SMIRK’S-MOLINOS CRUMBLES SETTLEMENT

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If you are represented by another lawyer (not Class Counsel), before you submit a Claim Form, contact the lawyer you hired to represent you in connection with your Daily Harvest Crumbles consumption and check that your lawyer has not already submitted a Claim Form on your behalf.

SUBMIT A CLAIM FORM

Class Members will be eligible to file a claim for personal injury damages and/or monetary damages related to another person’s personal injuries arising from consumption of the Crumbles.  If you have already filed a Claim Form in the DH/SGF Settlement and would like to participate in this Smirk’s-Molinos Settlement, you do not need to do anything.  If you did not file a Claim Form in the DH/SGF Settlement, in order to participate in the Smirk’s-Molinos Settlement, you must complete, sign, and submit the Claim Form found below, by January 21, 2025. This is the only way to receive an award if you qualify. 

THE DEADLINE TO SUBMIT A CLAIM FORM, INCLUDING ALL REQUIRED DOCUMENTATION AND SIGNATURES, IS JANUARY 21, 2025.

You can submit the Claim Form by one of the following ways:

• Submit the Claim Form and supporting documentation on this Website using the the link found below in the “HOW TO COMPLETE A CLAIM FORM SECTION” after Step 12; or
• Print the Claim Form by going to the Pleading and Important Documents tab, then complete, sign, and mail the Claim Form and all supporting documentation to the Settlement Administrator, postmarked no later than January 21, 2025, at P.O. Box 361930, Hoover, AL, 35236-1930.

HOW TO COMPLETE A CLAIM FORM

Step 1: Claimant Identification

Fill in the Claimant’s personal identification information.

Step 2: Exposure

Fill in the date(s) the Claimant purchased the Crumbles, if applicable. Then, answer the questions by marking “YES” or “NO”.

Step 3: Illness

Mark “YES” or “NO” to report experiencing an injury related to the Crumbles consumption.

If “YES” is marked, fill in the date the symptom(s) began (i.e, Date of symptom onset) and indicate in the provided box what symptoms were experienced by marking “Yes” or “No”. If you experienced symptoms that are not included in the provided box, please describe them in the area provided.

Mark “Yes” or “No” to report different types of treatment you received for the symptoms you indicated. Then, fill in the date your symptoms resolved. If your symptoms have not resolved, please describe the ongoing symptoms and medical care in the area provided.

Step 4: Category Description

Review all Category descriptions to determine which Category applies to your Claim. Only mark one Category descriptions to indicate the Category your claim falls under.

If you marked Category 2, 3, or 4, and you received medical treatment for your injuries and would like to be considered for an enhancement of your monetary benefits, please identify any special medical circumstances of your illness that should be considered in evaluating the claim in the area provided.

Step 5: Medical Providers

If you marked Category 1A or Category 1B, you may skip to Step 6: Medical Expenses.

If you marked Category 2, 3, or 4, list all the medical providers, and fill in their contact information, the dates of treatment, and you best estimate of the amount charged by the medical providers for the related medical treatment.

Step 6: Medical Expenses

Fill in the total medical expenses claimed. Then, submit additional documentation of these medical bills to support the amount you are claiming. You can only submit additional documentation to the Settlement Administrator by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

Additional documentation must be submitted by January 21, 2025, the Claim Form Deadline.

Step 7: Retained Expert or Treating Provider Report?

Indicate if you retained an expert, or have a Treating Provider Report, by marking “Yes” or “No”.

If “Yes” is marked, you will need to submit additional documentation of these reports. You can only submit additional documentation to the Settlement Administrator by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

Step 8: Signature

Fill in the State where you reside and provide your signature and signature date.

Step 9: Medical Insurance Benefit Questionnaire

Complete all sections to the best of your ability. Instructions for completing each section are outlined below.

1. Personal Information for the Injured Party

Complete this entire section using information for the Injured Party.

If you are completing this form on behalf of the injured party (as parent, guardian, representative, POA, GAL, etc.), fill in the Injured Party’s information. You will need to submit additional documentation designating you as the Injured Party’s parent, guardian, representative, POA, GAL, etc. You can only submit additional documentation to the Settlement Administrator by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

2. Settlement Injury Information

Fill in the approximate date your first ingested Daily Harvest, the onset date your symptoms/illness allegedly caused by Daily Harvest Crumbles, and the City, State, and County where the injury occurred.

If you do not know this information, please get this information from your attorney.

3. Government Medical Insurance Information

Mark “YES” or “NO” for each section (Medicare, Medicaid, Tricare, Veterans Administration Medical Benefits, and Indian Healthcare Service) to indicate whether you had Medicare, Medicaid, Tricare, Veterans Administration Medical Benefits, and/or Indian Healthcare Service at the time of your injury.

If “YES” is marked for any section, you must fill in the remaining blanks in that section and provide copies of the front and back of your insurance cards. You can only provide copies of the front and back of your insurance cards by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

4. Private Medical Insurance Information

Mark “YES” or “NO” to indicate whether you had private medical insurance at the time of your injury.

