Claim Form

To receive a payment from the Settlement Fund, you must complete and submit this Claim Form by September 17, 2019. Please read this form carefully and follow the instructions below.

You may submit the Claim online by clicking "File a Claim" below, completing the required information, and clicking "Submit" by September 17, 2019. You may also print out and mail the form, available on the Important Documents page.


To begin your claim, please enter the Claim ID number included on the settlement notice you received. If you no longer have the notice, you may e-mail the Settlement Administrator for your Claim ID number at info@DoughertySettlement.com or click "File a Claim" to skip this step.