Purdue Personal Injury Trust

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If you are represented by a lawyer in connection with your Purdue opioid-related personal injury, before you submit a Claim Form, contact the lawyer you hired to represent you in connection with your Purdue opioid-related personal injury and check that your lawyer has not already submitted a Claim Form on your behalf.

WHO SHOULD CONSIDER SUBMITTING

 A NAS PI CLAIM FORM?

NAS Claim Forms should be submitted by individuals who first filed a Proof of Claim against one of the Debtors in the Purdue Chapter 11 Bankruptcy case by the General Bar Date, and whose claim for personal injury arose on behalf of a child whose intrauterine exposure to opioids or opioid replacement medications caused the child to be diagnosed with a medical, physical, cognitive or emotional condition resulting from the intrauterine exposure, including but not limited to the condition known as Neonatal Abstinence Syndrome (“NAS”).

ELIGIBILITY AND CLAIM REQUIREMENTS

In order to be eligible for a Distribution from the PI Trust for a NAS PI Channeled Claim, a claimant will, among other things, be required to:

  1. Hold a NAS PI Channeled Claim against one or more Debtors;
  2. Have timely filed individual personal injury Proof of Claim for such NAS PI Channeled Claim against one or more Debtors in the Chapter 11 Cases; and
  3. Submit the required proof demonstrating a diagnosis by a licensed medical provider of a medical, physical, cognitive or emotional condition resulting from the NAS Child’s intrauterine exposure to opioids or opioid replacement or treatment medication, including but not limited to the condition known as NAS.

Important Note: If you provided the required documentation in connection with (i) the Mallinckrodt plc (Case No. 20-12522) (Bankr. D. Del.) bankruptcy, (ii) the Endo International plc (Case No. 22-22549) (Bankr. S.D.N.Y.) bankruptcy, or (iii) your Proof of Claim that was filed in the Debtors’ Chapter 11 Cases, you do not need to resubmit the required documentation, but shall provide the PI Claims Administrator with a statement (or if filing in bulk by the Firm, with a list) confirming the previously filed Claim(s) for the PI Claims Administrator to review;

ADDITIONALLY, each Holder of a NAS PI Claim seeking an Award from the PI Trust must complete, sign, and submit the following documents so that they are received on or before July 28, 2025 at 11:59 p.m. (Eastern Time) PI Claims Deadline:

  1. The NAS PI Claim Form;
  2. The applicable HIPAA consent form found on pages 13 and 14 of the NAS Claim Form;
  3. To the extent the NAS PI Channeled Claim concerns the injuries of a decedent of the Holder of such Claim, the Heirship Declaration, or valid estate documents authorizing the Holder of the Claim to act on behalf of the decedent’s estate; and
  4. For Holders of NAS PI Claims that are minors, a Proxy Form found on pages 10 through 12 of the NAS Claim Form, which can also be found in Exhibit D of the NAS PI TDP.

FAILURE TO TIMELY SUBMIT THE NAS PI CLAIM FORM ALONG WITH THE REQUIRED INFORMATION OUTLINED UNDER THE ELIGIBILITY SECTION ABOVE BY JULY 28, 2025, AT 11:59 P.M. (EASTERN TIME) IN ACCORDANCE WITH THE NAS PI TDP MAY RESULT IN THE NAS PI CLAIM BEING THE SUBJECT OF AN OBJECTION, DISALLOWANCE, OR DENIAL AND NOT RECEIVING ANY DISTRIBUTION.

Submitting this NAS PI Claim Form does not guarantee that your NAS PI Claim will be Allowed or that you will receive payment from the PI Trust.

IMPORTANT DOCUMENTS TO REVIEW

BEFORE FILING A NON-NAS PI CLAIM FORM

NAS PI Trust Distribution ProceduresDownload

NAS PI Claim FAQs (Coming Soon)

NCAM Grading MaterialsDownload
NAS PI Claim Form and Instructions, Including HIPAA and ProxyDownload
Heirship DeclarationDownload

INSTRUCTIONS ON HOW TO COMPLETE

 A NAS PI CLAIM FORM

The below provides instructions on how to complete the NAS PI Claim Form.

Step 1: Personal Information of NAS PI Claimant and His/Her Representative – Part 1 of the Claim Form

1.A: Fill in the NAS Child’s personal information.

