You may be eligible for a cash payment from a class action settlement if you owned or resided at a property with a private well drinking water source in Peshtigo, Wisconsin between 1965 and 2020.

To receive benefits, you must file a Claim Form either online via this website or by downloading a copy of the Claim Form and mailing it in to the Tyco Fire Products Administrator.

If you are filing a claim for Property Damages or Exposure Damages, the Claim Form deadline may be as soon as July 12, 2021. You must file a claim no later than this deadline.

If you are filing a claim for Personal Injury Damages, the Claim Form deadline may be as soon as June 21, 2021. You must file a claim no later than this deadline.

Claim Forms submitted after their deadline will not be considered timely and may not be accepted.

Before completing your Claim Form, it is important that you completely read and understand the information regarding the Settlement and your rights. Please review the information posted here.

Class Members may file for one or all three of the following types of funds.


Exposure Damages

Includes Residents in the Class Area during the Class Period (January 1, 1965, through December 31, 2020) who drank, cooked with, bathed in, or otherwise were exposed to water supplied from a Private Well Drinking Water Source for at least one (1) year during the Class Period.


Property Damage

Includes any person who is or was an Owner of a Property in the Class Area during the Class Period (January 1, 1965 through December 31, 2020) for at least one (1) year during the Class Period and is claiming benefits for loss of property value.


Personal Injury

Personal Injury Compensation may be available to eligible Class Members who were medically diagnosed with one or more of: (1) testicular cancer; (2) kidney cancer; (3) pregnancy-induced hypertension; (4) ulcerative colitis; or (5) thyroid disease (the “Eligible Personal Injuries”). Please see the Personal Injury Claim Form for full description of the eligibility requirements.

If you are making a claim for a Personal Injury (which is different than claims for Property Damages and Exposure Damages) you must file a separate Personal Injury Claim Form that can be found here. Personal Injury Claim Forms cannot be submitted online.



How to File Online:

To file online, you will be asked to provide information regarding the Class Member, Representation and/or Attorney (if applicable), property address of the Affected Property in the Class Area, and a description of why you are claiming damages. Lastly, you will be able to upload any documentation required to prove your claim.

Please Note: Online filing is only available for Exposure and Property Damages Claim Forms. You cannot submit a claim for Personal Injury Damages online.

How to File by Email or Mail:

If you would like to file by email or mail, download a copy of the Claim Form. Please read the form carefully, fill it out completely, and attach any documentation. Then, email or mail the completed Claim Form to the following:

Tyco Fire Products Administrator
P.O. Box 5855
Portland, OR 97228-5855
Claims@FireFightingFoamSettlementClaimForm.com



Documentation Documentation must be provided to support your claim. Failure to submit the required documentation may result in delay or rejection of your claim. Please review the table below to understand the type of documentation required to successfully prove your claim(s).

Situation: Required Documentation:
Claim Form filled out on behalf of the Class Member You must provide copies of documentation verifying your authority to act, such as a power of attorney or a court order stating your authority to act, or if no such documents are available, documents establishing your legal relationship to the Class Member identified in this Claim Form.
Class Member is deceased A Death Certificate or other proof showing that the Class Member is deceased.
Filling out a claim for Exposure Damages (Renter/Resident of Property)

Documentation establishing the Class Member's proof of residency in the Class Area at any time between January 1, 1965, and December 31, 2020, such as a State-issued identification with address (such as a driver’s license), utility bills, or other types of bills or bank statements or mail addressed to the Class Member and Affected Property Address.

If documentation establishing the Class Member's proof of residency is not possible, a declaration may be used instead to prove dates of residency when making a claim for Exposure Benefits. A declaration is not required, but it may help the Claims Administrator conclude that your claim for Exposure Benefits should be accepted. Please see the Declaration Form Regarding Residency here.

Documentation to support your explanation for your claims regarding the award Supplemental Exposure Damages such as well-water test results, medical bills, or testing invoices.

Filling out a claim for Property Damages (Owner of Property)

Documentation establishing the Class Member's proof of ownership of the Affected Property in the Class Area at any time between January 1, 1965, and December 31, 2020, such as a deed, property tax bill, mortgage statement, or homeowners insurance.

Documentation to support your explanation for your claims regarding the award Supplemental Ownership Damages such as well-water test results, water source invoices, or property value assessments.

Had PFAS testing on Private Well Drinking Water Source during the Class Period Copies of PFAS testing results.
Filling out a claim for Personal Injury Damages

Documentation establishing the Class Member's proof of residency in the Class Area at any time between January 1, 1965, and December 31, 2020, such as a State-issued identification with address (such as a driver’s license), utility bills, or other types of bills or bank statements or mail addressed to the Class Member and Affected Property Address.

Medical records sufficient to demonstrate your diagnosis for one or more of the Eligible Personal Injuries.

Medical Record Authorization Release Form included with the Proof of Personal Injury Claim Form.

Documentation needs to be clear, readable copies, as nothing will be returned to you. Acceptable files for online filing must be one of the following formats and no larger than 20MB per file: jpg, jpeg, png, gif, tif, tiff, doc, docx, xls, xlsx, pdf, txt, rtf, or zip.




Remember, if you are filing a claim for Property Damages or Exposure Damages the claim form deadline may be as soon as July 12, 2021. Claims for Personal Injury Damages deadline may be as soon as June 21, 2021. You must file a claim no later than these deadlines.