The Administrator may ask for additional documents to be provided in connection with your Claim whilst it is under review.

The Administrator may ask you, or the Registered Healthcare Professional(s) who completed your Supporting Evidence Form, or other persons, organisations or entities, for those additional documents depending upon the circumstances.

Any additional documents requested by the Administrator should be submitted within 90 days from the date of the Administrator’s request.

Whilst the Administrator is waiting for these additional documents, the review process for your Claim will be paused. Once the Administrator has received the requested documents, the review process will recommence.

Submit additional documents online

To submit additional documents online, please:

  1. Obtain and scan the additional documents requested by the Administrator.
  2. Upload and submit the additional documents on upload documents.

Note: To submit additional documents online the Claimant’s name and Claim number will be required.

Submit additional documents by email

To submit additional documents by email, please:

  1. Obtain and scan the additional documents requested by the Administrator.
  2. Email these scanned forms and documents (as one or more email attachments) to [email protected]

Note: Please be sure to include the Claimant’s name and Claim number in any email correspondence relating to additional documents that you submit.

Submit additional documents by regular mail

To submit additional documents by regular mail, please:

  1. Obtain and scan the additional documents requested by the Administrator.
  2. Send these scanned forms and documents by regular mail to one of the Scheme’s Regional Centres.

Note: Please be sure to include the Claimant’s name and Claim number in any additional documents that you submit.

Administrator

ESIS, Inc., the claims Administrator appointed to manage and administer the Program, including, but not limited to, the receipt and registration of Applications, distributing acknowledgements of receipt of Applications, setting financial reserves for Receivable Claims, review of Applications, Supporting Evidence, and other documents to assess receivability, assessing Receivable Claims, and approve or deny, as the case may be, Payment for compensation, in accordance with the terms of the Program's Protocol.

Claim

A written claim for compensation completed by a Claimant, using the Claim Form approved by and provided by the Administrator, as set forth in Schedule 2 of the Scheme’s Protocol, which must be accompanied by all Supporting Evidence.

Registered Healthcare Professional

Any healthcare professional, including physicians, surgeons, nurses, midwives, nurse practitioners, physicians’ assistants, psychiatrists, psychiatrists, physical therapists, occupational therapists, dentists, and pharmacists, who is duly licensed or legally authorised to practice the profession in the country in which the Patient resides and received the Vaccine, or in the case of birth defects, where the Patient’s mother resides and received the Vaccine.

Supporting Evidence

The supporting evidence, using the form in Schedule 3 of the Scheme’s Protocol, required to evaluate a Claim and that shall include:

  1. detailed medical documentation from a Registered Healthcare Professional describing the Injury and medical treatment required as a result of the Injury, together with details of any Hospitalisation or prolonged Hospitalisation, including but not limited to admission and discharge records;
  2. a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
  3. a statement from the Registered Healthcare Professional that the Injury was, in the Registered Healthcare Professional’s opinion, the result of the Vaccine or its administration;
  4. certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
  5. in the case of death, a death certificate and any other documentation available from a Registered Healthcare Professional of the cause and manner of death; and
  6. any further evidence that the Administrator may deem necessary to adjudicate the Claim and/or Receivable Claim, as applicable, guided, as appropriate, by the Scientific Advisory Committee, the Review Panel, and/or the Appeals Panel.
Claimant

Any individual, who meets all of the following requirements:

  1. is a Patient who was administered a Vaccine (or in the event the Patient has died, is a child, or is disabled or otherwise lacks the legal capacity to submit a Claim for himself or herself, is an individual who is a duly authorised heir (in the case of death), parent, legal guardian or other legal representative of the Patient); and
  2. is, or is duly authorised to represent, a Patient who has sustained an Injury which, in the opinion of a Registered Healthcare Professional, is deemed to have resulted from a Vaccine or its administration; and
  3. the Vaccine was administered before its Scope of Coverage Endpoint (as indicated in Schedule 1 of the Scheme’s Protocol); and
  4. has submitted a Claim for compensation, using the prescribed form in Schedule 2 of the Scheme’s Protocol, together with all Supporting Evidence, using the prescribed form in Schedule 3 of the Scheme’s Protocol to the Administrator, following the procedures described in the Scheme’s Protocol, and provided that this Claim is submitted: (a) in full observance of the waiting period of 30 days referred to in Section 1(c) and in Schedules 2 and 3 of the Scheme’s Protocol; (b) before the end of the Reporting Period; and (c) otherwise within the time limits set forth in Section 4 of the Scheme’s Protocol; and
  5.  has not received any prior payment from any other public source, including from any governmental or publically funded no-fault compensation scheme, as compensation for the Injury; and
  6. is not eligible to receive compensation from any other source for the Injury, or if eligible for such compensation, discloses the nature and full extent of such eligibility; and
  7. has no pending lawsuits or claims for compensation for the Injury; and
  8. agrees not to seek or make any claims for compensation from any other public source, including from any governmental or publically funded no-fault compensation scheme, for the Injury for as long as the Claim, and/or Receivable Claim, as applicable, is pending with the Scheme; and
  9. is not and does not represent a Patient in respect of whom the Administrator is by any applicable sanctions regime, including any UN Security Council sanctions regime, precluded from accepting a Claim and/or paying compensation under the Scheme.