MDL 2179 In re: Oil Spill by the Oil Rig "Deepwater Horizon" in Gulf of Mexico on April 20, 2010 – Official Court-Authorized Website.

 

Minimize

Frequently Asked Questions

*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.


I. GENERAL

1. When is the Effective Date of the Medical Settlement Agreement?  How long do I have to file a Proof of Claim Form?The Effective Date is February 12, 2014.  Class Members have one (1) year from the Effective Date to file claims.  Therefore, the envelope containing a Class Member’s Proof of Claim Form must be post-marked by or received via hand-delivery/courier and stamped with “Received Date” no later than February 12, 2015.  Electronic submissions of the Proof of Claim Form will not be accepted.  2. Is filing a Data Disclosure Form on the last day a claim must be filed sufficient to preserve my right to file a Proof of Claim Form?No; Class Members have one (1) year from the Effective Date to file a Proof of Claim Form.  Click here to obtain additional information on how to file a claim.

3. In Section I of the Proof Claim Form, there are three options for the means of communication between the Claims Administrator and the claimant: (1) mail, (2) e-mail, or (3) telephone. Can a claimant choose all three options?

Yes. A claimant may select all three options. If a claimant checks more than one option, the Claims Administrator will default to the use of mail as the primary method of contact as mailing is necessary for most communication required by the Medical Settlement Agreement. Only in cases where the claimant has selected 1) both phone and email 2) phone only or 3) email only will the Claims Administrator contact the claimant to verify his or her preferred method of communication with the Claims Administrator, in addition to explaining that for some specific correspondence, mail is the method of communication mandated by the Medical Settlement Agreement. The Claims Administrator will, where appropriate for transmission of confidential information and/or as mandated by the Medical Settlement Agreement, use a method of Communication different from the preferred method to efficiently administer the Medical Settlement, (e.g., an automated telephone call 24 hours before a Class Member’s scheduled Periodic Medical Consultation Program visit).

4. If a claimant is individually represented by an attorney, will the Claims Administrator communicate with the attorney instead of the claimant?

Generally, yes. If a claimant indicates in his or her Proof of Claim Form or Notice of Intent to Sue Form that he or she is individually represented by counsel, or otherwise confirms in writing that he or she is individually represented by counsel in connection with his or her claim, the Claims Administrator will communicate only with counsel, unless otherwise authorized under the Medical Settlement Agreement (e.g., to schedule a Periodic Medical Consultation Program visit pursuant).

5. What happens when there is a discrepancy between the name of an employer provided by a claimant in Section IV of the Proof of Claim and the employer’s name on documentary proof provided by the claimant and/or located in the databases and other documentary evidence provided by BP to the Claims Administrator?

The Claims Administrator will review all of the information provided in the Proof of Claim Form and supporting documentation to determine whether the claimant has established his orher status as a Clean-Up Worker. If the claimant establishes his or her status as a Clean-Up Worker, such a discrepancy would not be a Defect. If the claimant’s status as a Clean-Up Worker cannot be determined based on the review of all of the information, the Claims Administrator will issue a Notice of Defect and the claimant will have an opportunity to cure the Defect.

As a reminder, if a claimant is included in the databases, documentation or records provided by BP to the Claims Administrator (with the exception of the Training Database), his or her status as a Clean-Up Worker is established and the claimant does not need to submit other documentary evidence to establish his or her status. If a claimant is unsure whether he or she appears in such materials,he or she may find out by submitting a Data Disclosure Form to the Claims Administrator.

6. Is a discrepancy in the naming of a claimant’s employer in the Proof of Claim Form and supporting documents a basis for denying the claim?

No. References to the same employer by different names (e.g., “Garretson Resolution Group” vs. “GRG”) in a Proof of Claim Form and supporting documentation are not alone a basis to deny an otherwise valid claim.

7. When there is a discrepancy between the name of an employer in multiple documents, which name should a claimant provide in Section IV of the Proof of Claim Form? For example, what name should the claimant provide for the employer in Section IV.A of the Proof of Claim Form where the employer is located in one document as “The Signature” and another document as “STS Group”?

