You may locate your Claim ID and Confirmation Code at the top of the e-mail you received or on the front of the Postcard you received. Click HERE to see an illustration of the e-mail location, click HERE to see an illustration of the Postcard location.

If you received a personalized notice in the mail or via email with a Claim ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Claim ID exactly as it appears on your personalized Notice, (i.e. 12345678).

If you do not have your Claim ID and Confirmation Code, click below to verify your eligibility by looking up your information in the Settlement Class List. In order to be included on the Settlement Class List you must have had personal identifiable information (“PII”) that was compromised in Aditi Consulting’s Data Security Incident and you would have received an initial notification of the Data Security Incident from Aditi Consulting. The information you submit below, must match the Defendant’s records at the time Aditi Consulting sent your initial notification of the Data Security Incident. If the information you submit does not result in a positive match with the Defendant’s records, please verify that the information you are submitting includes your full name, email address and physical address at the time Aditi Consulting’s system was compromised in the December 9, 2021, Data Security Incident.

The deadline for submitting this Reimbursement Form is

Please add the email, Info@LarsonDataSecurityIncidentSettlement.com, to your contact list to ensure that future correspondence is delivered to your inbox.

Eligible Settlement Class Members may submit a Claim for reimbursement for documented Economic Losses related to the Data Security Incident that have not been reimbursed by other third parties, for:

  • Ordinary Losses for unreimbursed out-of-pocket costs fairly traceable to the Data Security Incident, as supported by third-party documentation, up to $500.00 aggregate total per Settlement Class Member; and/or,
  • Extraordinary Losses for unreimbursed Economic Losses more likely than not caused by the Data Security Incident, as supported by third-party documentation, and the Settlement Class Member’s written statement, up to $5,000.00 aggregate total per Settlement Class Member.

Settlement Class Members who wish to make a timely and properly supported Claim for reimbursement of Economic Losses related to the Data Security Incident for Ordinary Losses or Extraordinary Losses must provide to the Settlement Administrator the information required to evaluate the claim, including: (a) the Claimant’s name and current address; (b) if applicable, a signed copy of IRS Form 14039 along with a statement that the form was submitted to the Internal Revenue Service; and, (c) the bills or invoices documenting the amount of the Claim and proof that the bills or invoices were paid. Settlement Class Members who wish to make a timely and properly supported Claim for reimbursement of Economic Losses for Extraordinary Losses related to the Data Security Incident must additionally provide to the Settlement Administrator a signed statement indicating that: (i) the Extraordinary Losses claimed are fairly traceable to the Data Security Incident; and (ii) the total amount claimed has not been reimbursed by any other person or entity. Third-party documentation of Economic Losses is required to establish a Claim. Economic Losses are those that are reasonable and customarily incurred when responding to the harm suffered by the Settlement Class Member from the Data Security Incident.

In addition, any Settlement Class Member may submit a Claim for reimbursement for Lost Time related to the Data Security Incident, at a rate of $25.00 per hour, up to $75.00 aggregate total per Settlement Class Member. Settlement Class Members who wish to make a timely and properly supported Claim for reimbursement of Lost Time related to the Data Security Incident must provide to the Settlement Administrator the information required to evaluate the claim, including: (a) the Claimant’s name and current address; (b) if applicable, a signed copy of IRS Form 14039 along with a statement that the form was submitted to the Internal Revenue Service; and, (c) a signed statement indicating: (i) the time expended in connection with the Data Security Incident and the reason therefor; and (ii) showing that the Lost Time claimed is fairly traceable to the Data Security Incident.

CLAIMANT INFORMATION

* Required Fields

Please attach a statement confirming the form was submitted to the IRS and a signed copy of the form.

I declare that:

You may submit one or more reimbursement requests, but all of your requests cannot exceed an aggregate $500.00 for Ordinary Losses, or $5,000.00 for Extraordinary Losses. Only one (1) form is needed for multiple losses incurred from the Data Security Incident.

FOR CLAIMS FOR ORDINARY OR EXTRAORDINARY LOSSES

I further declare that:

  1. the Ordinary or Extraordinary Losses1 claimed on this form are fairly traceable to the Data Security Incident; and
  2. the total amount claimed has not been reimbursed by any other person or entity.

hours

(Maximum of three (3) hours at $25.00/hour totaling $75.00 in the aggregate)

1Claims for Extraordinary Losses also require the Settlement Administrator to make a determination that these Extraordinary Losses were more likely than not caused by the Data Breach.

UPLOAD SUPPORTING DOCUMENTATION

Requests for reimbursement of Economic Losses must include bills or invoices documenting the amount requested and proof that the bills or invoices were paid.

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected.

Please confirm in the grid below that your file has been successfully uploaded.

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    Payment Method

    You have successfully requested a payment. Click here if you would like to choose a different payment method.

    ATTESTATION & SIGNATURE

    Your claim will be submitted to the Settlement Administrator for review. If your Reimbursement Form is incomplete, untimely, or contains false information, it may be rejected by the Settlement Administrator. If your claim is approved, you will be mailed a check at the street address you provide. This process takes time; please be patient.

    Your Reimbursement Form has been submitted successfully.

    Reimbursement Form Status – Provisionally Denied – You are not listed as an eligible class member and are not eligible to receive any settlement offerings. The documentation you submitted is under review. A final determination will be made after the claim filing deadline on July 28, 2023. This final determination will be sent to the email address included on your Reimbursement form from info@LarsonDataSecurityIncidentSettlement.com. Please update your email account to include this email address is an authorized sender and monitor your junk or spam folders in the event that your security settings or policies erroneously route this final determination email.

    Reimbursement Form Status – Provisionally Denied – You are not listed as an eligible class member and are not eligible to receive any settlement offerings . You must submit supporting documentation that illustrates you were an employee of Aditi Consulting at the time the system was compromised in the December 9, 2021, Data Security Incident. A copy of the initial notice sent to you from Aditi Consulting notifying you of the data incident will be considered sufficient evidence. Other forms of documentation must include information that would lead a reasonable person to conclude that more likely than not, you suffered losses as a result of the Aditi Consulting Data Security Incident. If you fail to submit this documentation a final claim determination notice will be sent to the email address included on your Reimbursement form from info@LarsonDataSecurityIncidentSettlement.com. Please update your email account to include this email address is an authorized sender and monitor your junk or spam folders in the event that your security settings or policies erroneously route this final determination email.

    Please print this page for your records.

    Your Claim Details
    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    Street Address 2
    City
    State
    Province
    Zip Code
    Postal Code
    Country
    Email Address
    Telephone Number
    Signature
    Date

    If you have any questions regarding your Reimbursement Form, please provide the Submitted Claim ID listed above and email us at Info@LarsonDataSecurityIncidentSettlement.com

    Click here to edit your Reimbursement Form.

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