Q20-1: Is Breast Cancer covered under the Disease Option?
Q20-2: What is the difference between Atypical Connective Tissue Disease (ACTD) and General Connective Tissue Symptoms (GCTS)?
ACTD is a condition found in Disease Option 1. Disease Option 1 uses the same medical criteria and definitions that were used in the original global settlement. If you are familiar with the Revised Settlement Program (RSP), these same criteria were also used in the Fixed Amount Benefit Schedule. The payment amounts for ACTD are based upon the degree to which you are “disabled” by the condition, as determined by your treating physician or QMD. The guidelines for the disability statement are outlined in Q1-9 of the Class 5 Disease Claimant Information Guide. GCTS is a condition in Disease Option 2. The diseases and conditions in Disease Option 2 were not part of the original global settlement. They were defined in the RSP and were contained in the “Long Term Benefit Schedule.” In general, the medical criteria to qualify for a Disease Option 2 claim are more restrictive and require more medical documentation and laboratory testing than those in Disease Option 1. The payments for Disease Option 2 are higher than the payments for Disease Option 1. See the Disease definitions and characteristics outlined in Tab 1 of the Class 5 Disease Claimant Information Guide for more specific information.
Q20-3: What do I do if my disease is not mentioned in the list?
Not every disease or medical condition is covered by the Disease Option. If you do not have one of the eligible diseases or conditions listed in the Settlement Option, then you cannot receive a disease payment from the Settlement Facility. You may pursue your claim against the Litigation Facility if you opt-out.
Q20-4: I received a letter from the MDL 926 Claims Office stating that my Qualified Medical Doctor (QMD) is not an acceptable physician. They requested me to have my disease submission re-reviewed and paid for the cost of this re-review. If this happens in the Dow Corning Settlement Facility – i.e., my QMD is unacceptable - will the Settlement Facility pay for me to get a re-review of my disease claim done?
The Settlement Facility has the authority and obligation to assure acceptable levels of reliability and quality control of claims to assure that payment is made only for claims that meet the criteria. This authority allows the Settlement Facility to request a re-review of a claimant by a physician selected by the Settlement Facility and/or additional laboratory testing. These expenses will be paid by the Settlement Facility if the re-review is done at the request of the Settlement Facility. However, if a claimant and/or attorney have prior knowledge that a particular QMD or laboratory is unacceptable and submit records from that QMD or laboratory anyway, then the Settlement Facility will not pay for the expense of any requested re-review. The claimant must pay for the cost of a re-review in this instance.
Q20-5: I had a Bristol and Dow Corning breast implant. I was a Current Disease Claimant in the RSP in 1994 and was approved as a Fixed Benefit Schedule ACTD Level “C” claimant. Since that time, my condition has become more severe. Can I apply for a Level “B” ACTD condition and, if so, is this paid as from the Increased Severity Fund?
You can apply for a Level B Disease Option 1 claim. Check Box 4A on the Disease Claim Form (do not check Box 3 because this would indicate that you want to rely on the Level C award determination). If approved, the Level B claim will be paid as a Base Payment and not from the Increased Severity Fund.
Q20-6: I had a Bristol and a Dow Corning silicone gel breast implant. In the Revised Settlement Plan (RSP), my claim for ACTD Level C was approved and I received 50% of my approved payment of $10,000. Can I rely on the RSP disease and disability award to receive the remaining 50% disease payment from the Dow Corning Settlement Option (assuming that I also have acceptable proof that my second implant was made by Dow Corning)?
Yes, you may rely on the RSP award as long as you are seeking payment for the same disease at the same disability level evaluated and approved by the MDL 926 Claims Office. Once you submit acceptable proof you had a Dow Corning breast implant, we will issue payment for 50% of your eligible award determination (in this example, 50% of $10,000) (and assuming you do not have a lien filed on your claim or other deductions that apply), plus you will be eligible to receive 50% of any future Premium Payment that may be authorized.
Q20-7: I had a Baxter and a Dow Corning silicone gel breast implant. In the Revised Settlement Plan (RSP), my claim for MCTD Level C was approved and I received 50% of my approved payment of $10,000. Since then, my condition has gotten worse, and I believe I now qualify for Level A - total disability. Can I rely on the disease evaluation from the RSP and apply for Level A disability in the Dow Corning Settlement Option?
If you apply for a different disease or disability/severity level than what you were awarded in the RSP, the Settlement Facility will treat this as a new Disease Claim and review both the disease and disability submission. If you now qualify for Level A total disability (and have acceptable proof of a Dow Corning breast implant), then you will receive 50% of the Level A award in the Dow Corning Settlement Option, or 50% of $50,000. You also will be eligible to receive 50% of any future Premium Payment that may be authorized.
Q20-8: Can I withdraw my Disease Claim?
You may withdraw your Disease Claim by submitting the request in writing as long as either the Cure Deadline has not expired or you have not cashed a Disease award check.
Q20-9: If I receive payment for an Option 1 Level B disease and later become more ill, such that I would qualify for Level A disability, what are my options?
You can apply for an Increased Severity Payment in Disease Option 1 only. You cannot apply for Disease Option 2 benefits, even if you now meet the criteria for Disease Option 2. The payment will be made at the time premium payments are made. Premium Payments may not be distributed unless and until the District Court determines that all other Allowed and allowable Claims have been paid or adequate provision has been made to assure such payments. (See SFA 7.01 (c) (iv))
Q20-10: I received a check for ACTD but have not cashed it yet. I recently was diagnosed with Lupus. Can I apply for a Lupus disease payment?"] If you receive a check for compensation of your disease claim and you wish to return the uncashed check and elect a review for a new disease, your request will be placed in line for review based on the date of your new request.
