Disease/Expedited Release Forms

Before the Settlement Facility can review a claim for benefits, claimants must submit a signed Proof of Manufacturer form along with supporting medical records.  After the claimant establishes "acceptable" Proof of Manufacturer, the claim can be reviewed for benefits.  

Claims for Disease benefits will be reviewed only after the claimant submits a signed claim form for that benefit.  After the form is received, the claim is placed in line for review so claimants are urged to only submit a claim form and medical records when they have obtained all of the records needed to approve a claim for payment.  Claims are generally reviewed, to the extent practicable, in the order in which they are received.

If a claimant submits only a claim form for Disease benefits but has not established "acceptable" Proof of Manufacturer, the claim will not be reviewed.  Claimants with "acceptable" Proof of Manufacturer will not be reviewed for benefits until the desired benefits claim form and supporting medical records have been submitted. 

The deadline to apply for Rupture benefits, Silicone Materials benefits (Class 7), Other Products benefits (Class 9 and 10) and Explant benefits have expired.  For more information on settlement options, refer to Annex A To The Settlement Facility and Fund Distribution Agreement (Annex A), Article VI.

Disease Claim Forms

Disease Request for Review of Additional Information Form

How to File an Error Corrections Request

Disease Information Guide

Disease Frequently Asked Questions

Supplemental Disease Guidelines

The Appeals Process

Claims Administrator Letter