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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)
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File Is Complete
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Example 1
If forms/supporting documentation are incomplete or
missing, the claim cannot be approved.
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Example 2
If a Traceback is needed (Transfused Plan only) the
claim cannot be approved.
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Example 3
If there are indications of infection due to other
risk factors, the claim cannot be approved.
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All forms, documentation
and required proof are complete; the Evaluator will recommend
approval to a Supervisor. |
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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.
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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.
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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.
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Go to Step 4
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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.
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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.
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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.
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Go to Step 4
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Go to Step 4
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Go to Step 4
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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.
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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.
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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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