In the case of such a discrepancy, the claimant will want to provide in Section IV of his or her Proof of Claim Form all names of the employer that he or she believes are accurate. If additional space is needed, the claimant can provide that information on additional pages and submit the additional pages with his or her Proof of Claim Form.

8. What should a claimant do in Section IV.A of his or her Proof of Claim Form if the claimant had multiple employers?

The claimant may provide information regarding one employer in Section IV.A of the Proof of Claim Form, and provide information regarding additional employers on additional pages and submit the additional pages with his or her Proof of Claim Form.

9. Section IV.A of the Proof of Claim Form asks for a description of the claimant’s duties and the locations where the claimant worked. Where a claimant is filing a claim for a Specified Physical Condition and has submitted information about his or her work duties and locations worked in his or her declaration, will his or her claim be denied if that information is not also included in Section IV.A of the claimant’s Proof of Claim Form?

No.Where a claimant filing a claim for a Specified Physical Condition includes information about his or her work duties and locations worked in his or her declaration but inadvertently omits this information from his or her Proof of Claim Form, the Claims Administrator will not consider this a Defect or a reason to deny the claim. The claimant still has the obligation to prove to the Claims Administrator all of the elements of proof necessary to qualify for compensation for a Specified Physical Condition.

10. In Section VII of the Proof of Claim Form, can a claimant check multiple boxes for the conditions (A1, A2, A3, A4 and/or B1)?

Yes. A claimant can assert claims for multiple Specified Physical Conditions in a single Proof of Claim Form and declaration, though he or she is eligible to receive only one lump sum compensation payment for a Specified Physical Condition. The highest qualifying condition will be paid. A claimant who is claiming more than one Specified Physical Condition should check all of the applicable boxes in Section VII of the Proof of Claim Form for the conditions and proof requirements that he or she is asserting. (For example, if a Clean-Up Worker is asserting a Chronic Specified Physical Condition and one of the heat-related conditions specified on Level A4 of the Matrix, he or she should check the boxes for B1 and A4 in Section VII of the Proof of Claim Form.) A claimant can also check multiple boxes on Level A for the same Acute Physical Condition for which he or she believes that he or she satisfies the proof requirements.

11. Do the boxes checked in Section VII of the Proof of Claim Form have to match exactly with what is claimed on the medical record and declaration? If there is a mistake made while checking the boxes will the claim automatically be denied?

No. The Claims Administrator will review all of the information in the Proof of Claim Form, declaration, and other available evidence, including medical records, to determine whether, and if so at which Level(s), the claimant qualifies for compensation for a Specified Physical Condition pursuant to the Medical Settlement Agreement.

12. There are some conditions listed in Table 2 of the Matrix that are not included in Table 1 of the Matrix. Which box should be checked in Section VII of the Proof of Claim Form in this scenario (A1, A2, A3, A4 and/or B1)?

Unless also listed in Table 1 or Table 3 of the Matrix, the conditions listed in Table 2 (page 12) of the Matrix are not themselves compensable Acute or Chronic Specified Physical Conditions. The codes and conditions listed on Table 2 of the Matrix are used by the Claims Administrator to determine whether a Clean-Up Worker is eligible for compensation on Levels A3 and A4.

13. If a claimant provides medical records to the Claims Administrator with his or her Proof of Claim Form, will the costs of obtaining those records still be deducted from the claimant’s compensation?

No.

14. Section VIII of the Proof of Claim Form requests information regarding each Specified Physical Condition being claimed, including the identification of the condition. Where a claimant is filing a claim for a Specified Physical Condition and has submitted information about their work duties and locations worked in their declaration, will his or her claim be denied if that information is not also included in Section VIII of the Proof of Claim Form?

No. Where a claimant filing a claim for a Specified Physical Condition includes information about his or her Specified Physical Condition(s) in his or her declaration but inadvertently omits this in formation from his or her Proof of Claim Form, the Claims Administrator will not consider this a Defect or a reason to deny the claim.

15. What is the process if a Claimant submits a Proof of Claim Form before 1 year after the Effective Date but it is incomplete 1 year after the Effective Date?

A claimant who timely submits an incomplete Proof of Claim Form before one year after the Effective Date will be sent a Notice of Defect by the Claims Administrator and have 120 days to cure any Defects pursuant to the terms of the Settlement Agreement, even if the 120 day period is more than one year after the Effective Date. If he or she fails to do so, the Claims Administrator will make a determination of the claim based on the existing information.

