Submit a Claim

Claim Form Login

If you are a Centrelake Medical Group, Inc. patient with a California address, and received a notification from Centrelake Medical Group, Inc., "Defendant", of the Data Incident on or about April 16, 2019, via email or mailed postcard, you may be eligible for benefits from this Settlement.

If you are a Class Member and wish to receive cash Settlement Benefits then you must submit a claim form by June 12, 2026.

The Settlement established several benefits to Settlement Class Members as applicable. Depending on the benefit, a Claim Form must be submitted. Settlement Class Members may claim for one or more of these benefits, documented out-of-pocket expenses, fraudulent charges, lost time spent dealing with the Data Incident, documented and unreimbursed extraordinary monetary losses as a result of the Data Incident. The benefits are as follows:

Medical/Credit Monitoring: All Settlement Class Members can enroll in two years of free medical/credit monitoring services. The Notice Class Members received contains an Enrollment Code for a two-year subscription to CyEx Medical Shield Complete. To enroll, visit https://app.MedicalShield.CYEX.com/enrollment/activate/centrelake and enter your Enrollment Code along with the other information requested. Your CyEx Medical Shield Complete subscription will become active once the Court grants Final Approval to this Settlement. You do not need to file a Claim Form to receive this benefit.

Lost Time Reimbursement: Class Members can claim reimbursement for up up to three (3) hours of lost time (calculated at the rate of $20 per hour) spent dealing with the Data Incident if at least one full hour was spent. Examples include:

  • time spent dealing with replacement card issues;

  • reversing fraudulent charges;

  • rescheduling medical appointments and/or finding alternative medical care and treatment;

  • retaking or submitting to medical tests;

  • locating medical records;

  • retracing medical history; and

  • any other demonstrable form of disruption to medical care and treatment

Claims for lost time will be included in the $500.00 cap in out-of-pocket expenses (described below).

Documented Ordinary Expense Reimbursement: Class Members can claim reimbursement for up to $500.00 in documented out-of-pocket expenses (along with claims for lost time as described above) that were incurred as a result of the Data Incident. Expenses can include

  • unreimbursed bank fees;

  • unreimbursed card reissuance fees;

  • unreimbursed overdraft fees;

  • unreimbursed charges related to unavailability of funds;

  • unreimbursed late fees;

  • unreimbursed over-limit fees;

  • long distance telephone charges;

  • cell minutes (if charged by minute), Internet usage charges (if charged by the minute or by the amount of data usage and incurred solely as a result of the Data Incident), and text messages (if charged by the message and incurred solely as a result of the Data Incident);

  • unreimbursed charges from banks or credit card companies;

  • postage, gasoline for travel, and other incidental expenses;

  • interest on payday loans due to card cancellation or due to over-limit situation incurred solely as a result of the Data Incident; and

  • costs of credit report(s), credit monitoring, or other identity theft insurance product purchased by Settlement Class Members between April 16, 2019 and the date of the Preliminary Approval Order.

Documented Extraordinary Loss Reimbursement: Class members can claim reimbursement for up to $3,500.00 in documented, extraordinary losses that were more likely than not caused by the Data Incident, including:

  • unreimbursed identify theft losses;

  • reimbursement for having to re-purchase a service that had originally been provided by Centrelake within 12 months prior to the Data Incident, due to loss of the medical records during the Data Incident. Centrelake will fully reimburse these costs, provided that

    1. the re-purchased study was performed due to lost records at Centrelake (i.e., original study performed previously at Centrelake within 12 months prior to data breach); and

    2. the study was not a new study/order from medical provider;

Expenses that are claimed must have occurred between April 16, 2019 and October 30, 2025, and not already covered by one or more of the other categories of Settlement benefits.

Payment for California Residents for Viewing of Medical Information:If you were a California resident at the time of the Data Incident and have proof suggesting that someone viewed any medical information affected by the Data Incident, you may also claim an additional $50.00.

Class Members who make a claim for Documented Ordinary Expense Reimbursement, Extraordinary Loss Reimbursement or Payment for California Residents must provide documentation. Proof could include receipts, account statements (you may mark out any unrelated transactions if you wish), or other proof of identity theft or other misuse of your information more likely than not caused by the incident. You may submit “self-prepared” documents to clarify or support other submitted documentation, but self-prepared documents by themselves are not sufficient to file a valid claim.

For more information about each of these benefits please review the Notice, FAQs and the Settlement Agreement.

To start your online claim form, you must login with your Notice ID and PIN. You can find your Notice ID and PIN on the interior of the perforated postcard that was sent to you.

You may also download a Claim Form here and submit it, along with any supporting documentation, by U.S. mail to:

Centrelake Data Incident Settlement
c/o Claims Administrator
P.O. Box 25226
Santa Ana, CA, 92799-9958

The deadline to submit a Claim Form online is June 12, 2026. If you are mailing your Claim Form, it must be mailed with a postmark date no later than June 12, 2026.