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 FEBRUARY 15, 2019.

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

DO YOU NEED TO ATTACH DOCUMENTATION?

  • If your treatment was not covered by insurance or if you do not identify on your Claim Form an insurer who covered your treatment, then you must show receipt of IG, HAV vaccine, or blood tests by providing documentation from a medical provider. Your receipt of IG, HAV vaccine, or blood tests is subject to verification.
  • No documentation required if your treatment was covered by insurance as identified on your claim form.
  • No receipts required from Genki Sushi or other locations where you consumed food.

Return your completed claim by mail, fax or email to the Class Administrator so that it is received no later than FEBRUARY 15, 2019.

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.