Submit a Claim Form

To make a Qualified Claim, you must submit a completed and signed claim form.  Your claim must be received by the Class Administrator on or before MAY 2, 2019.  A claim form can be obtained by downloading the form here or by calling 1-800-741-4925

If the Treatment was not provided by the DOH, then you will need to show receipt of HAV vaccine, blood tests or IG shot by providing treatment documentation from a medical provider.

Return your completed claim by mail, fax or email to the Class Administrator so that it is received no later than MAY 2, 2019.  

  • To return your claim by fax, the Class Administrator’s fax number is: (888) 836-1124.
  • To return your claim by email, send your signed and scanned document to: claims@WaterlooHepA.com.

The mailing address of the Class Administrator is:

Waterloo Hep-A Settlement
c/o The Notice Company
P.O. Box 778
Hingham, MA  02043

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

FAILURE TO SUBMIT A VALID AND TIMELY CLAIM FORM SO THAT IT IS RECEIVED BY MAY 2, 2019 WILL BAR YOU FROM RECEIVING PAYMENT FROM THE SETTLEMENT.