Dear Doctor Letter

Disease and Disability Information
  1. New Protocol For Implants Implanted Prior to 1971

  2. Sample Approved Disease Option 1, Disability A Level Claim

  3. Sample Approved Disease Option 1, Disability B Level Claim

  4. Self-Care Questionnaire -- Claimants may consider completing and providing this questionnaire to their treating doctor or Qualified Medical Doctor (QMD) to use for the disability statement. For the questionnaire to be considered by the SF-DCT, the disability statement must state that the doctor reviewed the questionnaire and relied on it in making his or her determination.

  5. Disease Compensation Review Summary and Worksheet -- This is a worksheet that we believe SF-DCT claims reviewers may use for disease claims. It was developed in the original global settlement in 1994 so there is a section on "Age of Onset." The Dow Corning Settlement Plan does not consider age of onset so please disregard this section.

Requests for Re-Review, Error Correction and Appeal
  1. Request regarding Proof of Manufacturer Submission (file attached)

  2. Request regarding Rupture claim review (file attached)

NOTE: The CAC is working to obtain and post additional sample claims that have been approved by the SF-DCT.

Appeals Judge Decisions



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