II. Frequently Asked Questions Regarding Declarations and Requests for Additional Information

Requests for Additional Information letters are sent to claimants who have submitted a Proof of Claim Form requesting compensation for a Specified Physical Condition for the following reasons:

  1. No Declaration: Failure to submit a declaration for the claimed Specified Physical Condition(s); 
  2. Missing Requirements: Failure to include all of the requirements for the Specified Physical Condition in the declaration as outlined in the Request for Additional Information letter; 
    1. If the claimant has declared multiple Specified Physical Conditions, only those injuries that do not contain all of the requirements will be included on the Requests for Additional Information letter. 
    2. No further response is required for declared Specified Conditions that are not included on the Requests for Additional Information letter.  
  3. Claimed, but Undeclared Specified Physical Conditions: Failure to include a Specified Physical Condition that was claimed on the Proof of Claim Form in the declaration.

For more information regarding the requirements for compensation and Specified Physical Conditions, please see the Specified Physical Conditions Matrix (Exhibit 8 to the Medical Benefits Class Action Settlement Agreement), Sections V, VI and XXI of the Medical Benefits Class Action Settlement Agreement, and Section VII of the Proof of Claim Form.

You may also contact the Medical Settlement Claims Administrator at (877) 545-5111 and/or Medical Settlement Class Counsel at (504) 264-5757 for assistance.

Question 1:

What is a declaration for a Specified Physical Condition?

Answer 1:

A declaration for a Specified Physical Condition is a written statement in your own words, signed and submitted under penalty of perjury, which contains accurate information relating to the medical condition(s) for which you are seeking compensation.

If you are seeking compensation for a Specified Physical Condition(s) identified in Table 1 or Table 3 of the Specified Physical Conditions Matrix (e.g., all Specified Physical Conditions other than a level A4 heat-related condition), you MUST include the following information:

  1. The condition(s) or symptom(s), as set forth in Exhibit 8 (Specified Physical Conditions Matrix), you claim to have experienced;
  2. The amount of time that passed between your exposure to oil, dispersants, and/or other substances used to clean up the oil spill and when you first got the claimed condition(s) or symptom(s) [i.e., how many hours, days, or longer after you were exposed to the oil, dispersants, and/or other substances did you first have your condition(s) or symptom(s)?]
  3. What you were doing when you were exposed to oil, dispersants, and/or other substances used to clean up the oil spill. [Performing oil spill clean-up work or smelling the oil while walking along the beach are examples of how someone may have been exposed to oil. These are only examples. It is important that you accurately describe specifically how you were exposed to the oil, dispersants and/or substances used to clean up the oil spill];
  4. How you were exposed to the oil, dispersants, and/or other substances used to clean up the oil spill. [For example, breathing the oil (inhalation) or touching the oil (direct contact) are examples of the way in which someone can be exposed to oil. These are only examples. It is important that you accurately describe the specific way by which you were exposed to the oil, dispersants and/or substances used to clean up the oil spill etc.]
  5. The date(s) or approximate date(s) when you were exposed to oil, dispersants, and/or other substances used to clean up the oil spill; and,
  6. A statement that your declaration is signed under penalty of perjury, which must be followed by your handwritten signature. “Under penalty of perjury” means that you recognize that you could face punishment under the law for an untruthful statement.
    1. Specifically, the declaration must state, with these or similar words: “I declare (or certify, verify or state) under penalty of perjury that the foregoing is true and correct.”
    2. The statement must be signed with a handwritten signature.

Your declaration MUST contain each of the items above (1 through 6) to be complete.

If you are a Clean-Up Worker seeking compensation for a heat-related Specified Physical Condition (level A4 of the Specified Physical Conditions Matrix), your declaration must include:

  1. A statement saying that you had sunstroke (heat stroke), loss of consciousness (fainting) due to heat, heat fatigue (exhaustion) and/or disorders of sweat glands, including heat rash;
  2. A statement asserting that such condition(s) happened during or immediately after a shift working as a Clean-Up Worker; and
  3. What you were doing on that shift;
  4. The date(s) or approximate date(s) of that shift; and
  5. A statement that your declaration is signed under penalty of perjury, which must be followed by your handwritten signature. “Under penalty of perjury” means that you recognize that you could face punishment under the law for an untruthful statement.
    1. Specifically, the declaration must state, with these or similar words: “I declare (or certify, verify or state) under penalty of perjury that the foregoing is true and correct.”
    2. The statement must be signed with a handwritten signature.

