File a Claim

Claim Deadline: December 17, 2026

  • You must complete the Claim Form; AND

  • Upload Supporting Documents. A secure upload will appear after you click “Submit” for your Claim Form. COLLECT THESE SUPPORTING DOCUMENTS BEFORE YOU SUBMIT YOUR CLAIM FORM. Failure to submit supporting documents may result in the denial of your claim.

TWO WAYS TO SUBMIT YOUR CLAIM FORM:

  1. Online claim form: Can be accessed HERE

  • This is the preferred method of claims submission

OR

2. Printable / Email claim form PDF*

  • Submit the completed Claim Form to info@ierpsettlement.com

  • Wait to receive instructions on how to use a SFTP link to submit supporting document

  • Submit supporting documents

Download PDF Claim Form here

COLLECT YOUR SUPPORTING DOCUMENTS BEFORE YOU SUBMIT YOUR CLAIM FORM:

a. Eligibility Data

  • A copy of the 1099 form for each year employed as an independent ER physician, or 

  • A copy of the independent ER physician’s contract with the business staffing the emergency room for each year employed as an independent emergency room physician

  • Pay Records

  • Work Schedules

b. Damage Data

  • Cost of treatment charges and associated diagnostic codes 

  • Records of compensation received

  • Records of lost or reduced compensation

c. If Qualified Class Member is unable to reasonably access such Eligibility and/or Damage Data:

  • An affidavit (a form to be provided by the Claims Administrator for Class Member completion) under penalties of perjury detailing the reasons that s/he does not have reasonable access to such data AND 

  • An estimate of his lost or reduced compensation from Opioid Use Disorder (“OUD”) treatment together with a detailed explanation supporting that estimate.

Fraud Warning

  • A person who files a fraudulent claim on behalf of a Class Member may, at a minimum, be fined up to $500,000.00, imprisoned for up to five years, or both, in accordance with 18 U.S.C. §§ 152, 157. Class Members shall provide the information requested that is, to the best of their knowledge, current and valid as of the date this Claim Form is completed and delivered to the Notice and Claims Administrators.

file a claim