Documented Loss Payment Clause Samples

Documented Loss Payment. Class Members may submit a claim for a Settlement Payment of up to $10,000 for reimbursement in the form of a Documented Loss Payment. To receive a Documented Loss Payment, a Class Member must choose to do so on their Claim Form and submit to the Settlement Administrator the following: (i) a valid Claim Form electing to receive the Documented Loss Payment benefit; (ii) an attestation regarding any actual and unreimbursed Documented Loss made under penalty of perjury; and (iii) Reasonable Documentation that demonstrates the Documented Loss to be reimbursed pursuant to the terms of the Settlement and that the loss is more likely than not related to the Data Breach. If a Class Member does not submit Reasonable Documentation supporting a Documented Loss Payment claim, or if a Class Member’s claim for a Documented Loss Payment is rejected by the Settlement Administrator for any reason, and the Class Member fails to cure his or her claim, the claim will be rejected and the Class Member’s claim will instead be automatically placed into the Cash Fund Payment category described below at the discretion of the Settlement Administrator.

Documented Loss Payment. You may submit a timely and valid Claim Form and provide supporting Reasonable Documentation that you spent money or incurred losses related to the Data Breach for up to $10,000 per person. Examples of Reasonable Documentation include (but are not limited to): credit card statements, bank statements, invoices, telephone records, screen shots, and receipts. Documented Loss costs cannot be documented solely by a personal certification, declaration, or affidavit from the Claimant; a Class Member must provide supporting documentation. You will not be reimbursed for expenses if you have been reimbursed for the same expenses by another source, including compensation provided in connection with the credit monitoring and identity theft protection product offered as part of the notice provided by Defendant. If you file a claim for a Documented Loss Payment and don’t submit qualifying documentation, or if your claim is deemed incomplete by the Settlement Administrator, and you do not cure your Claim Form, the Settlement Administrator may automatically treat and consider your claim as eligible for a Cash Fund Payment at the Settlement Administrator’s discretion.

Documented Loss Payment. You may submit a timely and valid Claim Form and provide supporting Reasonable Documentation that you spent money or incurred losses related to the Data Breach for up to $10,000; OR

Documented Loss Payment. Class Members may also submit a claim for a Settlement Payment of up to $10,000 for reimbursement in the form of a Documented Loss Payment. To receive a Documented Loss Payment, a Class Member must choose to do so on their Claim Form and submit to the Settlement Administrator the following: (i) a valid Claim Form electing to receive the Documented Loss Payment benefit; (ii) an attestation regarding any actual and unreimbursed Documented Loss; and (iii) Reasonable Documentation that demonstrates the Documented Loss to be reimbursed pursuant to the terms of the Settlement. If a Class Member does not submit Reasonable Documentation supporting a Documented Loss Payment claim, or if a Class Member’s claim for a Documented Loss Payment is rejected by the Settlement Administrator for any reason, and the Class Member fails to cure his or her claim, the claim will be rejected.

Documented Loss Payment. Please check off this box for this section if you are electing to seek reimbursement for up to $10,000 of documented losses you incurred that are more likely than not traceable to the Data Breach and not otherwise reimbursed by any other source. Documented losses include unreimbursed losses and consequential expenses that are more likely than not related to the Data Breach and incurred on or after June 6, 2024. In order to make a claim for a Documented Loss Payment, you must (i) fill out the information below and/or on a separate sheet submitted with this Claim Form; (ii) sign the attestation at the end of this Claim Form (section VIII); and (iii) include Reasonable Documentation supporting each claimed cost along with this Claim Form. Documented losses need to be deemed more likely than not due to the Data Breach by the Settlement Administrator based on the documentation you provide and the facts of the Data Incident. Failure to meet the requirements of this section may result in your claim being rejected by the Settlement Administrator. If your claim for a Documented Loss Payment is rejected and you fail to cure the defect, your claim will automatically be considered as a claim for a Cash Fund Payment. ⭘ Unreimbursed fraud losses or charges ⭘ Professional fees incurred in connection with identity theft or falsified tax returns ⭘ Lost interest or other damages resulting from a delayed state and/or federal tax refund in connection with fraudulent tax return filing ⭘ Credit freeze (mm/dd/yy) / / (mm/dd/yy) / / (mm/dd/yy) / / (mm/dd/yy)

