The Vaccine Act established within the United States Court of Federal Claims an Office of Special Masters. When a petition for vaccine compensation is filed, the chief special master assigns the case to a special master who makes an initial determination as to whether entitlement to an award should be granted. In many cases, a trial is necessary to decide the issue of entitlement under the Program. Although the court is located in Washington, D.C., the entitlement hearing is often held in the state where the vaccine-injured party resides.

A finding of vaccine-causation is made in one of two ways. The claimant may show vaccine-causation by proving a specified injury occurred within a specified time period following vaccination. This entitles the claimant to a presumption of vaccine-causation that can only be rebutted if we establish, by preponderant evidence, a cause for the alleged injury other than the vaccine. If the claimant cannot meet the requirements for a presumptively vaccine-related injury, the claimant must prove vaccine-causation under more traditional standards of proof used in tort litigation. In either situation, these cases require the development of detailed factual evidence and medical evidence from experts in various medical specialties, such as neurology, pediatrics, immunology, rheumatology, epidemiology, infectious diseases, pathology and virology.

Once a determination of vaccine-causation is made, the claimant is generally entitled to compensation for actual and future unreimbursable medical expenses related to the vaccine injury. A life care planner is often retained to develop a life care plan to determine future medical and rehabilitative needs. Claimants are also entitled to lost wages, pain and suffering up to a jurisdictional maximum of $250,000, and reasonable attorney's fees and costs. Punitive damages are expressly prohibited. In cases resulting in a vaccine-related death, a death benefit of $250,000 is provided, and the estate of the decedent also may be eligible for actual unreimbursable expenses related to the vaccine injury resulting in death, as well as past pain and suffering and lost earnings. Cases that reach the compensation phase frequently are settled by the parties. Awards are paid from a trust fund, which is funded by an excise tax on vaccines.

Because of the severity of many vaccine injuries and the likelihood of lifelong future damages, vaccine cases require a complex economic analysis of the damage payments to be made to the injured party through lump sum payments, annuities, and/or reversionary trusts. The damages analysis may include interpretation of statutory compensation provisions and legal precedent for certain elements of damages. Consideration must also be given to other primary benefits to which the injured party is entitled such as private insurance, Medicare, and benefits under the Individuals With Disabilities Education Act (IDEA). Under the statute, these benefits may be offset against the vaccine compensation award. Medicaid-based programs are secondary to a Program award. Case law has determined that Social Security Disability Insurance benefits are not an offset against a vaccine compensation award, however.

Either party may appeal the special master's decision to the United States Court of Federal Claims. The Court of Federal Claims reviews the decision and enters judgment. The decision of the Court of Federal Claims may then be appealed to the United States Court of Appeals for the Federal Circuit, and ultimately the United States Supreme Court.

[updated April 20128]