Get Fuller-austin Claim Form - Jt Thorpe Company Successor ...

Filling out the Fuller-Austin claim form can seem daunting, but this guide will walk you through the process step by step. By following these instructions, you will be able to complete the form accurately and efficiently, ensuring your claim is processed without unnecessary delays.

Follow the steps to complete your claim form effectively.

1. Click ‘Get Form’ button to obtain the Fuller-Austin claim form and open it in your preferred editing tool.
2. Begin with Part 1, 'Injured Party Information'. Enter the injured party’s full name, social security number (SSN), and date of birth in the designated fields. Ensure accuracy in spelling and numbers.
3. Indicate if the injured party is living by checking 'Yes' or 'No'. If 'No', provide the date of death and the official representative's full name. This representative must have the appropriate documentation to act on behalf of the injured party.
4. In the Contact Information section, fill out the injured party's law firm details. Include the firm name, attorney's name, phone number, address, and email.
5. Proceed to Part 2, 'Diagnosed Diseases'. Check the appropriate box that represents the highest disease level claimed based on medical evidence. Remember to include the date of diagnosis for the claimed disease.
6. In Part 3, 'Statute of Limitations', answer questions regarding any existing lawsuits filed on behalf of the injured party. Provide detailed information about the lawsuit, including the state, county, and date filed.
7. Fill out Part 4, 'Occupational Exposure', if applicable. Provide details about the exposure period, employer, jobsite, and occupation during the exposure to asbestos.
8. If applicable, complete Part 5, 'Derivative Exposure'. Indicate the relationship between the injured party and the occupationally exposed person (OEP), and provide necessary details.
9. In Part 6, mark the proof of exposure sections that apply. Decide whether the claim form itself serves as your declaration or if supporting documents need to be attached.
10. Complete Part 7, 'Declaration', ensuring the declarant's name is printed, along with the date and location of signing. The signature must be included.
11. Finish with Part 8, 'Certification', presenting the signatures of the injured party or their representative. If an attorney is certifying, ensure their information is also provided in this section.
12. Lastly, review all information for accuracy and completeness, then save changes, download, print, or share the form as needed.

Complete your Fuller-Austin claim form online today to ensure your claim is processed promptly.