Documented Loss Payment. You may elect to submit a Claim Form for reimbursement of Documented Losses. If you spent money or time remedying or addressing identity theft and fraud that more likely than not resulted from the Cyberattack, or you spent money or time to protect yourself from future harm because of the Cyberattack, you may make a claim for a Documented Loss Payment for reimbursement of up to $7,500.00 in Documented Losses. Documented Losses consist of unreimbursed losses incurred on or after May 10, 2023, that you attest are fairly traceable to the Cyberattack. For example, Documented Losses include (a) unreimbursed costs, expenses, amounts or charges incurred as a result of identity theft or identity fraud, falsified tax returns, or other possible misuse of a Settlement Class Member’s private information; (b) unreimbursed costs incurred on or after May 10, 2023, associated with accessing or freezing/unfreezing credit reports with any credit reporting agency; (c) other unreimbursed miscellaneous expenses incurred related to any out-of-pocket expenses such as notary, fax, postage, copying, mileage, and long-distance telephone charges; (d) other mitigative costs that were incurred on or after May 10, 2023, through the date of the Settlement Class Member’s claim submission; and (e) unpaid time off work to address issues fairly traceable to the Cyberattack at the actual hourly rate of that Settlement Class Member. To protect the Settlement Fund and valid claims, all Claim Forms submitted that seek payment related to Documented Losses will be carefully scrutinized by the Settlement Administrator. Claims for Documented Loss Payments must be supported by Reasonable Documentation. Reasonable Documentation means written documents supporting your claim, such as credit card statements, bank statements, invoices, telephone records, and receipts. To receive a Documented Loss Payment, you must submit a completed Claim Form electing to receive a Documented Loss Payment. Claim forms may be submitted online, by printing a paper claim form from the Settlement Website and submitting it by mail, or by requesting a paper claim form by telephone from the Settlement Administrator and submitting it by mail.

Documented Loss Payment. In the event a Participating Settlement 11 Class Member does not submit a Claim for a Cash Fund Payment then that Participating Settlement 12 Class Member may submit a claim for a Settlement Payment of up to $5,000 for reimbursement in 13 the form of a Documented Loss Payment. To receive a Documented Loss Payment, a Settlement 14 Class Member must choose to do so on their given Claim Form and submit to the Settlement 15 Administrator the following: (i) a valid Claim Form electing to receive the Documented Loss 16 Payment benefit; (ii) an attestation regarding any actual and unreimbursed Documented Loss; and

Documented Loss Payment. In addition to CMIS, and as an alternative to the Cash Fund Payment (defined in subsection (c) below), Class Members may submit a claim for a Settlement Payment of up to $5,000.00 per Class Member for reimbursement in the form of a documented loss payment (“Documented Loss Payment”). To submit a valid Claim for a Documented Loss Payment, a Class Member must submit the following: (i) a valid Claim Form to the Settlement Administrator electing to receive the Documented Loss payment benefit; (ii) an attestation regarding any actual and unreimbursed Documented Loss made under penalty of perjury; and (iii) Reasonable Documentation that demonstrates to the satisfaction of the Settlement Administrator the Documented Loss to be reimbursed pursuant to the terms of the Settlement. If a Class Member does not submit Reasonable Documentation supporting a Documented Loss Payment claim, or if a Class Member’s claim for a Documented Loss Payment is rejected by the Settlement Administrator for any reason, and the Class Member fails to cure his or her claim, the claim will be rejected and the Class Member’s claim will instead be automatically placed into the Cash Fund Payment category below.

Documented Loss Payment. Class Members may submit a claim for a Settlement Payment of up to $10,000 for reimbursement in the form of a Documented Loss Payment. To receive a Documented Loss Payment, a Class Member must choose to do so on their Claim Form and submit to the Settlement Administrator the following: (i) a valid Claim Form electing to receive the Documented Loss Payment benefit; (ii) an attestation regarding any actual and unreimbursed Documented Loss made under penalty of perjury; and (iii) Reasonable Documentation that demonstrates the Documented Loss to be reimbursed pursuant to the terms of the Settlement. Claimants who submit a Claim Form for a Documented Loss Payment will not be permitted to make a claim for the Cash Fund Payment provided for under 3.2(b) below. If a Class Member does not submit Reasonable Documentation supporting a Documented Loss Payment claim, or if a Class Member’s claim for a Documented Loss Payment is rejected by the Settlement Administrator for any reason, and the Class Member fails to cure his or her claim, the claim will be rejected and the Class Member’s claim will instead be automatically considered a claim for a Cash Fund Payment, discussed below.