Claim Form Selection

Claim Form Selection

If you have a Class Member ID, use the form below. 

Yes I have a Class Member ID

If you received a notice via mail or email, you have been assigned a Class Member ID. If you are having trouble locating your Class Member ID, please view this example email Notice or example mail Notice. You can also contact the Settlement Administrator  for your Class Member ID.


If you do not have a Class Member ID, use the form below.  

No I do not have a Class Member ID

If you did not receive a notice via mail or email, or if you can't find your notice, you may still submit a claim without a Class Member ID. If you use this form and are not found to be part of the Class, your Claim will be denied. You can also contact the Settlement Administrator for your Class Member ID before submitting your Claim. If you have a Class Member ID, do NOT use this form.






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For more information, please call 1-888-665-1127.

Documents

Please read for a full explanation of the settlement and your options and all applicable timelines.

Contact

Contact us with any inquiries, comments, and/or requests.

Submit W-9 Form

Click here to safely and securely submit a Claim Form.

Submit Claim Form

Submit Claim Form

Important Dates

  • Exclusion Deadline

    Tuesday, January 18, 2022

    If you want to exclude yourself from the class, you must mail your exclusion request so that it is postmarked or received no later than Tuesday, January 18, 2022. See FAQ #15 for more information.

  • Objection Deadline

    Tuesday, January 18, 2022

    If you want to object to the Settlement, you must file your objection(s) so that it is/they are postmarked or received no later than Tuesday, January 18, 2022. See FAQ #18 for more information.

  • Final Approval Hearing Date

    Tuesday, February 1, 2022

    The Court will hold the Final Approval Hearing at 11:00 a.m. on Tuesday, February 1, 2022.  See FAQ #20 for more information.

  • Claim Form Deadline

    Tuesday, February 15, 2022

    Workwell Class Members must file their Claim Form so that it is received no later than Tuesday, February 15, 2022. See FAQ #8 for more information.

  • Form W-9 Deadline

    Tuesday, February 15, 2022

    In order for Employer Class Members to receive their full settlement payment as soon as possible, they must submit a form W-9 so that it is received no later than Tuesday, February 15, 2022. See See FAQ #8 for more information.

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