| Explantation Payment Option: Specific Eligibility Criteria and Terms. | ||
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Breast Implant Claimants who want to have their Dow Corning Breast Implants removed but do not have the funds to pay for the surgery may request the Claims Office to make arrangements to compensate the appropriate persons or entities (up to a maximum of $5,000) directly. The Claims Office shall be authorized to develop appropriate guidelines for direct payment to the appropriate person or entity who provided the explantation service upon receipt from the Claimant and surgeon of all documentation, including a signed release releasing the Claims Office, the Debtor, Reorganized Dow Corning, the Claimants Advisory Committee, and the Released Parties from any claims or actions arising out of the explant procedure. (Such release will not affect the Claimant's ability to recover benefits under the Settlement Program.) If the cost of explantation is less than the $5,000 Explantation Payment Option benefit, the Claims Office shall pay the difference between the actual cost and $5,000 to the Breast Implant Claimant. Prior to disbursing payment for the surgery to the appropriate persons or entities, the Claims Office shall obtain from the explanting surgeon and, if applicable, the pathologist, an agreement to complete any information necessary for the Explantation Payment Option Form, and if applicable, the Rupture Payment Option Form on behalf of the Breast Implant Claimant and cooperate with her and Claims Office to provide information relevant to these benefits. Claimants will not be denied an Explantation Payment if they participated in this direct payment procedure but were not explanted by the deadline for the Explantation Payment Option solely because the surgeon failed timely to return documents and/or releases. The Reorganized Dow Corning may, at its discretion, provide a list of surgeons who have advised the Reorganized Dow Corning of a willingness to perform explantation surgeries for up to $5,000. If such surgeon agrees, the Claims Office shall be authorized to release the names of such surgeon through the Claims Office, as provided above, then the Claimant must execute a release releasing the Claims Office, the Debtor, Reorganized Dow Corning, the Claimants Advisory Committee, and the Released Parties from any liability or claim arising out of such surgery (except that such release will not affect the Claimant's ability to recover benefits under this Settlement Program). Prior to releasing payment for the surgery to the appropriate persons or entities, the Claims Office shall obtain from the explanting surgeon and, if applicable, the pathologist an agreement to complete any information necessary for the Explantation Payment Option Form and, if applicable, the Rupture Payment Option Form on behalf of the Breast Implant Claimant and cooperate with her and the Claims Office to provide information relevant to these benefits. To obtain benefits under the Explantation Payment Option the Claimant must submit proof of explantation surgery and may be made by any of the following means: The itemized hospital bill; the bill from the explanting surgeon; the surgical report; an insurance company's statement of benefits; contemporaneous hospital records (including the hospital pathology report); the explanting surgeon's contemporaneous office notes; or a pre-operative medical document, together with confirmation from a medical provider or insurance company that surgery actually took place as scheduled. The Claims Office will not inquire about the Breast Implant Claimant's reason for choosing to have her Breast Implant(s) removed and will not deny benefits to Breast Implant Claimants based on the reason for explantation.
Each Eligible Breast Implant Claimant may receive only one payment under the
Explantation Payment Option, regardless of the number of qualifying
surgeries. |
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SECTION 6 -$5,000 EXPLANT PAYMENT PART A -CRITERIA FOR THE $5,000 EXPLANT PAYMENT T
The $5,000 Explant Payment is for removal of your Dow Corning breast
implant(s). To be eligible, your Q6-2. What documents do I need to submit to qualify for the $5,000 Explant Payment? Read Question 2 in the $5,000 Explant Payment Claim Form Instructions.
Q6-3. I plan to have (or I have just had) my Dow
Corning breast implants removed. Should I send the
No. Do not send any implants to the Settlement Facility unless you are
specifically requested to do so. If
Q6-4. Is there a list of plastic surgeons or other
qualified physicians who I can contact to remove my
The Settlement Facility does not have a list of physicians or surgeons who
are willing to do implant Q6-5. Can I receive payment for explant and other settlement benefits, such as Rupture?
Yes. Assuming you submit the necessary proof on or before the deadline for
each settlement benefit, you Q6-6. Do I need to have a medical reason for having my implants removed?
