Submit a Claim - Claim Instructions

If you were sent notice by UnityPoint Health in April and/or July 2018 that your personal information and/or protected health information may have been or was exposed to unauthorized third parties as a result of data security incidents, then you may be entitled to a payment from this Class Action Settlement. The only way to receive payment is to file a Claim. Claim Forms must be submitted online or postmarked no later than March 2, 2021. Claims submitted online after the deadline or postmarked after the deadline will be deemed untimely and may not be accepted.

You may file a claim to receive one year of credit monitoring services and/or for reimbursement of lost time, documented expenses, and/or monetary losses related to the security incident. For more information about the settlement benefits available, please review the Court-approved Notice, the Frequently Asked Questions (FAQs), and the Class Action Settlement Agreement. We also recommend you review the Claim Form to determine what forms of expenses are allowable and what forms of documentation are suggested if you plan to make a claim for reimbursement of documented Ordinary and/or Extraordinary Expenses.


Documentation:

If you plan to make a claim for reimbursement of documented Ordinary and/or Extraordinary Expenses, then documentation must be provided to support your Claim. Documents should be clear, readable copies, as anything you submit will not be returned to you. If you are filing online, please have this information ready before you start to file, as your Claim will not be saved if you have to come back and finish at a later time. If you are unable to electronically upload a copy of your documents as part of the online Claim Form, you will need to mail a printed Claim Form along with your documentation to the Claims Administrator. Acceptable documentation includes receipts, voided checks, bank statements, or other documents showing the amount of your losses and/or a detailed narrative description. When filing online, documents that you choose to upload must be less than 20 MB per file and in one of these formats: jpg, jpeg, png, gif, tif, tiff, doc, docx, xls, xlsx, pdf, txt, rtf, or zip.


File Online:

After clicking the button below, you will be asked to provide the Unique ID you received with your Notice from the Claims Administrator. If you did not receive a Notice or have lost yours, please contact the Claims Administrator to obtain your Unique ID. In this Claim Form, you will be asked to provide your contact information, detailed information about the losses you incurred, and any documentation you wish to provide to prove those losses. Please have all your documentation as described above ready, as your Claim will not be saved if you have to come back and finish at a later time.

Please click the button below to get started.


After submitting your completed claim online, you will receive an email with a Confirmation Code for your completed submission. Receipt of a Confirmation Code means your claim was successfully submitted. If additional information is required to complete your claim, you will be contacted by the Claims Administrator.


File by Mail:

If you wish to submit a Claim via standard mail, you may download a copy of the form here. You will need to provide all of the information requested on the Claim Form, attach any documentation, sign it, and date it. Then mail it to the following address:

UnityPoint Health Settlement
Claims Administrator
P.O. Box 4098
Portland, OR 97208-4098

Remember: All Claim Forms must be submitted online or postmarked no later than March 2, 2021.


What Happens After I File a Claim?

Once your Claim has been submitted, it will be reviewed for validity by the Claim Administrator. Accurate processing of Claims may take significant time. Thank you in advance for your patience.

If your Claim is determined to be invalid because it contains a defect with required documentation that could be cured, you will be notified and given one opportunity to address any deficiencies. If your Claim is invalid, and no documentation could cure the defect, your Claim will be rejected. If your Claim is determined to be valid, you will be eligible to receive benefits, depending on the results of the Final Fairness Hearing and any appeals that might occur. The Court in charge of this case still has to decide whether to approve the Settlement. Payments will not be made until the Court grants Final Approval and after any appeals are resolved.

It is your responsibility to update the Claims Administrator if you move or your contact information changes. You can provide your updated contact information by sending the information to the Claims Administrator at the following:

UnityPoint Health Settlement
Claims Administrator
P.O. Box 4098
Portland, OR 97208-4098
info@UPHSettlement.com

Please include this confirmation code and Unique ID (if applicable) with your correspondence.