Conclusion: The Applicant failed to timely file its second appeal and thus its appeal rights lapsed. Even if the appeal was timely, the Applicant did not document that 1) ambulance operation costs resulted directly from the disaster and 2) it pursued recovery of available insurance.
During an incident period from October 27 to November 8, 2012, Hurricane Sandy impacted New York City. The Applicant, which is a Private Nonprofit ambulance service, operates within the metropolitan area. FEMA prepared PW 2651 to document the Applicant’s ambulance operation costs, but determined the Applicant failed to establish those costs were a direct result of the disaster and did not award funding. FEMA also prepared PW 2654, which documented costs for damaged ambulances, medical supplies, and electronics. FEMA awarded funding but insurance proceeds, both received and anticipated, were deducted from the overall award. Through two separate first appeal letters dated September 30, 2016, the Applicant appealed FEMA’s determinations, requesting reimbursement of costs documented on PW 2651 and the anticipated insurance proceeds not funded through PW 2654. The Applicant asserted ambulance operation costs were previously determined eligible by FEMA personnel, and it never received anticipated insurance proceeds, asserting its insurance carrier had paid the “maximum allowable” under the policy. FEMA’s Region II Regional Administrator denied the appeals through two separate letters dated December 4 and 8, 2015, finding the Applicant did not document that the ambulance operation costs were for eligible work and that it pursued the maximum insurance recovery. The Applicant received the decisions on December 21, 2015 and filed a second appeal for both PWs, in an April 1, 2016 letter, reasserting its first appeal requests and arguments.
Authorities and Second appeals
- Stafford Act §§ 312, 403, and 423.
- 44 C.F.R. §§ 204.62(a), 206.201(a),(b), (c)(1), 206.206, 206.223(a)(1), 206.250.
- PA Guide, at 54.
- DAFS, DAP9580.104, Public Assistance for Ambulance Services, at 1.
- DAP9525.3 Duplication of Benefits, at 2.
- DAFS, DAP9580.3, Insurance Considerations for Applicants, at 2.
- Public Health Trust of Miami-Dade, FEMA-3259-EM-FL, at 2.
- Broward County School Board, FEMA-1609-DR-FL, at 2.
- Stafford Act § 423, as implemented by 44 C.F.R. § 206.206(c)(1), allows an applicant 60 days to file an appeal upon receipt of notice of an appealable action.
- The Applicant received notice of FEMA’s decision denying its first appeals on December 21, 2015. It filed its second appeal on April 1, 2016—100 days after it received notice and 40 days past the 60 day deadline. Thus, the appeal was not timely filed.
- Pursuant to Stafford Act § 312 and 44 C.F.R. § 206.250, FEMA must reduce the amount of assistance provided to an applicant by the amount of financial assistance the Applicant will receive from insurance.
- The Applicant failed to provide documentation establishing it pursued the maximum insurance recovery available. As such, FEMA cannot verify that the losses were not covered by insurance.