This Scheme has two types of appeals forms:

All appeals forms must be completed in English. Forms submitted in any other language will be rejected. Only documents and other information required along with the Notice of Appeal of Denied Receivable Claim Form (as described in that form) may be completed in other languages.

All appeals forms must be completed, signed, and dated when they are sent to the Administrator or uploaded via the Upload Documents page. Otherwise, they will not be considered.

Appeal online

To submit an appeal online, please:

  1. Download, print, and complete the correct appeals form on paper. This is either Schedule 4 or Schedule 5 depending on the circumstances.
  2. Upload and submit the completed appeals form on upload documents.

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

Appeal by email

To submit an appeal by email:

  1. Download, print, and complete the correct appeals form on paper. This is either Schedule 4 or Schedule 5 depending on the circumstances.
  2. Email these scanned forms and documents as email attachments to [email protected].

Appeal by regular mail

To submit an appeal by regular mail:

  1. Download, print, and complete the correct appeals form on paper. This is either Schedule 4 or Schedule 5 depending on the circumstances.
  2. Mail these scanned forms and documents to one of the Scheme’s Regional Centres.
Scheme

The Covid-19 Vaccine Facility No-Fault Compensation Scheme, established to provide fair compensation to eligible vaccine recipients who suffer a Serious Adverse Event related to a COVID-19 vaccination that has been either:

  • procured and/or delivered by UNICEF on a Participating Country’s behalf;
  • donated to a Participating Country through UNICEF; or
  • formally included into the Scheme (but otherwise procured and/or delivered but not by or through UNICEF),

as detailed in the Scheme Protocol and its Schedules.

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.

Receivable Claim

Any duly completed Claim for compensation (i) that is accompanied by all Supporting Evidence, (ii) that is filed/submitted by a Claimant prior to the end of the Reporting Period with the Administrator, and (iii) that is found by the Administrator, and/or by the Administrator’s Vice President of Risk Consulting to be receivable as provided in Section 4 or Section 7 of the Scheme's Protocol.

Notice of Appeal of Denied Receivable Claim

An appeal filed by a Claimant, following the denial of his Receivable Claim by the Review Panel, in accordance with the procedure described in Section 8 of the Scheme's Protocol and using the form in Schedule 5 of the Scheme’s Protocol.

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.

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.