If your personally identifiable information or protected health information was compromised as a result of the cyberattack that San Juan Regional Medical Center learned of or about September 8, 2020 (the “Cyberattack”), you are a Settlement Class Member and are eligible to complete this Claim Form to request two (2) years of Identity Defense Complete identity protection and credit monitoring service free of charge.
Please read the claim form carefully and answer all questions. Failure to provide required information could result in a denial of your claim.
This Claim Form may be submitted electronically or completed and mailed to the address below. Please type or legibly print all requested information, in blue or black ink. Mail your completed Claim Form, including any supporting documentation, by U.S. mail to:
SJRM Claims Administrator
1650 Arch Street, Suite 2210
Philadelphia, PA 19103
If you were notified by San Juan Regional Medical Center (“SJRMC”) that your Social Security, financial account, driver’s license, or passport numbers were potentially compromised as a result of the cyberattack that SJRMC learned of on or about September 8, 2020 (“Cyberattack”), you are a member of the Settlement Subclass and are eligible to complete this Claim Form to request two (2) years of Identity Defense Complete identity protection and credit monitoring service free of charge and/or compensation for unreimbursed losses, up to a total of $2,500 (“Unreimbursed Losses”).
Unreimbursed Losses include the following:
- Out-of-pocket expenses incurred as a result of the Cyberattack, including 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, or gasoline for local travel;
- Fees for credit reports, credit monitoring, or other identity theft insurance product purchased on or after the date on which the Settlement Subclass Member received written notice of the Cyberattack through October 13, 2022;
- Compensation for proven monetary loss, professional fees including attorneys’ fees, accountants’ fees, and fees for credit repair services incurred as a result of the Cyberattack; and
- Up to 3 hours of lost time at a rate of $17.50 per hour if at least one full hour was spent dealing with the Cyberattack.
Compensation for the above losses (except lost time) will only be paid if:
- The loss is an actual, documented, and unreimbursed monetary loss;
- The loss was more likely than not caused by the Cyberattack;
- The loss occurred between September 7, 2020 and February 8, 2023;
- You made reasonable efforts to avoid, or seek reimbursement for, the loss, including but not limited to exhaustion of all available credit monitoring insurance and identity theft insurance; and
- Documentation of the claimed losses is not “self-prepared.” Self-prepared documents, such as handwritten receipts, are, by themselves, insufficient to receive reimbursement.
Please read the claim form carefully and answer all questions. Failure to provide required information could result in a denial of your claim.
This Claim Form may be submitted electronically or completed and mailed to the address below. Please type or legibly print all requested information, in blue or black ink. Mail your completed Claim Form, including any supporting documentation, by U.S. mail to:
SJRM Claims Administrator
1650 Arch Street, Suite 2210
Philadelphia, PA 19103