Submit a Claim

Claim Form Login

Welcome to the In re: Clarke County Hospital Online Claim Form submission page.

Your claim must be submitted online or postmarked by: JANUARY 31, 2025

GENERAL INSTRUCTIONS

You are included in the Settlement Class if you received a Notice Letter from Clarke County Hospital (“CCH”) notifying you that your private information was compromised in the Data Incident. Excluded from the Settlement Class are: the Judge assigned to the Action, and that Judge’s immediate family and Court staff. Data Incident is the targeted cyberattack on the CCH’s computer systems that occurred on or about April 14, 2023, in which certain files that contained private information were allegedly accessed by an unauthorized individual.

YOU MUST COMPLETE A CLAIM FORM IF YOU ARE A CLASS MEMBER AND WISH TO RECEIVE ONE OR BOTH OF THE FOLLOWING SETTLEMENT BENEFITS

AVAILABLE BENEFITS

You are not limited to one benefit. If you are eligible for multiple benefits, as described below, you may file a claim for each of them.

Identity Theft Protection Services: All Class Members may claim one year of identity theft protection services provided by a credit monitoring bureau. This protection includes up to $1 million in identity theft insurance.

Reimbursement for Out-of-Pocket Expenses: Class Members may submit a Claim for reimbursement of documented out-of-pocket losses reasonably traceable to the Data Incident. Current or former CCH employees may claim up to $350 in reimbursements for Out-of-Pocket Expenses, and current or former patients of CCH may claim up to $250 in Out-of-Pocket Expenses. Out-of-Pocket Expense Claims include:

  • unreimbursed bank fees;
  • long distance phone charges;
  • cell phone charges (only if charged by the minute);
  • data charges (only if charged based on the amount of data used);
  • postage
  • freezing or unfreezing credit reports (with demonstration that a free freeze was not available)
  • copying or scanning, or faxing incident pertinent information;
  • fees for identity theft protection services and plans; and/or
  • gasoline for local travel.

You must submit documentation, such as receipts, to verify the costs you incurred. You may submit “self-prepared” documents to add clarity or support to other submitted documentation, but self-prepared documents by themselves are not sufficient to file a valid claim.

Lost Time Reimbursement: Class members who spent at least one full hour dealing with the Data Incident may claim up to 4 hours, at $25 per hour, for lost time. This benefit may be combined with Reimbursement for Out-of-Pocket Expenses, subject to the caps described above.

You must submit a brief description of how you spent this time, and attest that this time was spent responding to issues raised by the Data Incident.

Reimbursement for Actual Monetary Loss (Extraordinary Loss Reimbursement):Class Members who suffered an actual, documented monetary loss as a result of the Data Incident beyond the Out-of-Pocket Expenses may claim reimbursement for the loss. Current or former CCH may claim up to $3,500 in Extraordinary Loss Reimbursement, and current or former CCH patients may claim up to $1,500 in Extraordinary Loss Reimbursement. The losses must:

  • be actual, documented, and unreimbursed;
  • be more likely than not caused by the Data Incident;
  • have occurred between April 14, 2023, and January, 31, 2025; and
  • not have already covered by one or more of the other benefits, as described above.

You must also have tried to avoid these losses, or tried to get reimbursed from other sources, if possible.

For all cash benefits, you must also attest under penalty of perjury that these expenses or losses resulted from dealing with the Data Incident.


To start your online claim form, please login using your Unique ID and PIN found at the top of your email Notice. If you are unable to locate your ID & PIN, please contact us by emailing info@CCHDataSettlement.com. Please request your Unique ID & PIN by providing the Class Member’s full name and mailing address.

You may also download, print out and complete a Claim Form, and submit it by U.S. mail to: CCH Data Settlement, c/o Settlement Administrator, PO Box 25226, Santa Ana, CA 92799. An electronic image of the completed Claim Form can also be submitted by email to info@CCHDataSettlement.com.

The deadline to submit a Claim Form online is January 31, 2025. If you are mailing your Claim Form, it must be mailed with a postmark date no later than January 31, 2025.