Claim Packet
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
Thorpe Training Seminar Slides
Electronic Claim Template (to be filed by law firm representing claimant)(Microsoft Access Required) 06/19/2008
The Electronic Claim Template is not supported if you utilize Microsoft Office 2007. Please contact the trust if you have any questions
Claim Form
Full Claim Form
Section 1: Representation
Section 2: Injured Party/Decedent Information
Section 3: Injuries
Section 4: Diagnosis
Section 5: Chest X-Ray
Section 6: CT Scan
Section 7: Pulmonary Function Test
Section 8: Pathology Report
Section 9: Dependent & Beneficiary
Section 10: Land Exposure
Section 11: Shipboard Exposure
Section 12: Secondary Exposure
Section 13/14: Smoking History and Economic Loss and Medical Expense
Section 15: Asbestos Litigation
Section 16: Signature Page
Claim Checklists
Checklist - Grade I Asbestosis
Checklist - Grade I Enhanced Asbestosis
Checklist - Grade II Asbestos Related Pleural Disease
Checklist - Grade I Serious Asbestosis
Checklist - Lung Cancer
Checklist - Mesothelioma
Checklist - Other Cancer
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)
Verification for Responses/Answers to Interrogatories
Litigation Declaration
Litigation Declaration — Claimant
Litigation Declaration — Attorney
Traditional Occupation List
High Exposure Jobtypes
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.
Land Based Site List
J.T. Thorpe Site List 09/16/2010 (Excel)
J.T. Thorpe Site List 09/16/2010 (PDF)
J.T. Thorpe Site List-DELETED SITES 06/19/2008 (PDF)
Ship List
J.T. Thorpe Ship List 02/17/2011 (Excel)
J.T. Thorpe Ship List 02/17/2011 (PDF)
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