ir-ClaimInformation
Claim Information
Claim information is as follows. The required information for any claim information to be processed by the SimpleBatch system is in bold. If the minimum required information is not provided, no claim data will be imported into eClaims. Please see the requirements for each section.
AttorneyID
this is provided by CRMC
ContactID
this is provided by CRMC
CopyDocs
First Diagnosis Date
Alleged first diagnosis date
Jurisdiction State/Country
Claimant's jurisdiction election (state codes), or if outside U.S. (country code)
Jurisdiction Basis
Valid entries include:
Place of tort lawsuit
Place of exposure
Current Residence
Valuation Option
possible valuation options, they include:
IR
individual review (note that claims may get a lower value in IR than in ER, applies to all IR options)
IRE
individual review - extraordinary
IRH
individual review - exigent hardship
IRX
individual review - exigent health
Processing ElectionCD
possible elections include:
ACC
Annual contribution claim (most claims would fall into this election)
PEU
Pre-established Unliquidated
AsbLawsuitQuestion
Yes or No answer to the question “Has an asbestos-related lawsuit or claim ever been filed on behalf of the injured party?”
If “Yes”, the claimant and the claimant's law firm must attach to this Claim Form: the file-stamped copy of the complaint, as amended, any standard disclosures or interrogatories and the answers thereto required by the applicable jurisdiction, and any affidavits or deposition testimony submitted by or on behalf of the injured party. In addition to the submission of all documentation required by this Part 4, Subpart A, you must submit an affirmation in which you or your attorney affirm to the best of your (or your attorney’s) knowledge, information and belief, formed after an inquiry reasonable under the circumstances, that all documents required by Part 4 of the IR claim form have been submitted to CRMC as part of the claim file for this claim.
To the extent that affidavits or depositions from a person other than the injured party include information that bears on an injured party’s exposure to a NARCO asbestos-containing product (whether or not the affidavits or depositions mentioned NARCO) and were submitted on behalf of the injured party to a court, an insurance company, or an asbestos defendant in the tort system in an effort to support an asbestos claim, those affidavits and depositions must also be submitted. Such affidavits and depositions must be submitted regardless of whether they tend to support the claim of exposure to a NARCO asbestos-containing product. Affidavits and depositions that do not relate to the time period of the injured party’s exposure to a NARCO asbestos-containing product do not have to be submitted to the NARCO Trust, unless the affidavit or deposition: (1) names the injured party; and (2) contradicts the evidence of the injured party’s exposure to a NARCO asbestos-containing product. Affidavits that were submitted to other asbestos trusts only do not have to be submitted to the NARCO Trust.
Please see Part 4 of the IR Claim Form and the Part 4, Subpart A: Litigation History section of the Instructions for Completing the NARCO Asbestos Trust Proof of Claim Form for Unliquidated Claims to be Processed under Individual Review for more detail regarding these MANDATORY documentation requirements.
AffirmPOCReview
Yes or No response to the following statement: "I affirm I have reviewed and understood the Instructions for Completing the NARCO Asbestos Trust Proof of Claim Form for Unliquidated Claims to be Processed under Individual Review. I further certify that I am authorized by the Claimant to submit a claim, and that the information and materials with respect to this claim filed through the e-Claims system with the NARCO Trust, submitted now or in the future, including any supplemental documentation or information, changes and corrections are and will be submitted pursuant to and subject to the provisions of Rule 11 of the Federal Rules of Civil Procedure and the Hybrid Filer Agreement. In addition, by submitting this claim through e-Claims, I certify and warrant that if the claim is filed on behalf of the injured party and/or the injured party's estate, the person filing the claim is authorized by law to file the claim on behalf of the injured party, the injured party's heirs, representatives, successors, assigns and estate."
Litigation Information
AllegedDiseaseCD
Alleged Disease Other
If 'No Disease Level' is used for AllegedDiseaseCD then specify the alleged disease in this field
Alleged Bilateral Diag Date
Date of diagnosis of underlying bilateral asbestos related nonmalignant disease
IR Smoking Information
IR Econ Loss Information
IR Marital Status
Married
Single
Divorced
Widowed
IR Marriage Union Date
IR Marriage Partner FirstName
IR Marriage Partner LastName
IR Asbestos Claim Filed Question
Has a claim ever been filed on behalf of the injured party with any asbestos-related bankruptcy entity, asbestos-related trust, or asbestos-related claims resolution organization?
Valid entries include
Yes/No/DeclineToAnswer
If yes you must include entries in the ClaimHistory Section in the NarIR-ClaimHistory worksheet.
Extraordinary Claim Question
If you are claiming an Extraordinary Claim, did the injured party's asbestos exposure occur primarily from working at one or more manufacturing facilities of NARCO or its predecessors?
Valid entries include
Yes/No
Extraordinary NARCO Percentage
If you are claiming an Extraordinary Claim, identify the percentage of the injured party's total asbestos exposure that arises from NARCO asbestos-containing products.
IR Substance Exposure Question
Answer yes/no to question (required when alleging levels III-VI):
"To the best of your knowledge, was the injured party ever exposed to any of the following substances during the course of any employment that may have contributed to the injured party’s Disease Level?
arsenic, beryllium, cadmium, chromium, coal dust, coal tar, fiberglass, lead, nickel, radiation, silica, talc, welding fumes)"
If yes you must include entries in the SubstanceExposure section in the NarIR-SubstanceExposure worksheet.
IR Other Factors
In this field please explain any other factors which should be considered.