File a Claim Online | Ayers, et al. v. CIOX Health, LLC

Ayers, et al. v. CIOX Health, LLC Claim Form

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CLAIM FORM INSTRUCTIONS

In order for you to qualify to receive one or more payments related to Ayers, et al v. CIOX Health, LLC, as described in the Notice of this Settlement (the “Class Notice”), you must complete and file a Claim Form in the attached form either in paper or electronically on the Settlement Website, www.CIOXsettlement-Maryland.com. Your claim will be considered only if you comply with all of the following conditions:

You must be associated with the Law Firm, insurer, or copying service to whom a Class Notice was addressed, and the Law Firm, insurer, or copying service must be listed as a potential Class Member on the Ayers, et al. v. CIOX Health, LLC Class Member List. If you have a question about whether you are listed as a potential Class Member, please contact the Settlement Administrator at 866-274-4004.
You must accurately complete all required portions of the attached Claim Form.
By submitting the Claim Form, you must affirm that you paid one or more “Eligible Fees” that were charged in connection with a Medical Records Request made on behalf of an Individual pursuant to an authorization, but the fee was not otherwise reimbursed to you. If you were reimbursed for the fee by anyone, you may not submit a claim form in connection with that transaction and you are not eligible to participate in the Settlement with respect to that particular transaction (you also will not be bound by any terms of the Settlement in respect of that particular transaction).
Submitting a Claim Form in respect of Eligible Fees for which you were reimbursed will prevent your former client/authorized person from being able to make a claim and recover for that reimbursed payment.
Each invoice(s) that included an “Eligible Fee” that applies to you, that CIOX charged in connection with a request for Medical Records, including the date of the Medical Records Request and names of the Health Care Providers, are identified below.
You have two options to complete a Claim Form:

(1) ELECTRONICALLY SUBMIT the Claim Form using the Settlement Administrator’s Settlement Website, located at www.CIOXsettlement-Maryland.com. When you successfully complete the online Claim Form, you will receive a receipt that your claim has been submitted. Or (2) MAIL the completed Claim Form by First-Class U.S. Mail, postage prepaid, postmarked no later than December 4, 2026, to:

Ayers, et al. v. CIOX Health, LLC Class Action Settlement
c/o Strategic Claims Services
P.O. Box 230
600 N Jackson St, Suite 205
Media, PA 19063

If you do not complete and electronically submit or mail the Claim Form by December 4, 2026, you cannot receive any payment from the Settlement. So that you will have a record of the date of your mailing of the Claim Form and its receipt by the Settlement Administrator, you are advised to use (but are not required to use) either the Settlement Website or U.S. Mail by Certified Mail, Return Receipt Requested.

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Ayers, et al. v. CIOX Health, LLC Claim Form

Please provide your most current information.

Name(Required)

First Last

Name of Law Firm, insurer, or copying service

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Telephone Number(Required)

Country Phone Number

Reimbursed Client Information
If you are a Law Firm that received reimbursement from any current or former client(s) for the costs you paid to obtain their medical records, you are encouraged, but not required, to provide the last known contact information for those client(s). You may do so in the form below:
List
Invoice Number
Client Name
Client Address

Final Step
Once you click the submit button below you will receive a confirmation and copy of the submission to the email you provided ().
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