No. The Settlement Facility will not inquire about your reasons for choosing
to have your breast implants
Q6-7. I have had two (2) sets of Dow Corning breast
implants removed after December 31, 1990.
No. The $5,000 Explant Payment is a one-time payment regardless of the
number of eligible explant
Q6-8. Is the removal of other breast implants such
as those made by Mentor or Cox-Uphoff covered No. The Explant Payment is available only for the removal of Dow Corning breast implants. Q6-9. Are there any reductions to the $5,000 Explant Payment?
No.
No, the $5,000 Explant Payment will not be increased or decreased regardless
of the actual costs of your Q6-11. Does the $5,000 Explant Payment cover the costs of reconstruction? No. The Explant Payment is $5,000 regardless of your actual costs for implant removal or reconstruction. Q6-12. My implant removal surgery cost is $3,000. Will my Explant Payment be $3,000 or $5,000? The Explant Payment will be $5,000.
Q6-13. I had two (2) sets of breast implants. The
first (1st) breast implants were Silastic (Dow Corning
No. You must file acceptable proof of manufacturer for each set of Dow
Corning breast implants for
Q6-14. My Dow Corning breast implants were removed
in 1987. Am I eligible for the $5,000 Explant
No. To be eligible, your Dow Corning breast implants must have been
removed after
Q6-15. I can't afford to have the implant removal
surgery. Is there any financial assistance available
Yes. Submit the Proof of Manufacturer Form (the blue edge) and medical
records or documents that
Q6-16. Do I have to prove that I cannot afford the
implant removal surgery to be eligible for the No. Q6-17. Will the Explant Assistance cover all of my surgical costs?
No. The Explant Assistance Program will pay $5,000 for the removal of your
Dow Corning breast
Q6-18. If the costs paid to the physician by the
Explant Assistance Program are $4,000, will I be paid
Yes, the difference between the actual cost of the surgery and the $5,000
Explant Payment will be paid
Q6-19. My breast implants were removed in
1994 but I did not pay my plastic surgeon for the surgery.
No. Direct payment to your physician under the Explant Assistance Program is
not available to claimants
Q6-20. If I participate in the Explant
Assistance Program, how do I obtain my medical records from
We will make arrangements to have your medical records sent to us when your
Dow Corning breast
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$5,000 EXPLANT PAYMENT CLAIM FORM
Instructions |
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Use this form to apply for the $5,000 Explant Payment. Please read these Instructions I and Section 6 in the "Claimant Information Guide" for more information. 1. "What is the $5,000 Explant Payment?".
The
$5,000 Explant Payment is for removal of your Dow Corning breast implant(s).
To be eligible, your Dow 2. "What do I have to do to receive the $5,000 Explant Payment?"
First, complete and submit the Proof of Manufacturer Form (the blue
edge) and medical records or
Second, complete and submit the Explant Payment Claim Form (the
yellow edge) by the deadline and one
(a). an itemized hospital bill; or
3.
"Can I receive the $5,000 Explant Payment if I get Silicone Gel
breast implants to replace the Dow
The answer
depends on two (2) things: Please review the following standards carefully:
A. If your Dow Corning breast implant(s) were removed
during 1991 and you received any silicone gel or
B. If your Dow Corning breast implant(s)
were removed on or after January 1, 1992 and you I received
C. If your Dow Corning breast implant(s)
were removed, and you received only saline breast implants, and
4. "What types of Dow Corning breast implants are eligible for the $5,000 Explant Payment?"
The $5,000 Explant Payment is available for the removal of Dow Corning
saline, silicone gel and double lumen
5. "Can I recover the $5,000 Explant Payment if I
have two (2) sets Dow Corning breast implants No, you cannot recover more than one (1) $5,000 Explant Payment.
6. "I can't afford to have my Dow Corning breast
implants removed. Is there Financial Aid available so
Yes, there is an Explant Assistance Program that can assist you if you do
not have the money to have your 7. What is the Deadline to submit my Explant Payment Claim Form and Medical Records?"
You must submit the Explant Payment Claim Form and medical records on or
before ten (10) years after the
8. What if I have a problem or receive a "Deficiency
Notice" on my Explant Claim? Is there a |
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If your medical records meet the proof requirement described in Questions 2
and 3 above, then you will receive
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