Claim Application Packages:

The first claim deadline under this Agreement has now passed.

 

In certain situations, some claimants may submit an application up to June 30, 2016.

 

Applications for deceased HCV Infected Class Members must be delivered to the Administrator within three years after the death of the Infected Class Member.

 

Please refer to the exceptions below for other situations that may apply in the case of alive HCV Infected Class Members and/or Family Members/Dependants of HCV Infected Class Members.

 

Section 5.01 of the Settlement Agreement states:

 

5.01 First Claim Deadline

 

(1) Except as otherwise expressly provided in this Agreement, the Administrator shall not consider an application made for the first time after June 30, 2010 under this Agreement except:

 

  • where a Class Member was infected with Hepatitis C after July 1, 1990 and fails to submit an application by no fault of their own; or
  • where an application is made by a Family Member or Dependant within one year following the date on which the application submitted on behalf of the HCV Infected Class member from whom the claim is derived was approved; or
  • where an application is made up to one year after the applicant attains his or her age of majority; or
  • where an application is made within three years following the date upon which the HCV Infected Class Member first learned of his or her infection with HCV as a result of receiving Blood in the Class Period or being infected by a Class Member who received Blood in the Class Period, and the Court having jurisdiction over that person grants them leave to apply for compensation.

 

If you have questions about your eligibility or require application forms, please contact the Help Desk at 1 866 334-3361.

 
  HCV Infected Class Members
 
•
 Instructions  
 
•
 FORM 1 General Information Form
 
•
 FORM 2 Treating Physician Form
 
•
 FORM 3 Statutory Declaration Form
 
•
 FORM 4 Authorization to Initiate Traceback Procedure
and/or to Release Traceback Information
 
•
 FORM 5 Blood Transfusion History Form
 
•
 FORM 6 Authorization for Release of Information by the HCV Infected Class Member or
HCV Personal Representative
(Including cases where medical records are unavailable)
 
•
 FORM 7 Authorization to Release Other Settlement Information
 
•
 FORM 8  Uninsured Funeral Expense Form
 
•
 FORM 9 Instructions for Claiming Past Loss of Income and/or Loss of Support

Past Loss of Income and/or Loss of Support Form
 
•
 FORM 10 Past Loss of Services in the Home Form
 
•
 Request Form Deficiency Deadline Extension
       
 
Family Members and/or Dependants - Full Application
 
•
 Instructions  
 
•
 FORM A Family Member and/or Dependant Form
 
•
 FORM B Authorization to Release Other Settlement Information
 
•
 Request Form Deficiency Deadline Extension

Important Notice!

Any person who submits a claim form to the Administrator containing intentionally inaccurate and/or false information in order to obtain undue benefits under the Agreement is liable to criminal and/or civil action.


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