ATTENTION: This Claim Form is to be used to apply for monetary benefits from the settlement of a lawsuit with Defendant Valex Corporation (“Defendant” or “VALEX”). This class action lawsuit arises out of a targeted cyber-attack causing disruption to VALEX’s system, which was discovered by VALEX on or around July 1, 2021 (the “Data Security Incident”), and allegations concerning certain files allegedly accessed during the Data Security Incident that may have contained personally identifiable information (“PII”) about Valex’s current and former employees., including Social Security numbers. VALEX disagrees with Plaintiff’s claims in the Lawsuit and denies any wrongdoing.
To recover as a part of this Settlement, you must provide the information requested in this Claim Form for each applicable claim. PLEASE BE ADVISED that any documentation you provide must be submitted with this claim form.
You may submit claims in each applicable category below:
Compensation for ordinary losses attributable to the Data Breach, which include, but are not limited to:
Unreimbursed out-of-pocket expenses incurred as a result of the Data Breach, such as: (i) fees for credit reports; (ii) bank fees; (iii) long distance phone charges; (iv) cell phone charges (only if charged by the minute); (v) data charges (only if charged based on the amount of data used); (vi) postage; and (vii) gasoline for local travel;
Unreimbursed fees for documented fees for credit reports, credit monitoring, or other identity theft insurance product purchased between June 30, 2021 and November 7, 2023; and
Reimbursement for up to three (3) hours of lost time (calculated at the rate of $20.00 per hour) spent dealing with issues related to the Data Breach, if the Settlement Class Member submits a statement attesting to how the time spent was related to the Data Breach; and
Compensation for extraordinary unreimbursed proven monetary losses attributable to the Data Breach, if the loss: (i) is actual, documented, and unreimbursed; (ii) was more likely than not caused by the Data Breach; (iii) occurred between June 30, 2021 and July 1, 2021; (iv) is not already covered by one or more of the normal reimbursement categories; and (v) the Settlement Class Member made reasonable efforts to avoid, or seek reimbursement for such extraordinary losses, including, but not limited to, exhaustion of all available credit monitoring insurance and identity theft insurance.
The Settlement Notice describes your legal rights and options. Please review this website or call 1-833-338-0377 for more information.
II. CLAIM INFORMATION
Claim A-1: Ordinary Losses — Lost Time Reimbursement
Claim A-1: Ordinary Losses – Lost Time Reimbursement
Settlement Class Members are eligible for compensation for up to a total of $350.00 per person for Ordinary Losses, including expenses and lost time.
If you elect to obtain reimbursement for personal time addressing issues arising out of the Data Breach to try to prevent, detect, contest, remediate, and/or repair related damages as a result of the Data Breach, complete the following:
Number of Hours (Choose One):
If you will be claiming lost time benefits, you must provide a description of how the time you claimed above was spent dealing with issues relating to the Data Breach. After providing your statement you must then attest to your statement.
Provide a statement of how the time you claimed above was spent dealing with issues related to the Data Breach:
Attestation
Claim A-2: Documented Expense Reimbursement Resulting from the Security Data Incident:
To obtain reimbursement under this category, you must affirm one or more of the following, if applicable:
Please note that the above list of reimbursable documented ordinary out-of-pocket losses is not meant to be exhaustive, but is exemplary. You may make claims for any documented out-of-pocket losses that you believe are reasonably related to the Data Breach or to mitigating the effects of the Data Breach.
Please provide a description of each documented expense or loss claimed, the date of loss, the dollar amount of the loss, and the type of supporting documentation you will be submitting to support the loss.
You must provide ALL of this information for this claim to be processed.
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Claim C: Extraordinary Losses
To obtain reimbursement under this category, you must affirm the following:
I experienced proven monetary losses attributable to the Data Breach AND the loss is actual, documented, and unreimbursed AND the loss was more likely than not caused by the Data Breach AND the loss occurred between June 30, 2021 and November 7, 2023, AND the loss is not already covered by one or more the normal reimbursement categories AND I made reasonable efforts to avoid, or seek reimbursement for such extraordinary losses, including, but not limited to, exhaustion of all available credit monitoring insurance and identity theft insurance.
Certification
In order to be eligible for compensation under Claim C, you must certify below that you have made reasonable efforts to avoid or seek reimbursement for the loss.
I certify that I made reasonable efforts to avoid, or seek reimbursement for extraordinary losses, including, but not limited to, exhaustion of all available credit monitoring insurance and identity theft insurance.
Please provide documentation supporting both your claim and your associated expenses.
An example of documentation supporting your claim would include a letter from your health insurance company, financial institution, credit reporting agency, or another source informing you that a false health insurance claim had been filed or fraudulent financial loss had to be reversed.
An example of documentation supporting your associated expenses would include receipts, voided checks, bank statements, or other documents showing the amount of your losses and/or a detailed narrative description of what happened and what losses you incurred.
Failure to affirm or provide appropriate documentation will result in a delay in processing and may result in the denial of your claim.
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