Cummings v. Board of Regents of the University of New Mexico

Case No. D-202-CV-2001-00579

Second Judicial District Court State of New Mexico

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This is a Claim Form to participate in the UNM Child Cancer Settlement Fund created by the settlement of claims on behalf of a class of certain surviving family members of decedent pediatric cancer patients against the University of New Mexico. Please read these instructions carefully. Before you complete and submit this Claim Form by mail or online and to learn more about the settlement and the Settlement Fund, you should read the Long Form Notice available on the IMPORTANT DOCUMENTS page. If you need assistance completing the Claim Form, please visit the FAQ page, or you may send an email to the Claims Administrator at: Info@UNMChildCancerSettlement.com.

Deadline and Submission Method. Claim Forms must be either SUBMITTED ONLINE or mailed and POSTMARKED NO LATER THAN May 27, 2022, 2021 at 11:59 pm PST.

Eligibility. The Settlement will provide cash payments to certain family members of pediatric (children aged 0-18) patients who were treated for Acute Lymphoblastic Leukemia by the UNM Defendants during the class period (as defined below) and are now deceased (“the Decedent”). You, and possibly other beneficiaries, may be entitled to compensation from the settlement as members of the Decedent Class. The Decedent Class consists of:

Statutory beneficiaries, as defined in the New Mexico Wrongful Death Statute, NMSA 1978, §41-2-3, for all pediatric cancer patients with a diagnosis of Acute Lymphoblastic Leukemia who presented for treatment at the University of New Mexico Health Sciences Center from January 1, 1977 through March 31, 1997, and who, by December 1, 2019, were deceased, excluding individuals with whom UNM previously reached settlements, except that also excluded from the Decedent Class are those individuals who received only temporary treatment at UNM Health Sciences Center and whose treatment protocols were principally administered or designed elsewhere and who did not receive initial or relapse induction treatment in New Mexico.

YOU MAY BE A MEMBER OF THE CLASS AND A POSSIBLE CLAIMANT FOR A PORTION OF THE SETTLEMENT FUND IF YOU FALL INTO ONE OF THE FOLLOWING CATEGORIES:

  1. If you are a parent of the deceased pediatric cancer patient and there is no surviving spouse or children of the decedent pediatric cancer patient;
  2. If you are a brother or sister of the deceased pediatric cancer patient and there is no surviving parent, spouse, child or grandchild of the pediatric cancer patient;
  3. If you are a surviving spouse of the decedent pediatric cancer patient;
  4. If you are a child or grandchild of the decedent pediatric cancer patient; or
  5. If you are otherwise related to the deceased pediatric cancer patient (e.g., aunt, uncle, cousin) and there is no surviving parent, spouse, child, grandchild, brother or sister of the deceased pediatric cancer patient.

Under New Mexico law, which will govern the distribution of funds from the settlement to eligible claimants, funds will be distributed consistent with the following directions, as found in NMSA § 41-2-3:

  1. If there is a surviving spouse and no children, then funds are distributed to the spouse;
  2. If there is a surviving spouse (and a child or grandchild), then one-half of the funds will be distributed to the surviving spouse and the remaining one-half to the children and grandchildren;
  3. If there is no spouse, but there is a child or grandchild the funds will be distributed to the child and grandchildren;
  4. If the deceased is a minor, childless and unmarried, then the funds will be distributed to the father and mother who shall have an equal interest in the proceeds, or if either of them is dead, then to the surviving parent;
  5. If there is no living father, mother, husband, wife, child or grandchild, then the funds will be distributed to a surviving brother or sister if there are any; and
  6. If there is no living father, mother, husband, wife, child, grandchild, brother or sister, then the funds will be distributed to other relatives of the deceased pediatric cancer patient in a manner directed by law.

IF YOU HAVE ANY QUESTIONS AS TO WHETHER YOU MAY BE A CLASS MEMBER/CLAIMANT OR ABOUT THIS CLAIM FORM OR ABOUT HOW FUNDS MAY BE DISTRIBUTED OR WHETHER YOUR RELATIVE WAS TREATED AS A PEDIATRIC CANCER PATIENT FOR ACUTE LYMPHOBLASTIC LEUKEMIA AT UNM DURING THE RELEVANT TIME PERIOD, YOU MAY CONTACT THE CLAIMS ADMINISTRATOR BY TELEPHONE AT (855) 534-5953 OR BY EMAIL AT Info@UNMChildCancerSettlement.com.

Documentation. You must provide with this Claim Form documentation reflecting the following:

  1. The Decedent (your family member) was a pediatric cancer patient diagnosed with Acute Lymphoblastic Leukemia,
  2. The Decedent presented for treatment at the University of New Mexico Health Sciences Center between January 1, 1977 and March 31, 1997,
  3. The Decedent died by December 1, 2019, and
  4. You are a statutory beneficiary of the Decedent, as described above and defined by the New Mexico Wrongful Death Statute, NMSA 1978, §41-2-3.

If you do not have official documentation, you may provide a signed, notarized statement providing the appropriate information. If your Claim Form is incomplete, contains false information, or is not submitted online or postmarked by May 27, 2022, your claim will be rejected, and you will waive all rights to receive a payment under this Settlement. The Claims Administrator may contact you to request more information to verify your claim and will assess your claim using the information provided by you as well as any additional information available to the Claims Administrator. The information you provide will be treated as confidential and used for the purpose of this Settlement only.

* Some companies or attorneys may offer to help you file your Claim Form in exchange for a portion of your recovery from the settlement. While you may choose to use such companies or attorneys, you should know that you can file your Claim Form with the Class Administrator on your own, free of charge. Additionally, you are entitled to contact the Class Administrator or Class Counsel for assistance in understanding and filing your Claim Form. You may also contact the Class Administrator or Class Counsel if you have any questions about whether you need additional counsel or help in filing a claim. Again, these communications are at no cost to you.

Step 1—REQUIRED CLAIMANT INFORMATION (please provide your information below)
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Step 2—REQUIRED DECEDENT INFORMATION (please provide information about the deceased pediatric cancer patient)

Date(s) treated at UNM Health Sciences Center

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Step 3—DOCUMENTATION

Please include with your claim all documentation required to prove the following:

  1. The Decedent was a pediatric cancer patient diagnosed with Acute Lymphoblastic Leukemia,
  2. The Decedent was treated at UNM Health Sciences Center between January 1, 1977 and March 31, 1997,
  3. The Decedent died by December 1, 2019, and
  4. You are a statutory beneficiary of the Decedent, as described in the Claim Form Instructions and defined by the New Mexico Wrongful Death Statute, NMSA 1978, §41-2-3.
  5. To further support your claim you may complete and upload an Affidavit in Support of Settlement Claim available for download here.

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    Step 4—DECLARATION UNDER PENALTY OF PERJURY, SIGNATURE & DATE

    I declare under penalty of perjury that the information above is true and correct to the best of my knowledge and belief. I understand that my claim is subject to audit, review, and validation using all available information.

    Your Claim Form has been submitted successfully.

    HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: Info@UNMChildCancerSettlement.com.

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    Your Claim Details

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

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