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Claimants: Additional Information : Processing Claims - Step by Step

Processing Claims - Step by Step

Step 1: You must mail completed forms and supporting documentation to the Hepatitis C Claims Centre.
Step 2: The Hepatitis C Claims Centre will sort and scan your claim forms and supporting documentation into the computer system.
Step 3: An Evaluator will review the forms and supporting documentation. The initial review will include an assessment of the claimant type and the disease level of the HCV Infected Person.
File Has Incomplete or Missing Information (Possible Issues)
File Is Complete

Example 1

If forms/supporting documentation are incomplete or missing, the claim cannot be approved.

Example 2

If a Traceback is needed (Transfused Plan only) the claim cannot be approved.

Example 3

If there are indications of infection due to other risk factors, the claim cannot be approved.

All forms, documentation and required proof are complete; the Evaluator will recommend approval to a Supervisor.

A letter outlining what's missing or incomplete is mailed to claimant.

In many cases, if the Administrator has the authority, an Evaluator will call the claimant, the treating physician, or other relevant party to advise/discuss the problem.

The Administrator will initiate the Traceback, if necessary and/or contact Can. Blood Services / Héma-Québec to request that the procedure be completed.

In many cases, hospital transfusion record(s) confirmation is needed before the traceback can be undertaken.

An inquiry form about details relevant to the other risk factors is mailed to the claimant.

The claimant must complete the inquiry form and return it to the Administrator.

Go to Step 4

Once new information is received, an Evaluator will review the claim. Assuming that the claim is complete, the Evaluator will recommend approval to the Supervisor.

If the claim is still incomplete, the Evaluator will call the claimant to discuss the problem or issue a second letter.

Once the Traceback result is available, the Traceback Coordinator will review the claim in accordance with the Traceback Protocol.

  • If the Protocol directs that the claim be rejected, processing will cease and a denial letter will be mailed.
  • If the Protocol directs that the claim be approved, an Evaluator will recommend final approval to the Supervisor.

Upon receipt of a duly completed inquiry form, a committee of Evaluators will review the details relevant to the other risk factors.

  • If the committee finds that further investigation is needed, further inquiries will be made.
  • If the committee is of the view that no further investigation is needed, the file will be recommended to the Supervisor for approval.
 
Go to Step 4
Go to Step 4
Go to Step 4
 
       
Step 4: The Supervisor reviews the claim for approval. If the Supervisor disagrees with the recommendation to approve the claim, inquiries with the Evaluator will be made to clarify any uncertainty. If the Supervisor agrees, the Claim is approved.
Step 5:

If the Claim is approved, A Full and Final Release, covered with a letter confirming the compensation payment will be mailed to the Claimant.

In cases where the HCV Infected person died before January 1, 1999, supplemental forms (GEN 21 or GEN 21M) outlining the right to make an election will be attached.

Step 6: Claimants should carefully review, sign and date the Release in the presence of a witness. Claimants must return all pages of the original Release by mail to the Hepatitis C Claims Centre.
Step 7: Upon receipt of the original Release, the Hepatitis C Claims Centre reviews the Release to ensure that it is duly signed by the claimant.
Step 8:

The Hepatitis C Claims Centre will make a request to the Federal, Provincial and Territorial governments for funding equal to the total amount of approvals for the month. Requests for funding are made on the 5th business day of every month. In light of this fact, the Hepatitis C Claims Centre must receive the original signed Release no later than the end of the 3rd business day.

Step 9: Upon receipt of the funds from the Trustee, a cheque or direct deposit payment will be made to the Claimant. Payments are made once a month, within the last 10 business days of the month.
Step 10:

The HCV Infected Person or the Estate and Family Members and/or Dependants in the case where the HCV Infected Person is deceased may claim supplementary compensation, on an ongoing basis for some or all of the following:

  • $1,000.00 for every month of completed HCV Drug Therapy;
  • Out-of-pocket expenses;
  • Uninsured medical expenses;
  • Loss of income or loss of services in the home due to the HCV infection;
  • Loss of support for surviving Dependants if HCV materially contributed to the death of the deceased HCV Infected Person;
  • Costs of care (up to $50,000 per year for Level 6 approvals only).

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