Question 2:

This letter states that I did not submit my declaration, but I submitted all of the forms that were sent to me.

Answer 2:

In the answer above, we explain what a declaration is and what it must contain. A form declaration is not on the official medical settlement website or in the notice packet you received. You must, however, send in a declaration plus the Proof of Claim Form. If you need assistance with your declaration, the Proof of Claim Form or anything else relating to the submission of your claim, you should contact the Medical Settlement Claims Administrator at (877) 545-5111 or Class Counsel’s Office at (504) 264-5757.

Question 3:

Why does this letter state that I am missing information regarding a condition(s) or symptom(s) identified in Table 1 or Table 3 of the Matrix?

Answer 3:

If you are making a claim for compensation for a Specified Physical Condition, you must identify the specific condition(s) or symptom(s) for which you are seeking compensation. Only the conditions and symptoms identified in the Specified Physical Conditions Matrix, which is included in the notice packet you received, can allow you to get compensation. If you need another copy of the Matrix, please contact the Medical Settlement Claims Administrator at (877) 545-5111 or send a written request to the Medical Settlement Claims Administrator at 935 Gravier Street, Suite 1400, New Orleans, LA 70122. If you are a Clean-Up Worker or a Zone B Resident who did not experience a symptom or condition as a result of your exposure to the oil, dispersants or other substances used to clean up the oil spill, you are still eligible to receive benefits under the Periodic Medical Consultation Program.

Note: If you are declaring Dermal (“skin”) symptoms, you must have experienced at least two of the symptoms found in that category to be eligible for compensation for those symptoms. For example, declaring only “itching” will not be sufficient to qualify for compensation for dermal symptoms. It is important that you list all (but at least two) of the symptoms that you experienced.

If you are declaring Upper Airway and Respiratory symptoms, you must have experienced at least two of the symptoms found in that category to be eligible for compensation for those symptoms. For example, declaring only “coughing” will not be sufficient to qualify for compensation for Upper Airway and Respiratory symptoms. It is important that you list all (but at least two) of the symptoms that you experienced.

Question 4:

Why does this letter state that I am missing information about “route of exposure?”

Answer 4:

Your declaration must state how you were exposed to oil, dispersants, and/or other substances used to clean up the oil spill. For instance, if you were exposed to oil through direct contact, you would put “I was exposed to oil through direct contact”. This is only an example. It is important that you state accurately how you personally were exposed to oil, dispersants, and/or other substances.

Question 5:

Why does this letter state that I am missing a “timeframe?” What does that mean?

Answer 5:

Your declaration must state how much time has passed between your exposure to oil, dispersants, and/or other substances used to clean up the oil spill and when you first noticed the claimed condition(s) or symptom(s). For instance, if your condition occurred 24 hours after exposure you would say “my [insert your exact Specified Physical Condition] first began 24 hours after my exposure to oil dispersants, and/or other substances.” Similarly, if your condition occurred 3 hours after exposure, you would say “my [insert your exact Specified Physical Condition] first began 3 hours after my exposure to oil dispersants, and/or other substances.” These are only examples. It is important that you state accurately the timeframe that applies to your situation.

Question 6:

Why does this letter state that I am missing the “circumstances” of exposure? What does that mean?

Answer 6:

Your declaration must state what you were doing when you were exposed to oil, dispersants, and/or other substances used to clean up the oil spill. Include only activities you were engaged in as a:

  • Clean-Up Worker
    • For example: picking up tar balls, walking the shore, laying boom, etc.
  • Zone A Resident or Zone B Resident
    • For example: smelled the oil while walking along the beach, touched the oil at the shore, etc.

These are only examples. It is important that you accurately describe specifically how you were exposed to the oil, dispersants and/or substances used to clean up the oil spill.