Q20-11: In the above situation, is there a time deadline on when I must submit the new claim for Lupus?
No, there is no specific time deadline other than the 15 year deadline to file a Disease Claim.
Q20-12: I received a check approving ACTD Level C, but I think my claim should have been paid at ACTD Level B. What can I do?
First, when you receive an award letter from the Settlement Facility and disagree with the review results, you should write to us indicating that you want the review results to be reconsidered. Attach any supplemental documents or information to support your position. If you have received a check, return it to the Settlement Facility along with a letter as described above. The Settlement Facility will inform you on the results of your request. If you do not qualify for the higher disability level, you may still accept your original award payment amount.
Q20-13: Is osteoarthralgia an eligible symptom for ACTD? Can it be counted under the criteria of “arthralgia” in ACTD?
“Osteoarthralgia” can be counted towards the symptom of arthralgia in ACTD, however, use of the word on its own cannot be credited unless it meets the Settlement Plan criteria for the symptom of arthralgia.
Q20-14: I submitted a disease claim in the original global settlement in 1994. If I submit additional records now that show that some of my symptoms documented in the 1994 letter have improved or gone away, will the Settlement Facility still be able to credit the 1994 symptoms?
No, we cannot credit symptoms that have subsequently improved or disappeared as of the date the claim is reviewed.
Q20-15: Under the criteria for GCTS, the definition of polyarthritis states that there must be synovial swelling and tenderness in 3 or more joints on at least two different joint groups observed on more than one physical examination. Does “joint groups” include left and right joints as a single group. For example, if there is synovial swelling in both elbows, does this count as one joint group or two?
Both elbows are two joints in one joint group. Joint groups include wrists, elbows, shoulders, hips, knees, ankles, joints of the forefoot, metatarsal phalangeal joints, interphalangeal joints of the toes, DIP/PIP/distal/proximal interphalangeal joints (as one joint group) and MCP – metacarpal phalangeal joints.
Q20-16: Under the criteria for GCTS, if my board certified doctor documents synovial swelling and tenderness in my pinkie and ring finger on one visit, and then in my thumb and index finger on the same hand on a subsequent visit, does this meet the criteria for “polyarthritis” (three or more joints in at least two different joint groups observed on more than one physicial examination ….”)?
Whether the various parts of the hand could qualify would depend on the joints involved (for example, DIP/PIPs and MCPs).
Q20-17: I received a check for $2,000 for the Expedited Release option in Class 5 but I have not cashed it. I want to return it so that I can apply for a Disease claim within the 15 year deadline for disease claims. Can I do this?
A claimant may return the Expedited Release Payment check or draft and apply for a Disease Claim (or Medical Condition claim in Class 9 or 10) provided that 1) the uncashed check is returned to the Settlement Facility within 60 days of the date of its issuance, 2) the returned uncashed check or draft is accompanied by a statement from the Claimant or her attorney withdrawing the Expedited Release claim, and 3) the Claimant has not previously withdrawn an Expedited Release claim.
Q20-18: If I return the Expedited Release check as described in the question above, does this trigger any deadline to apply for a Disease claim or any other claim?
No. Returning the Expedited Release check is not contingent upon filing a Disease claim at the same time.
Q20-19: I represent a woman who was an Other Registrant in the Revised Settlement Program. She had a Disease evaluation done and her QMD placed her at ACTD Level A; however, she was not eligible for ACTD as an Other Registrant. She did not meet the criteria for any disease or condition in Long Term Benefits (Disease Option 2). She is now deceased. Has she marshaled so that her estate can apply for a Class 7 claim using the ACTD Level A statement from her QMD?
Yes. The claimant is deceased and is therefore not eligible for any additional benefits in the Revised Settlement Program. She has marshaled and is eligible to apply for a disease payment in Class 7.
Q20-21: If a Claimant has deficiencies in her Disease Claim and receives a Notification of Status letter, can she apply for a second Disease Claim while her time to cure the deficiencies in the first claim is running?
Yes. She may apply for a second Disease Claim while her time to cure the deficiencies in the first Disease Claim is running. The Claimant has the option of changing her election back to the first Disease Claim but only up to the deadline to cure deficiencies for that first Disease Claim (which is one year from the date of the Notification of Status letter advising the Claimant of deficiencies in that first Disease Claim). Once the cure deadline has expired, the Claimant may not change her election back to that first disease and the Claimant is barred from payment for that first disease.
Q21-1: The Claim Form says that I do not have to re-submit medical records that were previously sent for the original global settlement or the Revised Settlement Program (RSP). I sent in medical records for the “Foreign Revised Settlement Program” or FRSP. Will the Settlement Facility have these records or should I resubmit them?
The Settlement Facility has access to these records. You do not need to re-submit them.
Q21-2: I was a Current Disease Claimant in the Foreign Revised Settlement Program but I was unable to supply the proof of manufacturer information by the deadline in 1999. I have now obtained those documents and was implanted with a Surgitek (Bristol) implant. Have I marshaled against my manufacturer as required?
Yes, you have marshaled because you are no longer able to collect any money from the Foreign Revised Settlement Program or from the manufacturer directly.