Claim Application for Mass Tort Benefits (Standard Form 95 – SF-95)

If you’ve experienced personal injury affecting your physical or mental health, you may qualify for compensation through a Mass Tort claim.

Personal injury claims may include, but are not limited to:

Faulty or defective product use or circulation
Physical, emotional, or mental abuse
Exposure to unsafe or harmful environments
Financial or monetary damages resulting directly or indirectly from product use or unsafe conditions

Have You Applied for Mass Tort Claims Before?

If you’ve already submitted an application, please to check your claim status.

What to Know Before You Fill Out This Form

Check Your Eligibility

Before you begin, confirm that you meet our eligibility requirements for claim enrollment and disbursement.

Note: We can help you connect with your bank — regardless of your banking history or institution type.

Gather Your Information

Before starting your application, please have the following information ready:

Law firm(s) representing your claim (include details if your case has been transferred between law firms)
Social Security Numbers for yourself and any dependents or blood relatives eligible to receive claim benefits
Valid bank account and routing number
Card information (only required if bank authentication fails more than twice)

Start Your Application

We’ll guide you through each step of the process — it typically takes about 45 minutes to complete.

Sign in or create an account

Note: We have removed an option for disbursement process through check due to unwarranted delays and rise of identity theft cases revolving to the mass tort claims. The disbursement will be followed strictly through EFT's (Electronic fund transfers) into an eligible bank accounts.

Need help?

Technical Support

If you have trouble using this online application, call our support line:

800-LAW-CLAIM (529-2524)

(TTY: 711) We are here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.

Questions about the Lawsuit

For questions specific to your settlement or case details, contact your accredited legal representative.

Get help from a Legal Representative →

/ Compensation Application Form

Compensation Application Form

Please complete all sections to finalize your claim disbursement.

Personal Information

Full Name

Date of Birth

Social Security Number (SSN)

Claim Number / Case ID

Entering your Claim ID will auto-fill your Legal Representation details.

Phone Number

Email Address

Address Information

Street Address

City

State

Zip Code

Claim Information

Type of Lawsuit

Date of Filing the Claim

Court of Jurisdiction

Date of Judgment

Legal Representation

**These details are auto-populated** based on your Claim ID and cannot be edited.

Enter a valid Claim Number / Case ID above to auto-fill legal representation details.

Compensation Details

Total Compensation Amount

Bank Name

Bank Account Number

Bank Routing Number

Bank Account Type

Payment Information

Please select how you would like to receive your compensation payment. We offer two secure methods: instant bank linking for immediate verification, or manual document upload for review.

Your information is protected by bank-level security and is not stored on our servers. The instant link option is generally faster.

Choose Payment Method

Securely Link Bank Account (Recommended)

Connect instantly to verify account and routing numbers. Fastest way to receive funds.

Upload Documents for Manual Review

Upload a voided check or bank statement. Requires 5-7 business days for manual review.

Instant Bank Verification

Connect your bank account securely using your online banking credentials. This only verifies the account; we cannot see your balance or make transactions.

Required Document

Please upload a valid government-issued photo identification document to verify your identity. Accepted forms include a Driver’s License, State ID, or Passport.

Your identification document is required to comply with federal verification standards under the Fair Claims Act. Uploaded files are encrypted and securely stored.

Upload Your Valid Government-Issued Photo ID

Accepted formats: PDF, JPG, PNG (max file size: 5MB)

**WARNING:** Submitting invalid or forged identification documents may result in permanent disqualification of your claim.

Consent & Declaration

I declare that the information provided is true and accurate to the best of my knowledge. I consent to the transfer of the compensation to the bank account provided. I agree to the terms and conditions. Read Terms & Conditions

Claimant Signature

Sign within the box above

Need help?

Technical Support

If you have trouble using this online application, call our support line:

800-LAW-CLAIM (529-2524)

(TTY: 711) We are here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.

Questions about the Lawsuit

For questions specific to your settlement or case details, contact your accredited legal representative.

Get help from a Legal Representative →

Apply for a Personal Injury and Mass Tort Claim Disbursement

Claim Application for Mass Tort Benefits (Standard Form 95 – SF-95)

Have You Applied for Mass Tort Claims Before?

What to Know Before You Fill Out This Form

Check Your Eligibility

Gather Your Information

Start Your Application

Sign in or create an account

Need help?

Technical Support

Questions about the Lawsuit

Compensation Application Form

Please complete all sections to finalize your claim disbursement.

Personal Information

Address Information

Claim Information

Legal Representation

Compensation Details

Payment Information

Choose Payment Method

Instant Bank Verification

Document Upload

Required Document

Consent & Declaration

Claimant Signature

Need help?

Technical Support

Questions about the Lawsuit

Verifying Bank Credentials...

Verification Complete!