Question 7:

Why does this letter state that I am missing the date(s) or approximate date(s) of exposure?

Answer 7:

Your declaration must state the date(s) or approximate date(s) when you were exposed to oil, dispersants, and/or other substances used to clean up the oil spill. Be sure to specifically state that they are either the actual or approximate dates you were exposed.

Question 8:

Why does this letter say that the declaration was not signed under penalty of perjury? I did sign it.

Answer 8:

Your declaration must include a statement affirming that everything you wrote was truthful, and that you understand you could be subject to punishment if you did not tell the truth. The Medical Benefits Class Action Settlement Agreement is administered under a federal court’s supervision, and your declaration has the same effect as if you gave the statements under oath in court.

  1. Specifically, the declaration must state, with these or similar words: “I declare (or certify, verify or state) under penalty of perjury that the foregoing is true and correct.”
  2. The statement must be signed with a handwritten signature.

Question 9:

I stated other conditions in my declaration that are not in this letter. Why are those conditions not included in the letter?

Answer 9:

The Requests for Additional Information letter only lists conditions that are missing declaration requirements. If you declared one or more conditions that are not listed in the letter, then no further information is needed for these conditions. You should only respond to those conditions listed in the letter. 

Question 10:

If I have declared other conditions in my declaration that are not included in this letter, do I still have to respond for the conditions listed in this letter?

Answer 10:

Responding to the conditions listed in this letter provides you an opportunity to address any missing requirements for those conditions and is in your best interest.  If you declared Specified Physical Conditions not listed in this letter, you may still qualify for compensation for one of those conditions regardless of whether you supply the missing information for the conditions in this letter.  You must provide all information specified for a condition in the Specified Physical Conditions Matrix to qualify for compensation for that condition.

Questions Related Only to Clean-up Workers (Heat-Related Injuries)

Question 11:

Why does this letter state that my declaration is missing an assertion of a heat-related condition?

Answer 11:

If you are a Clean-Up Worker and you claim compensation in your Proof of Claim Form for a level A4 condition, then you must say whether you had sunstroke (heat stroke), loss of consciousness (fainting) due to heat, heat fatigue (exhaustion) and/or disorders of sweat glands (including heat rash).

Question 12:

This letter states that my declaration is missing a statement that my heat-related condition occurred during or immediately following my shift as a Clean-up Worker. What do I do?

Answer 12:

If you are a Clean-Up Worker claiming a heat-related Specified Physical Condition, you must state whether your claimed heat-related condition(s) happened during or immediately after your shift working as a Clean-Up Worker. If your claimed heat-related condition(s) did not happen on or immediately after your shift as a Clean-Up Worker, that condition is not eligible for compensation.

Question 13:

This letter says that my declaration is missing the circumstances or activity during my work shift that I believe caused my condition. I said I was a Clean-up Worker; that’s my circumstance.

Answer 13:

Clean-Up Workers who are claiming a heat-related condition must provide a description of the Response Activities they were performing when their heat-related condition happened to them. You should also provide the location and date(s) of the Response Activities you performed during the relevant work shift or shifts.

Question 14:

This letter says that my declaration is missing the date(s) or approximate date(s) of the shift that resulted in my condition. What do I do?

Answer 14:

Your declaration must state the date(s) or approximate date(s) of the work day that you believe resulted in your heat-related condition(s).

You may contact the Medical Settlement Claims Administrator at (877) 545-5111 and/or Medical Settlement Class Counsel at (504) 264-5757 for assistance with your declaration.

III. Frequently Asked Questions Regarding Authorized Representatives and Bankruptcy

THE CLAIMS ADMINISTRATOR HAS TRAINED REPRESENTATIVES ON HAND TO ASSIST YOU IN SUBMITTING PROPER AUTHORIZED REPRESENTATIVE DOCUMENTATION. TO SPEAK TO A REPRESENTATIVE OR TO SCHEDULE AN APPOINTMENT WITH A REPRESENTATIVE IN OUR NEW ORLEANS OFFICE, CALL (877) 545-5111. YOU CAN ALSO REACH A REPRESENTATIVE BY E-MAIL, AT info@deepwaterhorizonmedicalsettlement.com.

