI.B.1 of the Medical Settlement Agreement.
39. What happens after I timely submit a complete Mediation Information Form or timely cure the Defects in my Mediation Information Form?
Within 10 days of determining that your Mediation Information Form is complete and timely, the mediating parties may either agree to a mediator, or the Claims Administrator will assign a mediator to mediate the claim. Within 10 days of assignment, the mediator will contact you and the mediating BP defendant(s) and will set a date for the mediation. The mediation will begin within 6 months of the appointment of the mediator, though the start date can be extended if you, the mediating BP defendant(s), and the mediator agree to it.
40. Where will the mediation take place?
The mediation will take place at a location mutually selected and approved by you, the mediator, and the mediating BP defendant(s). If everyone can’t agree on a location, the mediation will take place in New Orleans, Louisiana.
41. How long will the mediation last?
The mediation won’t last for more than 2 days, unless you, the mediator, and the mediating BP defendant(s) agree to extend it.
42. What information will the mediator consider? May I submit more information or documentation than I included with my Notice of Intent to Sue and/or Mediation Information Form?
The mediator will consider the information that you and the mediating BP defendants provide. The Claims Administrator will provide the mediator with your Notice of Intent to Sue, your Mediation Information Form, and any other materials that you submitted with those forms. You may choose to submit additional information to the mediator, and so may the BP defendants.
43. What happens after the mediation concludes?
Within 10 days of the conclusion of the mediation, the mediator will submit a written notice to you, the Claims Administrator, and the mediating BP defendant(s), certifying that the mediation concluded and indicating whether or not you and the BP defendant(s) agreed to settle the claim. If you reached an agreement in principle to settle, you and the mediating BP defendant(s) will have 30 days, or longer if you mutually agree, to finalize your settlement agreement. If you and the mediating BP defendant(s) are unsuccessful in reaching a final settlement agreement within the specified time period, you and the mediating BP defendant(s) must notify the mediator. Within 10 days of receiving that notification, the mediator will submit a written notice to you, the Claims Administrator, and the mediating BP defendant(s), certifying that the mediation has been concluded and was unsuccessful. Within 10 days of receiving notification from the mediator, the Claims Administrator shall issue a notice to you that the mediation was unsuccessful and that you have 6 months from the date of the notice to file your Back-End Litigation Option Lawsuit against the BP defendant(s) as to whom your claim is not resolved.
BACK-END LITIGATION OPTION LAWSUITS
44. When may I file a Back-End Litigation Option Lawsuit?
You may only file a Back-End Litigation Option Lawsuit after you file a compliant Notice of Intent to Sue and the Claims Administrator notifies you that either (1) all of the BP defendants named in your Notice of Intent to Sue elected not to mediate your claim for a given Later-Manifested Physical Condition or, if applicable, (2) that mediation did not resolve your claim as to all BP defendants named in your Notice of Intent to Sue.
45. What is the deadline for filing a Back-End Litigation Option Lawsuit?
It depends on whether any of the BP defendants named in your Notice of Intent to Sue elected to mediate your claim for a given Later-Manifested Physical Condition. If none of the BP defendants elected mediation, then you must file your Back-End Litigation Option Lawsuit for that Later-Manifested Physical Condition within 6 months of the date of the notice from the Claims Administrator informing you that none of the BP defendants elected mediation. If one or more of the BP defendants named in your Notice of Intent to Sue elected mediation, you must file your Back-End Litigation Option Lawsuit for that Later-Manifested Physical Condition within 6 months of the date of the notice from the Claims Administrator confirming that the mediation did not resolve your claim for that Later-Manifested Physical Condition as to all BP defendants named in your Notice of Intent to Sue.
46. Where do I have to file my Back-End Litigation Option Lawsuit?
You must file your Back-End Litigation Option Lawsuit in the United States District Court for the Eastern District of Louisiana. The Court, however, may later transfer your lawsuit to another court in accordance with applicable law.
