Claim Form Login

GENERAL INSTRUCTIONS

If you previously received a notice letter notifying you of the data incident Wasserstrom discovered in April 2023, you are a Settlement Class Member. The event that caused your data to be lost is referred to here as the “Data Incident.”

The Settlement establishes a $350,000.00 fund to compensate Settlement Class Members for their lost time and out-of-pocket losses or expenses as well as for the costs of notice and administration, and attorneys’ fees and expenses as awarded by the Court. As a Settlement Class Member, you are eligible for cash payments as reimbursement for your money spent in response to the Data Incident (such as money spent on credit monitoring or as a result of incidents of fraud or identity theft caused by the Data Incident), as well as for a pro rata cash payment. You must fill out this claim form to receive these benefits.

The benefits are as follows:

  1. Unreimbursed Economic Losses Expenses: You are eligible to receive reimbursement of actual, documented, Unreimbursed Economic Losses resulting from the Data Incident (up to $5,000.00 in total), upon submission of a claim and supporting documentation, for unreimbursed ordinary and/or extraordinary economic losses incurred as a result of the Data Incident, including, without limitation, unreimbursed losses relating to:

    • Fraud or identity theft;

    • Professional fees including attorneys’ fees, accountants’ fees, and fees for credit repair services;

    • Costs associated with freezing or unfreezing credit with any credit reporting agency;

    • Credit monitoring costs that were incurred on or after the Data Incident through the date of claim submission; and

    • Miscellaneous expenses such as notary, fax, postage, copying, mileage, and longdistance telephone charges.

  2. $100 Pro Rata Residual Cash Payment: After distributing funds for the claim’s payments set forth above to claimants, as well as attorneys’ fees, Class Counsel’s litigation expenses, and Administrative Fees, if there is any money left over, the Settlement Administrator will make pro rata settlement payments of the remaining Settlement Fund to each Settlement Class Member who submits a cash payment claim. The remaining amount of the Settlement Fund will be distributed pro rata for each Settlement Class Member who submits a claim, which may increase or decrease the $100.00 cash payment amount.

Note: that any Settlement Class Member who will receive payment of over $750 under this Settlement will be required to provide additional information, including their full name, gender, date of birth, and Social Security Number (last five digits at a minimum) or full Medicare Beneficiary Number to be eligible for payment.


The DEADLINE to submit this Claim Form online is December 17, 2024.


To complete this claim form, you must login. You can find your Claim Login ID & Claim Login PIN printed on the postcard Notice that was mailed to you. If you are unable to locate your ID & PIN, please contact us at (833) 285-3416.