Claim Form

If you wish to receive a portion of the Settlement, you must make a claim as described below. Your Claim Form must be received by the Class Administrator on or before NOVEMBER 29, 2018.

A Claim Form can be obtained by downloading the form here. You may also obtain a Claim Form by calling 1-800-532-9250.

When submitting your claim, you must provide the information requested on the claim form to support and verify your claim. Acceptable proof of receiving IG, HAV vaccine, or HAV blood tests are:

  • signed statement,
  • documentation from a medical provider, and/or
  • verification by your health insurer.

Return your completed claim by mail, fax or email to the Class Administrator so that it is received no later than November 29, 2018.

The mailing address of the Class Administrator is:

Hawai’i Hep-A Claims
c/o The Notice Company
P.O. Box 455
Hingham, MA 02043

Claims may also be submitted

You must complete and submit a separate claim form for each person who received IG, HAV vaccine or HAV blood test.

You will not be entitled to receive a payment from this Settlement if you do not file a timely claim. If you wish to receive a portion of the Settlement, you must make a claim as described above. If your timely submitted claim form shows that you qualify as a Class Member, your claim will then be paid, following the Court’s approval of the Settlement.