Submit a Claim - Claim Instructions


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If you are an individual who was notified that your Personal Information was potentially compromised as a result of a network security incident (the “Network Incident”) impacting Empress Ambulance Service, LLC’s (“Empress”) computer systems, you are a Class Member.

As a Class Member, you are eligible to make a claim for:

  1. twelve months of Credit Monitoring and Insurance Services;

    AND

  2. one of the following two options for a cash Settlement Payment:

    • up to a $10,000 cash payment for reimbursement of Documented Losses that are supported by Reasonable Documentation and determined by the Settlement Administrator to be more likely than not a result of the Empress Network Incident, and not otherwise reimbursable by insurance (“Documented Loss Payment”);

      OR

    • a pro rata Cash Fund Payment, the amount of which will depend on the number of Class Members who participate in the Settlement.

The Credit Monitoring and Insurance Services are offered through TransUnion and will include the following services, among others: (i) up to $1,000,000 of identity theft insurance coverage; and (ii) 12 months of three-bureau credit monitoring providing, among other things, notice of changes to the Class Member’s credit profile. If you already subscribed to credit monitoring services through a previous offer of credit monitoring from Empress, or from another provider obtained as a result of the breach, you will have the option to postpone the commencement of the Credit Monitoring and Insurance Services by up to 12 months for no additional charge.

Cash Fund Payments may be reduced or increased pro rata (equal share) depending on how many Class Members submit claims. Complete information about the Settlement and Settlement Benefits are available in the Notice and on the Frequently Asked Questions (FAQs) page of this website.

Please complete this Claim Form on behalf of the individual who received a notification from Empress. If you are the parent of a minor(s) who received a breach notification, please submit the form using the minor(s)’s personal information.

Claim Forms must be submitted online or postmarked (if mailed) no later than May 8, 2024. Claims submitted after the deadline will be deemed untimely and may not be accepted.


Documentation:

If you plan to make a claim for reimbursement of out-of-pocket expenses, documentation must be provided to support your claim. Documents should be clear, readable copies, as anything you submit will not be returned to you. You may redact unrelated transactions and all but the first four and last four digits of any account number (if applicable). See the table below for examples of sufficient documentation for expense types.

Expense Type Examples of Documentation Required
Unreimbursed fraud losses or charges. Account statement with unauthorized charges highlighted; Correspondence from financial institution declining to reimburse you for fraudulent charges.
Professional fees incurred in connection with identity theft or falsified tax returns. Receipt for hiring service to assist you in addressing identity theft; Accountant bill for re-filing tax return.
Lost interest or other damages resulting from a delayed state and/or federal tax refund in connection with fraudulent tax return filing. Letter from IRS or state about tax fraud in your name; Documents reflecting length of time you waited to receive your tax refund and the amount.
Credit freeze. Notices or account statements reflecting payment for a credit freeze.
Credit monitoring that was ordered after July 14, 2022 through the date on which the Credit Monitoring and Insurance Services become available through this Settlement. Receipts or account statements reflecting purchases made for credit monitoring and insurance services.
Miscellaneous expenses such as notary, fax, postage, copying, mileage, and long- distance telephone charges. Phone bills, gas receipts, postage receipts; detailed list of locations to which you traveled (i.e. police station, IRS office), indication of why you traveled there (i.e. police report or letter from IRS re: falsified tax return) and number of miles you traveled to remediate or address issues related to the Empress Ambulance Network Incident.

If you are filing online, please have this information ready before you start to file, as your claim will not be saved if you have to come back and finish at a later time. Documents that are uploaded must be less than 20 MB per file and in one of these formats: jpg, jpeg, png, gif, tif, tiff, doc, docx, xls, xlsx, pdf, txt, rtf, or zip. If you are unable to electronically upload a copy of your documents as part of the online Claim Form, you will need to mail a printed Claim Form along with your documentation to the Settlement Administrator.

Please Note: The Settlement Administrator may contact you to request additional documents to process your claim. Settlement benefits will be distributed after the Settlement Agreement is approved by the Court and becomes Final. Your cash payment may decrease depending on the number of claims filed.


File Online:

Before Claim Filing: You will need the Unique ID printed on the Notice that you received in the mail. If you did not receive a Notice or have lost yours, please contact the Settlement Administrator at 1-888-482-4942 for assistance

During Claim Filing: As part of filling out your Claim Form, you will be asked to verify information associated to the losses claimed. You must also submit all required supporting documentation. Documents supporting your claim could include credit card statements, bank statements, invoices, telephone records, and receipts. Documented Loss costs cannot be documented solely by a personal certification, declaration, or affidavit from you. Supporting documentation should be clear, readable copies, as they will not be returned to you. Please keep copies of everything you submit, as your claim may be audited, and you could be asked to provide additional information to process the claim.

After Claim Filing: After submitting your completed claim online, you will receive an email with a confirmation code for your completed submission. Be sure to keep your confirmation email and code and refer back to them if you have any questions about your Claim Form. If additional information is required to complete your claim, you will be contacted by the Settlement Administrator.

Please click the button below to get started.


Start Your Claim


File by Mail:

If you wish to submit a Claim Form via standard mail, you may download a copy of the Claim Form here. You will need to provide all the information requested on the Claim Form, attach any supporting documentation, sign it, date it, and then mail it to the following address:

Finn v. Empress Ambulance
Empress Ambulance Settlement Administrator
PO Box 2059
Portland, OR 97208-2059

Remember: All Claim Forms must be submitted online or postmarked no later than May 8, 2024.