1.B: Fill in the personal information of the representative of the NAS Child.

Step 2: Medical Provider Information – Part 2 of the Claim Form

2.A.: Fill out and provide the information of the licensed medical provider(s) who have diagnosed the NAS Child with any medical, physical, cognitive or emotional condition resulting from his/her intrauterine exposure to opioids or opioid replacement or treatment medication(s).

2.B: details the types of Competent Evidence required to show the exposure and diagnosis of injury for a NAS Child.

2.C: Complete the information regarding the medical facility, if any, in which the NAS Child was born.

Step 3: Medical Liens – Part 3 of the Claim Form

3.A: Answer Yes or No as to whether any insurance company paid for medical treatment for the NAS Child’s opioid related treatment.

3.B: Mark “YES” or “NO” for each section (Medicare, Medicaid, Tricare, Veterans Administration Medical Benefits, and Private Insurance Provider(s)) to indicate whether the NAS Child had Medicare, Medicaid, Tricare, Veterans Administration Medical Benefits, and/or Private Insurance over the last twenty (20) years.

If “YES” is marked for any section, fill in the remaining blanks in that section.

Step 4: Signature – Part 4 of the Claim Form

Fill in the name, email address, and phone number of the NAS Child and the person signing this form on behalf of the NAS Child.

If you are signing this form as the claimant or as the representative of the NAS claimant, sign in the appropriate signature block.

If you are signing this form as counsel of record (the attorney) for the claimant or representative, sign in the appropriate signature block.

Step 5: Confirmation of Submission of Required Evidence Part 4 of the Claim Form

Check the box that indicates the status of your required evidence that demonstrates that a licensed medical provider has diagnosed the NAS PI Claimant with any medical, physical, cognitive or emotional condition resulting from the NAS Child’s intrauterine exposure to opioids or opioid replacement or treatment medication(s) prior to September 15, 2019.

Indicate whether the required evidence has previously been submitted with a previously been filed for the NAS Child with the MNK PI Trust or the Endo PI Trust, or if the required evidence was submitted with the Proof of Claim filed in the Purdue Chapter 11 Bankruptcy Case.

Indicate whether a claim has previously been filed for the NAS Child with the MNK PI Trust or the Endo PI Trust. If so, indicate which Trust has previously received the submission for the NAS Child.

Step 6: Purdue Proxy Form for NAS Minor Claimants

If you are filing a NAS PI Claim on behalf of a NAS Minor Claimant, this form must be completed.

Please fill out the form with the required information, and indicate the Proxy type.

If you are the Custodial Parent, other than the Birth Parent, please provide the legal document that names you as such. For example, if the NAS Child has been adopted, please provide the Adoption Decree. 

If you are a Court Appointed Legal Guardian, provide with the claim submission the legal document that appoints you as the NAS Child’s guardian.

If you are providing custody and care for the NAS Child but are neither the Custodial Parent or the court appointed guardian, please fill out the section and provide one of the acceptable forms of evidence as outlined. 

Step 7: HIPAA Release Form

Complete and sign this entire form using information for the Injured Party (the NAS Child).

Please note that the SSN is required of the NAS Child.

HOW TO SUBMIT A NAS PI CLAIM FORM

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

  1. Submit the NAS PI Claim Form and supporting documentation, including the required evidence of a Qualifying Opioid, on this Website by clicking HERE; or
  2. Print the NAS PI Claim Form by clicking HERE, then complete, sign, and return the NAS Claim Form, including all supporting documentation and required evidence of a Qualifying Opioid by:
  1. e-mail to purduepitrust@purduepitrust.com,
  2. mail to Purdue PI Trust, P.O. Box 361930, Hoover, Alabama, 35236-1930, or
  3. fax to Purdue PI Trust at 205-716-2364.

THE DEADLINE TO SUBMIT A NAS PI CLAIM FORM, INCLUDING ALL REQUIRED DOCUMENTATION AND SIGNATURES, IS JULY 28, 2025, by 11:59 P.M. (EASTERN TIME).

QUESTIONS?

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

If you have additional questions not answered in the FAQs, NAS PI Claims Tab, or the Pleadings and Important Documents tab, contact the Claims Administrator: