We have received your details.

What happens next
Our team will review your responses and contact you to confirm the next steps. If you indicated that data may be available, we may ask what formats you can access (for example pharmacy claims or utilisation files).

What to prepare (if available)
Claims or utilisation data, dates of service, quantities, and amounts paid or reimbursed, as well as high level plan structure details. If you do not have records available, you may still be able to participate and we can explain options.

Important disclosures
Submitting this form does not determine eligibility and does not create an attorney client relationship. Eligibility is determined by the Court appointed Claims Administrator. This page is for general informational and claims assistance purposes only and does not constitute legal advice.