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Click ‘Get Form’ to open the medical WTC form in the editor.
Begin by entering the WCB Case Number and Carrier Case Number at the top of the form. This information is crucial for tracking your claim.
Fill in the Date of Accident, your Name, Date of Birth, and Social Security Number. Ensure all personal details are accurate to avoid processing delays.
Provide your Address, along with details about the Injured Person, Employer, and Insurance Carrier. This section helps establish context for your claim.
In the DATE OF FILING OF C-7 section, enter the date you are submitting this form. This is important for record-keeping purposes.
Attach an itemized list of all medical bills related to your treatment. Include details such as Date of Treatment, Name and Address of Medical Provider, Diagnostic Codes, and Amounts Outstanding.
Finally, ensure that you sign and date the form where indicated. This confirms that all information provided is true and complete.

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What does WTC mean in medical terms?

The World Trade Center (WTC) Health Program provides medically necessary monitoring and treatment for certified WTC-related health conditions. The Program also covers medically associated conditions, which are conditions that result from the treatment or progression of a certified condition.

What are the WTC medical conditions?

Active or retired member of a fire or police department (fire or emergency personnel), worked for a recovery or cleanup contractor, was a volunteer, was an employee of the Department of Defense or any other Federal agency, worked for a contractor of the Department of Defense or any other Federal agency between

Who qualifies for the WTC Health Program?

The WTC Health Program provides no-cost, 9/11-related healthcare to those who were there, including children, teenagers, and students at the time.

What conditions are covered by the WTC Health Program?

As of December 2017, the most common conditions certified by the World Trade Center Health Program were rhinosinusitis, gastroesophageal reflux disease (GERD), asthma, sleep apnea, cancer, post-traumatic stress disorder, respiratory disease, chronic obstructive pulmonary disease, depression, and anxiety disorder.

What is a WTC-related illness?

Most Common VCF Covered Conditions Non-melanoma skin cancer. Melanoma of the skin. Prostate cancer. Leukemia. Lymphoma. Multiple myeloma. Kidney cancer. Lung cancer.