Example: barber

14 CIG Disease BOOKLET 5 8/10/02 3:50 pm Page 1

Disease CLAIMANTINFORMATION GUIDEDOW CORNING BREAST IMPLANT CLAIMANTS(CLASS 5)5-DCIG-ENG14_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 1A note about the use of capitalized terms in this Claimant InformationGuide:When you see capitalized terms that are not otherwise defined, theyhave the meaning assigned to them in the following documents in thefollowing Joint Plan2. Amended Disclosure Statement3. Dow Corning Settlement Program and Claims Resolution Procedures4. Funding Payment Agreement5. DCC Litigation Facility, Inc. Agreement (this document and the preceding ones in this list are collectively referred to as the Plan Documents )6. Bankruptcy CodeContact us at:Settlement Facility-Dow Corning Box 52429 Houston, Texas 77052(Toll Free) 2002 Disease CLAIMANT INFORMATION GUIDEDOW CORNING BREAST IMPLANT CLAIMANTS(CLASS 5)14_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 3 This Claimant Information Guide was produced by the office ofthe Settlement Facility-Dow Corning Trust.

disease claimant information guide dow corning breast implant claimants (class 5) 5-dcig-eng 14_cig_disease_booklet_5 8/10/02 3:50 pm page 1

Tags:

  Disease, Booklet, 14 cig disease booklet 5 8

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of 14 CIG Disease BOOKLET 5 8/10/02 3:50 pm Page 1

1 Disease CLAIMANTINFORMATION GUIDEDOW CORNING BREAST IMPLANT CLAIMANTS(CLASS 5)5-DCIG-ENG14_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 1A note about the use of capitalized terms in this Claimant InformationGuide:When you see capitalized terms that are not otherwise defined, theyhave the meaning assigned to them in the following documents in thefollowing Joint Plan2. Amended Disclosure Statement3. Dow Corning Settlement Program and Claims Resolution Procedures4. Funding Payment Agreement5. DCC Litigation Facility, Inc. Agreement (this document and the preceding ones in this list are collectively referred to as the Plan Documents )6. Bankruptcy CodeContact us at:Settlement Facility-Dow Corning Box 52429 Houston, Texas 77052(Toll Free) 2002 Disease CLAIMANT INFORMATION GUIDEDOW CORNING BREAST IMPLANT CLAIMANTS(CLASS 5)14_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 3 This Claimant Information Guide was produced by the office ofthe Settlement Facility-Dow Corning Trust.

2 The information contained in this Claimant Information Guide is intended to summarize the information contained in the Plan Documents. Any conflicts between the information in this Claimant InformationGuide shall be controlled by the provisions in the Plan Documents in the order reflected on the cover Claimant Information Guide may be copied freely without amendment or Settlement Facility reserves the right to make changes to the Claimant Information Guide without of publication: December 200214_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 4 For assistance or questions call Toll Freeat 1-866-874-6099 or go to CLAIMANT INFORMATION GUIDEDOW CORNING BREAST IMPLANT CLAIMANTS(CLASS 5)This Disease Claimant Information Guide provides information about the criteriafor receiving a Disease Payment.

3 Please use only these materials when you complete yourClaim Form (the red edge).TABLE OF CONTENTSSECTION 1 ELIGIBLE DISEASES AND GUIDELINES FOR PAYMENT ..2 SECTION 2 ELIGIBILITY GUIDELINES FOR Disease PAYMENT CLAIMS ..8 SECTION 3 HOW TO APPLY FOR A Disease PAYMENT ..9 SECTION 4 Disease OPTION 1 GUIDELINES ..10 SECTION 5 Disease OPTION 2 GUIDELINES ..14 SECTION 6 INCREASED SEVERITY PAYMENT FOR Disease OPTION 1 AND Disease OPTION 2 CLAIMS ..16 SECTION 7 PROCESSING OF Disease CLAIMS AND NOTIFICATION OF STATUS LETTERS ..17 SECTION 8 DEADLINES ..21 GLOSSARY OF TERMS ..22 TAB 1 MEDICAL CONDITIONS AND CHARACTERISTICS, OUTLINE OFDEFINITIONS, AND CLASSIFICATION CRITERIA ..2314_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 1 For assistance or questions call Toll Freeat 1-866-874-6099 or go to 1 ELIGIBLE DISEASES AND GUIDELINES FOR is the Disease Payment Option?

4 The Disease Payment Option provides payments ranging from $12,000-$300,000(including a Premium Payment) if you submit medical records and documents thatshow that you have one (1) of the diseases or conditions in Disease Option 1 orDisease Option 2 as listed in Q1-2. (Read the Claimant Information Guide for moreinformation about Base and Premium Payments.) are the eligible diseases and conditions?Eligible diseases and conditions in Disease Option 1 are:Atypical Connective Tissue Disease (ACTD)Atypical Neurological Disease Syndrome (ANDS)Primary Sjogren's Syndrome (PSS)Mixed Connective Tissue Disease (MCTD)/Overlap SyndromeSystemic Sclerosis/Scleroderma (SS)Systemic Lupus Erythematosus (SLE)Polymyositis (PM)Dermatomyositis (DM)Eligible diseases and conditions in Disease Option 2 are:Systemic Sclerosis/Scleroderma (SS) Systemic Lupus Erythematosus (SLE)Polymyositis (PM)Dermatomyositis (DM)General Connective Tissue Symptoms (GCTS) is the difference between Disease Option 1 and Disease Option 2?

