American Family Class Action Settlement Claim Form

To receive a payment from the Settlement Fund, you must complete and submit this Claim Form by April 20, 2020. Please read this form carefully and follow the instructions below.

FILL OUT THIS CLAIM FORM TO CLAIM YOUR SETTLEMENT BENEFITS OF UP TO 140% OF THE P0041 OR CODE 41 REDUCTIONS MADE TO YOUR BILLS.


You may also print out and mail the form, available on the Important Documents page.


To begin your claim, please enter your 10-digit Class Member ID number on the settlement notice you received (it is not required to file a claim).


If you do not have your Class Member ID number available, you may skip this step by clicking “File a Claim” below.