Submit a Claim - Page 1

Class Member Information:

The Settlement Administrator will use this information for all communications regarding this Claim Form and the Settlement. If this information changes prior to the distribution of payments, you must notify the Settlement Administrator. If your Claim Form is approved, Settlement Class Member Benefits will be sent to you using the information you provide here.

Please Note: When the Settlement becomes final, and if your Claim Form is deemed eligible, if you select a payment by check, you will receive a check made payable to your legal name (as prepopulated above) will be sent to the address provided below. Otherwise, you will receive an electronic payment in the form you select.

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Claim Options

What kind of compensation would you like to receive?*

Cash Payment A : Documented Losses - If you have actual, documented, and unreimbursed costs, expenses, losses, or charges incurred as a result of identity theft or identity fraud, falsified tax returns, or other possible misuse of your Private Information attributed to the Data Incident, you are eligible to submit a Claim for a documented losses Cash Payment for up to $5,000, subject to the below requirements.

To receive a documented loss payment, you must (i) elect Cash Payment A in the Claim Form; (ii) attest under penalty of perjury to having communicated after-hours with a healthcare provider or their office between May 12, 2014 and May 12, 2024, and incurred documented losses attributed to the Data Incident; and (iii) provide a description of the documented losses along with supporting documentation that is not self-prepared.

You will not be reimbursed for losses if you have been reimbursed for the same losses by another source in connection with the identity protection and credit monitoring services offered as part of the notification letter provided by Defendants, or otherwise.

By making this selection, I affirm that I communicated after-hours with a healthcare provider or their office between May 12, 2014 and May 12, 2024.
  •  Yes  No
Cash Payment B : Alternate Cash Payment - Even if you do not have documented losses, you are eligible to submit a Claim for an alternate Cash Payment for a maximum amount of $75, subject to the below requirements.

To receive an alternate cash payment, you must: (i) elect Cash Payment B on the Claim Form; and (ii) attest under penalty of perjury to having communicated after-hours with a healthcare provider or their office between May 12, 2014 and May 12, 2024. In the event the amount of Valid Claims exhausts the Settlement Fund, the amount of the Cash Payments will be reduced pro rata accordingly.

For purposes of calculating whether any pro rata decrease to the amount of Cash Payments is necessary, the Settlement Administrator must distribute the funds in the Settlement Fund in the following order: (1) Dark Web and Medical Data Monitoring; (2) Cash Payment A – Documented Losses; and (3) Cash Payment B – Alternate Cash.

By making this selection, I affirm that I communicated after-hours with a healthcare provider or their office between May 12, 2014 and May 12, 2024.
  •  Yes  No

Would you like to receive Dark Web and Medical Data Monitoring?*

  •  Yes
  •  No