Submit a Claim

Claim Form Login

To be eligible to make a Claim, your information must have been potentially impacted by the Data Incident, as indicated by your receipt of notice of the Data Incident in or around March 2024. If so, you are eligible to receive benefits from a proposed $675,000.00 class action Settlement Fund by submitting a claim.

If you wish to receive Medical Identity-Theft Monitoring and Protection Services, a Monetary Payment, or reimbursement for Out-of-Pocket Expenses and/or Extraordinary Losses, you must submit a Claim Form by November 11, 2025.

Eligible Settlement Class Members may submit a Claim Form for any or all of following Settlement Benefits:

  1. Medical Identity-Theft Monitoring and Protection Services: All Settlement Class Members who submit a valid Claim Form will be eligible to receive an activation code for two (2) years of three-bureau credit monitoring and additional protection services offered through CyEx Medical Shield Total. In addition to providing credit monitoring, this service monitors medical and healthcare data to help determine whether an individual's PHI is at risk or has been exposed to medical fraud.

  2. Reimbursement for Out-of-Pocket Expenses: Settlement Class Members may submit a claim for up to $500.00 for Out-of-Pocket Expenses upon submission of a valid Claim Form with an attestation regarding the Out-of-Pocket Expenses and Reasonable Documentation showing the Out-of-Pocket Expenses to be reimbursed;

  3. Reimbursement for Extraordinary Losses: Settlement Class Members may submit a claim for up to $2,500.00 for reimbursement of Extraordinary Losses upon submission of a valid Claim Form with an attestation regarding the actual and unreimbursed Extraordinary Losses incurred and Reasonable Documentation showing the Extraordinary Losses to be reimbursed;

  4. Monetary Payment: Settlement Class Members may submit a Claim for a Monetary Payment from the Net Settlement Fund after all other Settlement Benefits have been paid, including payment for all Claims for Medical Identity-Theft Monitoring and Protection Services, Out-of-Pocket Expenses, and Extraordinary Losses. The amount of the Monetary Payment will depend on the participation rate of the Settlement and other factors, as the Net Settlement Fund will be distributed on a pro rata basis to all Settlement Class Members who submit Approved Claims for Monetary Payment.

Please refer to the Long Form Notice or FAQs for more information on submitting a Claim Form and settlement benefits.

To start your online claim form, you can find your Notice ID & PIN printed on the Notice that was sent to you. If you misplaced your notice, please contact the Settlement Administrator at (844) 496-0751. Please request your Notice ID & PIN by providing your full name and mailing address.

You may also download a Claim Form here, and submit it, along with your supporting documentation, by U.S. mail to:

R1/Dignity Data Incident Settlement
c/o Settlement Administrator
P.O. Box 25226
Santa Ana, CA 92799

The deadline to submit a Claim Form online is November 11, 2025. If you are mailing your Claim Form, it must be mailed with a postmark date no later than November 11, 2025.