Russell G. Binder v. The Charles Town General Hosp et al and Smith v Camden Clark Mem. Hosp. et al.

Submit Claim

REQUESTORS: YOU MUST SUBMIT YOUR CLAIM FORM (WITH ALL SUPPORTING DOCUMENTS IF REQUIRED) BY SEPTEMBER 22, 2026, TO HAVE YOUR CLAIM REVIEWED.

PATIENTS: YOU MUST SUBMIT YOUR CLAIM FORM (WITH ALL SUPPORTING DOCUMENTS IF REQUIRED) BY DECEMBER 21, 2026, TO HAVE YOUR CLAIM REVIEWED.

A separate claim must be filed for each invoice.

 

If the Claim Form is being submitted on behalf of a child or person with disability, or a deceased Claimant, please provide documentation showing you have the authority to sign on behalf of the Claimant, such as a Birth Certificate for a child Claimant, a Power of Attorney for a disabled Claimant, or Letters of Administration for a Deceased Claimant.