GENERAL INFORMATION
47. How does the Claims Administrator determine the date on which I mailed a Notice of Intent to Sue, a Mediation Information Form, or a response to a Notice of Defect?
The Claims Administrator will consider you to have mailed a document on either (a) the postmark date or, (b) if applicable, the date of an electronic date stamp that shows the date on which the United States Postal Service accepted custody of the mailing. If the United States Postal Service fails to postmark or electronically date stamp a document that the Claims Administrator receives in the mail, the Claims Administrator will permit you to establish the date on which the United States Postal Service received the document by submitting a written statement under penalty of perjury attesting to the date on which you mailed the document and any additional facts on which you wish to rely to prove the date on which you mailed the document, such as any procedures you had in place to track and record the date of mailing.
48. Who must sign a Notice of Intent to Sue or Mediation Information Form?
A Medical Benefits Settlement Class Member or a Medical Benefits Settlement Class Member’s Authorized Representative must sign a Notice of Intent to Sue or Mediation Information Form.
49. May my attorney sign a Notice of Intent to Sue or Mediation Information Form on my behalf?
No. An attorney may not sign a Notice of Intent to Sue or Mediation Information Form on behalf of a Medical Benefits Settlement Class Member or on behalf of a Medical Benefits Settlement Class Member’s Authorized Representative.
50. May I sign a Notice of Intent to Sue or Mediation Information Form using an electronic signature?
Yes. The Claims Administrator will treat an electronic signature as valid. Generally speaking, an electronic signature is an electronic symbol attached to or incorporated within the NOIS record that is either executed, or explicitly adopted, by the claimant with the intent to have it serve as his/her signature on that particular record. Use of an electronic signature service such as Adobe Echo Sign or DocuSign is highly recommended.
51. How do I withdraw a claim for a Later-Manifested Physical Condition?
You may withdraw a claim for a Later-Manifested Physical Condition by submitting a Notice of Withdrawal to the Claims Administrator. You can find a copy of the Notice of Withdrawal on the Claims Administrator’s website at www.deepwaterhorizonmedicalsettlement.com, or you can contact the Claims Administrator at 1-877-545-5111 or info@deepwaterhorizonmedicalsettlement.com to request a copy.
VI. PERIODIC MEDICAL CONSULTATION PROGRAM
You may contact our call center to discuss scheduling a PMC Program appointment whenever you are ready; the program is currently underway and will continue through February 12, 2035.
Call the Claims Service Center at (877) 545-5111. We will confirm that you are eligible for a consultation, identify a provider, and schedule your Appointment.
After setting your appointment, we will mail you an appointment reminder letter and a program ID card. We will follow up with a call to remind you of your appointment. Always be sure to bring your Program ID card and a photo ID to your PMC scheduled appointments.
Please call the Claims Service Center at (877) 545-5111 for assistance.
No. You are eligible to receive a medical consultation every three years during the 21 years of the program, but you are not required to do so. As long as you wait at least three years between program appointments, you may request a medical consultation visit anytime during the 21-year period.
The program is funded by BP as a benefit of the Deepwater Horizon Medical Benefits Class Action Settlement.
During a PMC Program consultation, you will receive a medical evaluation that includes comprehensive medical, occupational and environmental histories and a physical examination, including vision screening. The program may also pay for some or all of the tests listed below if the consulting physician believes they are indicated. You must provide your informed consent before the tests are performed:
It may be necessary for your network provider to refer you to another facility for a covered service. You will need to bring your PMC Program ID card and a photo ID to your referral appointment.
If your network provider needs to refer you elsewhere for a covered service, they will contact us after your appointment and notify us of the referral. One of our representatives will then contact you to schedule the referral appointment.
The medical information from your PMC Program visit is confidential and is subject to the protections of HIPAA and other applicable privacy laws. You can find more information about the confidentiality of your medical information in Section VII.E of the Medical Benefits Settlement Agreement.