Question 1:What documentation is required to be an Authorized Representative of a Deceased Member of the Medical Benefits Settlement Class?

Answer 1:In addition to completing Appendix A and providing a copy of the deceased class member's death certificate, you must submit proper documentation proving you are the legal representative and have the authority to act on behalf of a deceased class member. This may include one of the following:

  1. Valid Letters of Representation, signed and filed in Local Probate Court;
  2. Determination of Heirship, signed and filed in Local Probate Court;
  3. Small Estate Affidavit, if decedent lived in a state that allows for alternate probate process (e.g., Mississippi), notarized and signed by all necessary parties;
  4. A valid, signed, Trust agreement, and Assignment of Assets (Deepwater Horizon Medical Benefits Settlement Proceeds) to Trust, signed by Decedent prior to Date of Death; or,
  5. Opinion Letter stating authority is granted to you and opening an Estate is not required, prepared and signed by a local probate attorney.

Question 2:What documentation is required to be an Authorized Representative of a Minor Child of the Medical Benefits Settlement Class?

Answer 2:In addition to completing Appendix A, you must submit proper documentation to prove you are the legal representative and have the authority to act on behalf of the minor child. This may include one of the following:

  1. Valid Letters of Appointment, for the Guardianship/Conservatorship of the Estate of the minor child, signed and filed in Local Probate Court; or,
  2. If the minor child is a resident of any of the following states; Alaska, Arizona, Arkansas, Colorado, District of Columbia, Hawaii, Idaho, Indiana, Louisiana, Massachusetts, Minnesota, Missouri, Nebraska, New Mexico, North Carolina, Rhode Island, Virginia, Wisconsin, a copy of a Custodial Trust Agreement, signed by a local Trust Attorney and following the Uniform Custodial Trust Act.

Question 3:What documentation is required to be an Authorized Representative of an Incompetent Adult of the Medical Benefits Settlement Class?

Answer 3:In addition to completing Appendix A, you must submit proper documentation to prove you are the legal representative and have the authority to act on behalf of the incompetent adult. This may include one of the following:

  1. Financial Power of Attorney, which is signed by Incompetent Adult prior to becoming incompetent and by its terms survives the adult's incompetency; or,
  2. Valid Letters of Appointment for Guardianship/Conservatorship of the Estate of the Incompetent Adult, signed and filed in Local Probate Court.

Question 4:What if I have filed for bankruptcy in the past and/or currently have a bankruptcy in process?

Answer 4:Pursuant to Federal rules, a bankruptcy trustee may have an interest in your potential settlement. Those Federal rules may also require you to tell the trustee about your involvement in the Deepwater Horizon Medical Benefits Class Action Program. You must provide Direction from the Bankruptcy Estate. The directive may include one of the following:

  1. Copy of Schedules B and C of your Voluntary Petition, listing the Class Action Settlement and showing it as fully Exempt;
  2. Filed Motion and Order of Dismissal, executed by Judge, showing your bankruptcy case was Dismissed; or,
  3. Order executed by Judge, providing payment instructions of the Deepwater Horizon Medical Benefits settlement proceeds.

THE CLAIMS ADMINISTRATOR HAS TRAINED REPRESENTATIVES ON HAND TO ASSIST YOU IN SUBMITTING PROPER AUTHORIZED REPRESENTATIVE DOCUMENTATION. TO SPEAK TO A REPRESENTATIVE OR TO SCHEDULE AN APPOINTMENT WITH A REPRESENTATIVE IN OUR NEW ORLEANS OFFICE, CALL (877) 545-5111.

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. How do I find out what liens and complications are linked to my name?

You can consult with your attorney or contact the Claims Administrator to find any liens and complications that may be linked to your name. The Claims Administrator will inform you in writing of any liens that have been asserted against your settlement proceeds. You will receive a Projected Disbursement Statement on a monthly basis indicating any lien holdbacks and payment complications holding up payment of your claims, as well as the status of those liens and complications.

The Claims Administrator will also send detailed correspondence with regard to many liens and complications, which will include any steps you need to take to resolve the complications.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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

24. 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.

25. 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.

26. 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

27. 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.

28. 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.

29. 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

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. 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.

36. 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.

37. 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.