Submit a Claim - Claim Instructions

This Claim Form should be filled out online or submitted by mail if you had documented out-of-pocket expenses, fraudulent charges, lost time spent dealing with the Data Incident, documented, unreimbursed extraordinary monetary losses as a result of the Data Incident, or you wish to receive a pro-rata cash payment. Checks will be mailed, or electronic payments will be made, to eligible Settlement Class Members if the Settlement is approved by the Court.

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

Claim Forms must be submitted online or postmarked (if mailed) no later than September 23, 2024. Claims submitted after the deadline will be deemed untimely and may not be accepted.


Documentation:

If you plan to make a claim for reimbursement of Ordinary Out-of-Pocket Expenses or Extraordinary Loss Reimbursement, documentation must be provided to support your claim. Documents should be clear, readable copies, as 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, please have this information ready before you start to file, as your claim will not be saved if you have to come back and finish at a later time. 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.

Please Note: The Settlement Administrator may contact you to request additional documents to process your claim. Settlement benefits will be distributed after the Settlement Agreement is approved by the Court and becomes Final. Your cash payment may decrease depending on the number of claims filed.


File Online:

Before Claim Filing: You will need the Unique ID and PIN printed on the Postcard Notice that you received in the mail. If you did not receive a Postcard Notice or have lost yours, please contact the Settlement Administrator at info@NationwideSightcare.com for assistance.

During Claim Filing: As part of filling out your Claim Form, you will be asked to verify information associated with the losses claimed. You must also submit all required supporting documentation. Documents supporting your claim could include credit card statements, bank statements, invoices, telephone records, and receipts. Documented Loss costs cannot be documented solely by a personal certification, declaration, or affidavit from you. Supporting documentation should be clear, readable copies, as they will not be returned to you. Please keep copies of everything you submit, as your claim may be audited, and you could be asked to provide additional information to process the claim.

After Claim Filing: After submitting your completed claim 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 back to them if you have any questions about your Claim Form. If additional information is required to complete your claim, you will be contacted by the Settlement Administrator.

Please use the login below to get started.


Submit a Claim Form - Login
:*
:*

Where can I find my login information?



File by Mail:

If you wish to submit a Claim Form via standard mail, you may download a copy of the Claim Form here. You will need to provide all the information requested on the Claim Form, attach any supporting documentation, sign it, date it, and then mail it to the following address:

Nationwide Sightcare Data Incident
Settlement Administrator
P.O. Box 2713
Portland, OR 97208-2713

Remember: All Claim Forms must be submitted online or postmarked no later than September 23, 2024.