MDL 2179 In re: Oil Spill by the Oil Rig "Deepwater Horizon" in Gulf of Mexico on April 20, 2010 – Official Court-Authorized Website.

 

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Forms


Download the Printable Form version to handwrite your submission. Download the Fillable Form version to type your submission – please note you will still need to print this version and sign (wet signature) the form. All forms must be mailed to Claims Administrator. No electronic submissions will be accepted.


Form Name Description Download Link
Request for Review

If a claimant has submitted a Proof of Claim Form and receives a “Notice of Denial” of a claim for compensation for a Specified Physical Condition or for participation in the Periodic Medical Consultation Program, the claimant may request a one-time review of the Claims Administrator’s determination if he or she believes that the Claims Administrator has made a clearly erroneous factual determination. The claimant shall make a request in writing to the Claims Administrator within 14 days of receipt of a Notice of Denial, using the Request for Review Form. Submission of this form prior to receiving a Notice of Denial is premature. (MSA, Section V.M.)

Printable Version

Fillable Form
Class Membership Challenge Form

If a claimant has received a “Notice of Denial” based on a determination that the claimant is not a Medical Benefits Settlement Class Member, the determination may be challenged with the Court. The Class Membership Challenge Form must be submitted to the Claims Administrator within 60 days after the notice of the Claims Administrator’s determination is sent to the claimant.

Printable Version

Fillable Form
Notice of Intent to Sue

All Class Members applying for compensation from BP for a Later-Manifested Physical Condition (LMPC) must submit a Notice of Intent to Sue and all required documentation to support such claim. A Notice of Intent to Sue must be submitted within 4 years after either first diagnosis of that LMPC or the Effective Date, whichever is later. This form is NOT required in order to submit a claim for a Specified Physical Condition, or for participation in the Periodic Medical Consultation Program.

Printable Version

Fillable Form
Mediation Information

Any BP defendant named in a Notice of Intent to Sue may exercise an option to mediate. After a Class Member has received notification from the Claims Administrator that BP has requested mediation, the Class Member will have 60 days to submit this form. Submission of this form prior to receiving a Notice of Mediation is premature. This form is NOT required in order to submit a claim for a Specified Physical Condition, or for participation in the Periodic Medical Consultation Program.

Printable Version

Fillable Form
Specified Physical Condition Withdrawal

A Class Member may withdraw claims for designated Specified Physical Conditions. Use this form to withdraw your claim for any Specified Physical Condition for which you do not want the Claims Administrator to issue a determination. Please note that the withdrawal of a Specified Physical Condition does not result in the withdrawal of any documentation previously submitted to the Claims Administrator.

Printable Version

Fillable Form
Proof of Claim

Anyone applying for compensation for a Specified Physical Condition and/or participation in the Periodic Medical Consultation Program must submit a Proof of Claim Form and all required documentation to support such claim. All Proof of Claim Forms must be submitted no later than 1 year after the Effective Date. Please note that Notices of Determination or Denial will not be sent, and payments will not be made, until after the Effective Date.

Printable Version

Fillable Form