If “YES” is marked, you must fill in the remaining blanks in this section to provide your insurance company’s contact information and your Member/Plan/Contract identification number and provide copies of the front and back of your insurance cards. You can only provide copies of the front and back of your insurance cards by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

If “YES” is marked, you must mark “YES” or “NO” at the end of this section to indicate whether this is a Medicare Advantage or Medicare supplement plan.

5. Pre-Settlement Funding Loans/Advances

Mark “YES” or “NO” to indicate whether you obtained a pre-settlement funding loan (loans from lenders such as Fast Trak, Cartiga, etc.) or loans from your attorney.

If “YES” is marked, provide each lender name, lender contact phone number, account/contract number, loan amount, and current amount due, including interest, if known, in the space provided.

6. Bankruptcy

Mark “YES” or “NO” to indicate whether you have ever declared Bankruptcy.

If “YES” is marked, provide the filing date, discharge date (if applicable), and mark “YES” or “NO” to indicate whether the bankruptcy case is still active.

7. Release and Signature

Sign and date this section.

If you are completing this form on behalf of the injured party (as parent, guardian, representative, POA, GAL, etc.), sign and date this section, and then fill in your contact information in the boxed section provided.

Step 10: HIPAA Release Form

Complete and sign this entire form using information for the Injured Party.

Step 11: Medicare Proof of Representation

Complete and sign this entire form using information for the Injured Party. Please complete and sign this form even if you do not believe you are a Medicare Beneficiary.

Step 12: Submit Claim Form

You can submit the Claim Form by one of the following ways:

• Submit the Claim Form and all supporting documentation on this Website using the below link; or

• Print the Claim Form using the below link, then complete, sign, and mail the Claim Form, including all documentation, to the Settlement Administrator, postmarked no later than January 21, 2025, at P.O. Box 361930, Hoover, AL, 35236-1930.

Online Claim Form (you must have a valid email address)

If you complete your Claim Form online using the link above, please submit any supporting documentation with the form below.

CLAIMS EVALUATION PROCESS

The Settlement Administrator will evaluate each claim based on materials submitted and grade each claim according to an agreed formula called the “Allocation Matrix” that can be found under the “Pleadings and Important Documents” tab.  The amount of the payment will depend upon the “Category” into which the Class Member’s personal injury or monetary damages fall, and the number of Class Members who ultimately filed a valid claim. The table below sets forth the estimated expected payments to claimants in each Category. Please note that if you already submitted a claim for benefits in the DH/SGF Settlement, the amounts below are in addition to those you will receive if you qualify for benefits from the DH/SGF Settlement:

Category #	Estimated Award in the DH/SGF Settlement	Estimated Award in this Smirk’s-Molinos Settlement	Estimated Total Award
1A	$500	$165	$665
1B	$1,000	$335	$1,335
2	$15,000	$5,000	$20,000
3	$30,000	$10,000	$40,000
4	$130,000	$43,330	$173,330

Importantly, the $7,671,000 amount of the Settlement Fund may be reduced depending upon the number of people who opt out of the settlement and the category such people would have occupied had they not opted out. As a result, the above estimates could change.

A description of each Category is summarized below and detailed in the Allocation Matrix linked below.

Please note, if you marked Category 2, 3, or 4, you will need to submit additional documentation separately by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

Category 1A:

If you did not suffer personal injuries directly, but you suffered monetary damages arising from or related to another person’s personal injuries arising from consumption of the Crumbles.

Category 1B:

If you directly suffered personal injuries related to your consumption of the Crumbles, but you did not receive medical treatment for these injuries.

Category 2: Additional Documentation Required

If you directly suffered personal injuries related to your consumption of the Crumbles, and you received medical treatment for these injuries, but were not hospitalized.

You will need to submit additional documentation of the medical treatment you received for these injuries separately by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

Category 3: Additional Documentation Required

If you directly suffered personal injuries related to your consumption of the Crumbles, received medical treatment for these injuries, and were hospitalized for these injuries.

You will need to submit additional documentation of the medical treatment and hospitalization you received for these injuries separately by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

Category 4: Additional Documentation Required

If you directly suffered personal injuries related to your consumption of the Crumbles, and you underwent a cholecystectomy (gallbladder removal surgery) related to these injuries.

You will need to submit additional documentation of the cholecystectomy (gallbladder removal surgery)  separately by either (1) attaching and emailing them to SMsettlement@crumblessettlement.com, or by (2) mailing them to P.O. Box 361930, Hoover, AL, 35236-1930.

Questions?

Please check the FAQs posted on this Website under the FAQs tab for answers to frequently asked questions.

If you have additional questions not answered in the FAQs or the Pleadings and Important Documents, contact the Settlement Administrator:

• Email: SMsettlement@crumblessettlement.com
• Phone: (877) 229-1937
• Mail: Smirk’s-Molinos Crumbles Settlement, P.O. Box 361930, Hoover, AL, 35236-1930.