Healthcare Benefits Damages Calim Form

During and after 2012, the State experienced delays in processing dental and medical benefits for BU 8 members in a timely manner.  Delays or difficulties included:

  • Failure to establish the initial right to use benefits in timely manner;
  • Failure to institute requested changes in benefits (i.e., add dependents, changes in plan type, etc.).

The State’s delay or difficulties in this regard may have resulted in various BU 8 members being “damaged.”  Should a settlement be reached in this matter, damages may be paid as compensation for loss or injury.    The State and the appointed arbitrator has not yet determined what, if any, damages may be compensated or whether the BU 8 contract was violated.  However, we have agreed with the State that these declarations may be used as evidence in the claims process to effectuate settlement of the dispute.

The attached declaration is to be used by BU 8 members who actively attempted to use healthcare benefits in 2012 and/or 2013 but were unable to do so through no fault of their own.

Claims can be made on behalf of the individual BU 8 member so long as you properly tried to enroll in a healthcare plan for you and/or your dependents but were unable to get treatment for you and/or your dependents.

Please provide all facts and documents that support your claim.  Use additional pages if there is not sufficient space for your response.

Healthcare Benefits Damages Claim Form

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