Claim Member Information
Payment Eligibility Information
Certify and Submit
This claim form should be filled out online or submitted by mail if you received a notification from Overlake Hospital Medical Center or Overlake Medical Clinics, LLC (collectively “Overlake”) relating to a cyberattack against Overlake’s computer systems that occurred in December 2019 (the “Data Incident”), and you had out-of-pocket expenses, fraudulent charges, lost time spent dealing with the Data Incident, or unreimbursed extraordinary monetary losses as a result of the Data Incident. You may get a check if you fill out this claim form, if the settlement is approved, and if you are found to be eligible for a payment. This claim form must be submitted by December 13, 2021.