If you received a personalized notice in the mail or via email with a Class ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Class ID exactly as it appears on your personalized Notice, (i.e. 12345678).

You may locate your Class ID and Confirmation Code in the footer of the Postcard that you received. Click HERE to see an illustration of the location.

You are a Settlement Class Member if you were notified that your personal information could have been accessed in a cyber-attack perpetrated on SuperCare in July 2021 (the “Data Incident”).

As a Settlement Class Member, you may be eligible to receive the following benefits:

  • Credit monitoring: All Settlement Class Members and California Subclass Members may claim one (1) year of three-bureau credit monitoring, including up to $1 million in fraud insurance coverage.
  • Tier 1 Benefits: All California Subclass Members may elect to claim a cash payment of $100.
  • Tier 2 Benefits: All California Subclass Members who elect to claim Tier 2 benefits (in lieu of Tier 1 benefits) and all other Settlement Class Members can claim up to $2,500 in out-of-pocket expenses that were incurred as a result of the Data Incident, including but not limited to receiving up to four (4) hours of lost time spent dealing with issues arising out of the Data Incident (calculated at the rate of $25 per hour).

Please read the Claim Form carefully and answer all questions. Failure to provide required information and/or supporting documentation could result in a denial of your claim.

I. CLASS MEMBER NAME AND CONTACT INFORMATION

Provide your name and contact information below. You must notify the Claims Administrator if your contact information changes after you submit this form.

* Required Fields

II. CREDIT MONITORING SERVICES
III. TIER 1: CALIFORNIA SETTLEMENT SUBCLASS MEMBERS

You are a California Subclass Member who is eligible to receive either a $100 cash payment with no supporting documentation required or out of pocket expense reimbursement up to $2,500 for documented expenses. By selecting the option to receive $100 cash payment, skip to Section VII Attestation and Signature.

IV. TIER 2: OUT-OF-POCKET EXPENSES (OTHER THAN LOST TIME)

All Settlement Class Members and California Subclass Members (who elect to claim Tier 2 benefits) can claim up to $2,500 in out-of-pocket expenses that were incurred as a result of the Data Incident, including, but not limited to: (i) unreimbursed bank fees; (ii) unreimbursed card reissuance fees; (iii) unreimbursed overdraft fees; (iv) unreimbursed charges related to unavailability of funds; (v) unreimbursed late fees; (vi) unreimbursed over-limit fees; (vii) long distance telephone charges; (viii) cell minutes (if charged by minute), Internet usage charges (if charged by the minute or by the amount of data usage and incurred solely as a result of the Data Incident), and text messages (if charged by the message and incurred solely as a result of the Data Incident); (ix) unreimbursed charges from banks or credit card companies; (x) interest on payday loans due to card cancellation or due to over-limit situation incurred solely as a result of the Data Incident; (xi) costs of credit report(s), credit monitoring, and/or other identity theft insurance products purchased by members of the Settlement Class between August 18, 2021 and the Claims Deadline; and (xii) other losses incurred by Settlement Class Members determined by the Claims Administrator to be fairly traceable to the Data Incident, including, but not limited to, the cost of postage and fuel for local travel.

Complete the chart below and provide supporting documentation for your unreimbursed out-of-pocket expenses.

To receive reimbursement for any of these out-of-pocket expenses, Settlement Class Members must submit supporting documentation of these expenses and a description of the loss below.

Cost Type Approximate Date of Loss Amount of Loss
+ Add Row
V. TIER 2: LOST TIME REIMBURSEMENT

California Subclass Members (who elect to claim Tier 2 benefits) and all other Settlement Class Members are eligible to receive up to four (4) hours of lost time spent on dealing with issues arising out of the Data Incident (calculated at a rate of $25 per hour). You must attest that you spent the lost time dealing with issues arising out of the Data Incident. Claims made for lost time are included in the $2,500 cap for out-of-pocket expenses.

Attestation

hours
VI. UPLOAD SUPPORTING DOCUMENTATION

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected.

Please confirm in the grid below that your file has been successfully uploaded.

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    VII. PAYMENT METHOD

    You have successfully requested a payment. Click here if you would like to choose a different payment method.

    VIII. ATTESTATION & SIGNATURE

    I swear and affirm that the information I have supplied in this Claim Form is true and correct to the best of my recollection, and that this form was executed on the date set forth below.

    I understand that all information provided on this Claim Form is subject to verification and that I may be asked to provide supplemental information by the Claims Administrator before my claim will be considered complete and valid.

    Your Claim Form has been submitted successfully.

    Claim Status – Provisionally Denied – You are not listed as an eligible class member and are not eligible to receive a settlement payment. The documentation you submitted is under review. A final determination will be made after the claim filing deadline on July 5, 2023. This final determination will be sent to the email address included on your claim form from Info@SupercareDataIncident.com. Please update your email account to include this email address is an authorized sender and monitor your junk or spam folders in the event that your security settings or policies erroneously route this final determination email.

    Claim Status – Provisionally Denied – You are not listed as an eligible class member and are not eligible to receive a settlement payment. You must submit supporting documentation that illustrates you were a customer of Supercare Health at the time the system was compromised in the July 2021 Data Incident no later than July 5, 2023. A copy of the initial notice sent to you from Supercare notifying you of the data incident will be considered sufficient evidence. Other forms of documentation must include information that would lead a reasonable person to conclude that more likely than not, you suffered losses as a result of the Supercare Data Incident. If you fail to submit this documentation a final claim determination notice will be sent to the email address included on your claim form from Info@SupercareDataIncident.com. Please update your email account to include this email address is an authorized sender and monitor your junk or spam folders in the event that your security settings or policies erroneously route this final determination email.

    Please print this page for your records.

    Your Claim Details
    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    Street Address 2
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    Email Address
    Telephone Number
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@SuperCareDataIncidentSettlement.com

    Click here to edit your Claim.

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