5 Disease Option 1 uses the same medical criteria and definitions that were used in theoriginal global settlement. If you are familiar with the Revised Settlement Program(RSP), these same criteria were also used in the Fixed Amount Benefit diseases include both classic and atypical presentations of the rheumatic dis-eases listed in Q1-2. Disease Option 1 also includes two (2) conditions - AtypicalNeurological Disease Syndrome (ANDS) and Atypical Connective Tissue Disease (ACTD). You must document a disability or severity that is related to your compen-sable Disease or 1 Eligible Diseases and Guidelines for Payment14_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 2 For assistance or questions call Toll Freeat 1-866-874-6099 or go to diseases and conditions in Disease Option 2 were notpart of the original globalsettlement.

6 They were defined in the RSP and were contained in the Long TermBenefit Schedule. In general, the medical criteria to qualify for a Disease Option 2claim are more restrictive and require more medical documentation and laboratorytesting than those in Disease Option 1. You must document a disability or severitylevel that is related to your compensable Disease or condition. The payments forDisease Option 2 are higher than the payments for Disease Option 1. (Read Q1-4 formore information on the payment amounts.) are the payment amounts for approved Disease claims in Disease Option 1and Disease Option 2? Disease Option 1 Payments are determined by the disability or severity level of yourapproved Disease or OPTION 1 PAYMENT AMOUNTS** If you have acceptable proof that you have or had a Bristol, Baxter or 3M silicone gel breast implant, the Total Payment Amount will be reduced by 50%.

7 Any approveddisease inDisease Option 1with a Severity orDisability Level ofA, B, C or DYou must have proof that you have or had a Dow Corning breast implant and have not had a Bristol, Baxter or 3M silicone gel breast implant**Base+ Premium= TotalPaymentPaymentPaymentSeverity /Disability Level A$50,000+ $10,000= $60,000 Severity /Disability Level B$20,000+ $4,000= $24,000 Severity /Disability Level C or D$10,000+ $2,000= $12,000 SECTION 1 Eligible Diseases and Guidelines for Payment14_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 3 For assistance or questions call Toll Freeat 1-866-874-6099 or go to Option 2 Payments are determined by the severity levelof your approveddisease or OPTION 2 PAYMENT AMOUNTS ** If you have acceptable proof that you have or had a Bristol, Baxter or 3M silicone gel breast implant, the Total Payment Amount will be reduced by 50%.

8 Locate yourapproved Disease orcondition in DiseaseOption 2 below andthe Severity Level ofthat Disease or conditionYou must have proof that you have orhad a Dow Corning breast implantand have not had a Bristol, Baxter or3M silicone gel breast implant**Base+ Premium= TotalPaymentPaymentPaymentScleroderma (SS) or Lupus (SLE); Severity Level A$250,000+ $50,000= $300,000 Scleroderma (SS) or Lupus (SLE); Severity Level B$200,000+ $40,000= $240,000 Scleroderma (SS) or Lupus (SLE); Severity Level C$150,000+$30,000= $180,000 Polymyositis (PM) or Dermatomyositis (DM) (there is only one severity level for PM and DM);General Connective Tissue Symptoms (GCTS), Severity Level A$110,000+ $22,000= $132,000 General Connective Tissue Symptoms (GCTS); Severity Level B$75,000+ $15,000= $90,000 SECTION 1 Eligible Diseases and Guidelines for Payment14_CIG_Disease_BOOKLET_5 8/10/02 3:50 pm Page 4 For assistance or questions call Toll Freeat 1-866-874-6099 or go to should I submit my claim for the Disease Payment?

9 Complete and submit your Disease Payment Claim Form (the red edge) and medicalrecords onlyafter you:1. Complete and return the Proof of Manufacturer Form (the blue edge) and submit the medical records or documents that show that you were implanted with a Dow Corning breast implant. (Read the Proof of ManufacturerForm Instructions and Section 5 in the Claimant Information Guide for more information.);and2. Obtain all of the medical records and statements necessary to support your claim for an eligible Disease or condition and a related disability or severity level.(Review this Guide and Tab 1 for the medical criteria and documents you willneed.)

10 Do not send your medical records to the Settlement Facility in a piece-meal fashion. Once a Disease claim is received, the Settlement Facility will reviewand evaluate your claim based on the medical records in your file at that time. Ifyou have not submitted all of the necessary records, a letter notifying you of aproblem with your claim will be sent. You will have only one (1) year from the dateof the letter to correct the problem. (Read Q8-1 for more information.) do I have to submit the Proof of Manufacturer Form first?Your claim for a Disease Payment will be reviewed only after the Settlement Facilitydetermines that you have submitted acceptable proof that you were implanted witha Dow Corning breast implant (or your proof has only a minor deficiency as definedin Q5-12 in the Claimant Information Guide).


Related search queries