Claim Forms

PLEASE READ THIS INFORMATION CAREFULLY BEFORE COMPLETING AND SUBMITTING YOUR CLAIM

The forms required to make an application for payment are set out below. Instructions for completing the Claim Form are listed at the start of the Form. Part 4 of the Claim Form has a checklist for the extra documents that you MUST submit in order to receive compensation. Please ensure that you complete every question in the Claim Form and submit all documents required in the category of the Compensation Grid you are making your claim.

For your convenience, a link to the Compensation Grid is also listed below. Please review the Compensation Grid to determine which category you are making an application for payment under. Moreover, please ensure that you submit to the Administrator along with your Claim Form every item listed in the required documents list for that category. Failure to submit all documents in the required documents list could invalidate your claim completely or result in you being compensated in a lower category.

For all claims under any of the categories you MUST submit a copy of your birth certificate showing that you were a minor at the time of your illness.

If you did not see a Doctor when you got sick and are making an application for compensation under category 1, you MUST submit a sworn affidavit along with your Claim Form and Birth Certificate.

There are draft affidavits below, please chose the one that applies to you or the person you are submitting this claim on behalf of. If the Affidavit is accurate you can fill in the blanks and take it to a Commissioner for Oaths, Notary or Lawyer to sign in front of. If the Affidavit is not accurate please prepare your own in the same style and take it to a Commissioner for Oaths, Notary or Lawyer to be sworn. A sworn Affidavit MUST be submitted with every claim.

If you resided in North Battleford or within a 30 km radius of North Battleford during the Cryptosporidiosis outbreak, please use the Affidavit (resident) templates. If you resided outside of a 30 km radius of the City of North Battlefrod at that time and got sick from drinking the water while visiting the City you will need to attach some proof that you were in the City of North Battleford or Battleford during this time. If you resided outside of a 30km radius of North Battleford at the time you got sick, please use the Affidavit (non-resident) templates.   

If you saw a Doctor when you got sick and are making an application for compensation under categories 2, 3 or 4, you MUST submit medical proof of your claim in addition to submitting the Claim Form and Affidavit. You will need to obtain your medical file, for the period you were ill, from your doctor to submit with your claim.

If you saw a Doctor when you got sick, were sick for 32 days or more and plan to make an application for compensation under categories 5, 6, 7 or 8 you MUST submit along with your Birth Certificate, Claim Form, Affidavit and Contemporaneous Medical Documentation, a medical report from your Doctor giving a probable diagnosis of cryptosporidiosis (for Category 5) or a report from your Doctor confirming a diagnosis of cryptosporidiosis and prolonged duration of illness due to an immunocompromised or high risk state (for Categories 6, 7 or 8).

IF YOU DO NOT SUBMIT THE REQUIRED MEDICAL DOCUMENTATION YOUR’RE CLAIM WILL AUTOMATICALLY FALL INTO CATEGORY 1

If your Doctor no longer has your medical records from that period of time or if you cannot recall which Doctor(s) you saw, you will need to request a Medical Services Report from Sask. Health. This report will detail the Doctors you saw at that time and should also show whether or not you were treated for a gastro-intestinal issue. Your Medical Services Report from Sask. Health can then be used to determine from which Doctor(s) you need to request your medical records. Your Medical Services Report from Sask. Health (assuming it shows that you were treated for a gastro-intestinal issue) can be submitted along with your Birth Certificate, Claim Form and Affidavit as a Contemporaneous Medical Document as required in the Compensation Grid.

Class Counsel are prepared to assist you in making your application. However, we do not assume any liability in ensuring your application is submitted by the Claim Deadline of November 25, 2017. As such, we are prepared to help you complete your application, draft and swear your affidavit and/or locate your medical records. However, we will only be offering to assist in locating medical records up to October 1, 2017 so as to ensure we have sufficient time to contact Sask. Health and your Doctor. We will continue to offer assistance in completing your claim form and preparing your affidavit up to November 9, 2017. Anyone wanting to submit a claim after November 9, 2017 will need to complete the paperwork on their own and submit their claim directly to the Administrator at the address listed in the Claim Form by the Claims Deadline of November 25, 2017.

If you have any questions or wish to have Class Counsel assist you in making your application our contact information is set out below.

CUELENAERE, KENDALL, KATZMAN & WATSON

Attn: NB Water Class Action Class Counsel

#500, 128 – 4th Avenue South

Saskatoon, SK  S7K 1M8

Telephone: (306) 477-7247

Fax: (306) 652-4171

e-mail: northbattlefordREMOVE_THIS@cuelenaereREMOVE_THIS.com

Documents