Submit a Claim Form – Instructions

Settlement Class Members may submit a Claim Form to receive the following Settlement Benefits:

  1. Cash Payment A - Documented Losses: You may submit a Claim Form and provide reasonable documentation for up to $4,000 per Settlement Class Member;
  2. OR

  3. Cash Payment B – Alternate Cash: Instead of Documented Losses, without providing documentation, you may submit a Claim Form to receive a pro rata (a legal term meaning equal share) cash payment in the estimated amount of $75;
  4. AND

  5. Medical Record Monitoring: In addition to Documented Losses or Alternate Cash, you may also submit a Claim Form to receive two years of one bureau of a medical record and credit monitoring product.

Complete information about the Settlement and Settlement Class Member Benefits are available on the Frequently Asked Questions (FAQs) page of this website.

Claim Forms must be submitted online on January 10, 2027, or postmarked (if mailed) no later than January 10, 2027. Claim Forms submitted after the deadline will be deemed untimely and may not be accepted.

Documentation:

Settlement Class Members can choose to submit a claim of up to $4000 for reimbursement for documented expenses or a pro rata cash payment. Claimed reimbursements must be supported by documentary evidence. Documents should be clear, readable copies, and note that anything you submit will not be returned to you. You may redact unrelated transactions and all but the first four and last four digits of any account number (if applicable).

If you are filing online on this Settlement Website, please have this information ready before you start to file, as your Claim will not be saved if you must come back and finish later. Documents that are uploaded must be less than 20 MB per file and in one of these formats: jpg, jpeg, png, gif, tif, tiff, doc, docx, xls, xlsx, pdf, txt, rtf, or zip. If you are unable to electronically upload a copy of your documents as part of the online Claim Form, you will need to mail a printed Claim Form along with your documentation to the Settlement Administrator at Washington Gastroenterology Data Breach Incident Settlement Administrator, P.O. Box 6630, Portland, OR 97228-6630.

Please Note: The Settlement Administrator may contact you to request additional documents to process your Claim Form. Settlement Class Member Benefits will be distributed only after the Settlement Agreement is approved by the Court and becomes final.


File Online:

Before Claim Filing: You will need the Unique ID and PIN from your Postcard Notice. If you didn’t receive or have lost your Notice, contact the Settlement Administrator at 1-877-377-7781 or email info@WAGastroDataIncidentSettlement.com.

During Claim Filing: Depending on the type of Settlement Class Member Benefit you request, you may need to provide supporting documents with your Claim Form. Submit all reasonable documentation and keep copies, as your Claim may be audited and you could be asked for more information. For examples of acceptable documents, see FAQ 8.

After Claim Filing: After submitting your completed Claim Form online, you will receive an email with a confirmation code for your completed submission. Be sure to keep your confirmation email and code and refer to them if you have any questions about your Claim Form.

Please use the login below to get started.


Submit a Claim Form - Login
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How to File by Mail:

If you wish to submit a Claim Form via standard mail, you may download a copy of the Claim Form from the Important Documents Page. You will need to provide all the information requested on the Claim Form, sign it, date it, and then mail to the following address:

Washington Gastroenterology Data Breach Incident
Settlement Administrator
P.O. Box 6630
Portland, OR 97228-6630


Remember: All Claim Forms must be submitted online or postmarked by 11:59 PM PST on January 10, 2027.