To be eligible to receive Settlement Benefits, you must complete and timely submit the Settlement Claim Form. You are only required to submit one Settlement Claim Form per patient/insured arising from an auto accident. Your submission will automatically include all your charges for that patient under that PIP claim. Separate Settlement Claim Forms must be submitted for each patient/insured. So if you treated six people and submitted claims to one of The GEICO Companies, you will have to submit six separate forms. Available supporting documents, such as an Explanation of Benefit (EOB) or Explanation of Review (EOR) (if available) should also be submitted with the Settlement Claim Form.

Your claim must be submitted by February 24, 2025.

You will have the option to upload the completed Settlement Claim Form or to complete the required information through the online form. To begin your online Claim Form, please click 'Online Claim' below.

To upload your completed Claim Form please click “Upload Claim” below.
 

If you would prefer to mail your completed Settlement Claim Form(s), as opposed to filing online, you may send your claims by First-Class Mail, postage prepaid, addressed to: Florida All X-Ray Settlement, c/o JND Legal Administration, PO Box 91067, Seattle, WA 98111. Your completed Settlement Claim Form(s) must be postmarked no later than February 24, 2025. Settlement Class Members who submit a qualifying Settlement Claim Form will also receive a postage and submission payment in the flat amount of five dollars ($5.00) for each valid Settlement Claim Form submitted via U.S. Mail. If you submit claims through the website, you do not have to mail in your Settlement Claim Form(s).