Claims Packet
Claim Packet Information
CRITICAL CLAIM DOCUMENTS:
This section contains all the documents and information necessary to complete the claim process. You may submit your claim electronically or by mail. These documents may be printed off the web site, or you may write to the Trust and we will send you the documents that you request.
Claim Filing Instructions (07/11/06)
Electronic Claim Template (to be filed by law firm representing claimant) (06/18/2008) (Microsoft Access Required)
The Electronic Claim Template is not supported if you utilize Microsoft Office 2000/2007. Please contact the trust if you have any questions.
Claim Form
Full Claim Form (09/06)
Section 4: Diagnosis (09/06)
Section 5: Chest X-Ray (09/06)
Section 6: CT Scan (09/06)
Section 7: Pulmonary Function Test (09/06)
Section 8: Pathology Report (09/06)
Section 9: Dependent & Beneficiary (09/06)
Section 10: Land Exposure (09/06)
Section 11: Shipboard Exposure (09/06)
Section 12: Secondary Exposure (09/06)
Section 15: Asbestos Litigation (09/06)
Section 16: Signature Page (09/06)
Claim Checklists
Checklist - Grade I Asbestosis (09/15/04)
Checklist - Grade I Enhanced Asbestosis (09/15/04)
Checklist - Grade II Asbestos Related Pleural Disease (09/15/04)
Checklist - Grade I Serious Asbestosis (09/15/04)
Checklist - Lung Cancer (09/15/04)
Checklist - Mesothelioma (09/15/04)
Checklist - Other Cancer (09/15/04)
Trust Approved Interrogatories
California Claim Form Interrogatories — Personal Injury (PDF)
California Claim Form Interrogatories — Personal Injury ) (Word)
California Claim Form Interrogatories — Wrongful Death (PDF)
California Claim Form Interrogatories — Wrongful Death (Word)
Minnesota Claim Form Interrogatories (11/09/04)
Sample Verification for Answers to Interrogatories (08/19/04)
Litigation Declaration
Litigation Declaration — Claimant (08/12/04)
Litigation Declaration — Attorney (08/12/04)
Traditional Occupation List
Occupational List (07/26/05) (PDF)
Occupational List (07/26/05) (Excel)
Disclaimer
Pursuant to Section VII, subsection b, of the Case Valuation Matrix, the site/ship lists may be modified in light of additional evidence or experience with claims processing. However, if a claim is submitted with exposure at a site or on a ship which is subsequently removed from the approved list after the claim was submitted and before it is approved for payment, the claim's filing fee will be fully refunded.
Site List
California On Land Site List (03/06/2009) (PDF)
California On Land Site List (03/06/2009) (Excel)
California On Land Site List_Deleted Sites
Minnesota On Land Site List(02/17/2011) (PDF)
Minnesota On Land Site List (02/17/2011) (Excel)
Minnesota On Land Deleted Site List (06/18/2008) (PDF)
North Dakota On Land Site List (03/06/2009) (PDF)
North Dakota On Land Site List (03/06/2009) (Excel)
Ships List
Western Ships Repaired List (02/17/2011) (PDF)
Western Ships Repaired List (02/17/2011) (excel)
Western Ships Built List (09/26/2011) (PDF)
Western Ships Built List (09/26/2011) (excel)
Western Ships Repaired List - Deleted Ships (04/19/2007) (PDF)
Western Ships Built List - Deleted Ships (04/17/2008) (PDF)
How to Add a Site or Ship to the List
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