LG REFRIGERATOR CLASS ACTION SETTLEMENT

BENTLEY, ET AL. V. LG ELECTRONICS U.S.A., INC.

Case No. 19-CV-13554 (D.N.J.)

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW JERSEY

If you received a personalized notice in the mail or via email with a Claim Identification Number/Notice ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Claim Identification Number/Notice ID exactly as it appears on your personalized Notice, (i.e. ABC12345678).

OR

If you did not receive a personalized Notice in the mail or via email, click below to complete a Claim Form (where you do not need a Claim Identification Number/Notice ID or Confirmation Code).

QUALIFIED CLAIM FORM

TO RECEIVE PAYMENTS RELATED TO LG REFRIGERATOR COOLING ISSUES

INSTRUCTIONS

This claim form is for LG Refrigerator owners who have experienced a No-Cooling Event, as described in the Notice of Proposed Class Action Settlement. You may be eligible for benefits from LG as a result of a class action settlement. To receive a payment from the settlement, you must complete and submit this form.

  • Any Settlement Class Member who wishes to submit a Claim must timely complete, sign (by hard copy or electronic signature), and submit a Claim Form providing the Settlement Administrator with all requested information.
  • The Settlement Administrator shall receive, process, and make determinations regarding all Claim Forms, pursuant to the terms of this Agreement, as promptly as possible. To the extent practicable, Claim Forms shall be processed in the order in which they are received.
  • The Settlement Administrator shall provide the Notice of Proposed Class Action Settlement and Claim Form to any Person requesting such documents at any time during the Claim Period.

How To Complete This Qualified Claim Form

  1. There are three ways to submit a claim form to the Settlement Administrator: (a) online at this page; (b) by email to Info@LGFridgeSettlement.com. Click here to download a claim form.; or (c) by U.S. Mail sent to the following address: LG Fridge Settlement c/o Administrator, 1650 Arch Street, Suite 2210, Philadelphia, PA 19103. Click here to download a claim form. If you submit your claim by U.S. mail, make sure to include the completed and signed claim form and all supporting materials in one envelope.
  2. All questions below must be answered. Please type or print your responses in ink. Write “Not Applicable” if the question does not apply to you.
  3. You may recover up to $450 for past No-Cooling Events upon signing the claim form as to each item under oath. You may be able to recover more if you support your claim with proof. To receive the maximum possible recovery, you should support your claim with receipts, invoices, photographs, payment card records, inspection records, insurance records, or any other available proof. Please keep a copy of your claim form and supporting materials you submit. Do not submit your only copy of the supporting documents. Materials submitted will not be returned. Copies of documentation submitted in support of your Claim should be clear and legible.
  4. If the Settlement Administrator has any questions regarding your claim after it is submitted, you will be notified by mail and email. You must respond to any request by the Settlement Administrator for additional information. If you do not respond, the Settlement Administrator will be unable to process your claim, and you will waive your right to receive money under the Settlement.
  5. If you have any questions, please contact the Settlement Administrator by email at info@lgfridgesettlement.com or by telephone at 1-855-918-4661, or send your question to the settlement administrator by U.S. mail using the address above.
  6. You must notify the settlement administrator if your address changes. If you do not, you may not receive your payment.

Deadline

Your claim must be submitted by January 11, 2021.

After You Submit Your Claim

If you submit your claim online or by email, then you will receive an electronic confirmation that your claim has been received.

If you submit your claim by U.S. mail, you will not receive an acknowledgment of receipt from the Settlement Administrator. If you want to be assured that your claim and supporting materials were received, please use a shipping method that provides delivery confirmation.

It will take several months for the Settlement Administrator to process your claim. Please check the settlement website for updates. If you are contacted by the Settlement Administrator, please respond promptly.

I. YOUR CONTACT INFORMATION AND MAILING ADDRESS

Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form.

* Required Fields
II. INFORMATION ABOUT YOUR LG REFRIGERATOR AND PURCHASE

Note: The model number and serial number of your LG Refrigerator appear on the sticker on the inside door of your LG Refrigerator, your owner’s manual, purchase receipt, invoices for in-home delivery of your LG Refrigerator, service tickets, repair documents, or certain communications with LG.

Please provide the information requested below:
IF YOU STILL HAVE YOUR LG REFRIGERATOR, TAKE A PICTURE OF THE STICKER ON THE INSIDE DOOR OF YOUR REFRIGERATOR AND SUBMIT IT WITH THIS FORM. THE PHOTOGRAPH WILL SERVE AS YOUR PROOF OF PURCHASE. (PLEASE CHECK THAT THE MODEL NUMBER AND SERIAL NUMBER ARE READABLE). PLEASE ALSO SUBMIT ANY OTHER PROOF OF PURCHASE IF AVAILABLE. YOU MAY LOCATE YOUR STICKER HERE.

OR:

IF YOU NO LONGER HAVE YOUR REFRIGERATOR OR IF THE STICKER IS MISSING, PLEASE COMPLETE THE INFORMATION REQUESTED BELOW AND PROVIDE PROOF OF PURCHASE (RECEIPT, INVOICE, REPAIR DOCUMENTS).


Are you a resident of the U.S. or its territories who purchased an eligible LG Refrigerator from an authorized retailer for household use?

(The list of eligible models is available here.)

If you answer NO to this question, then please STOP as you are not a Settlement Class Member entitled to compensation under the Settlement.

III. PAYMENT SELECTIONS
After purchasing my LG Refrigerator, I experienced at least one or more of the following in connection with a No-Cooling Event on my LG Refrigerator: Please fill in the blanks if applicable and select one box from each section that applies to you:
1

Unsuccessful Repairs
My LG Refrigerator had a No-Cooling Event, which I reported, but even though it was repaired, my LG Refrigerator had at least one more No-Cooling Event.

Select one of the following:

+ Add Date

+ Add Date

Examples of acceptable proof include phone records, invoices, bills, repair records, cancelled checks, work orders, photographs, payment records, etc.

2

Delayed Service
I waited more than ten (10) days after the date I first reported a No-Cooling Event to LG before my LG Refrigerator was repaired. (Count of waiting days excludes the date reported and the date repaired.)

Select one of the following:

If you experienced delays related to more than one No-Cooling Event, please provide the dates applicable to each event. Upload an additional page if necessary.

Examples of acceptable proof include phone records, invoices, bills, repair records, cancelled checks, work orders, photographs, payment records, etc.

3

Labor Cost
I paid for labor for a repair technician to diagnose, estimate, service, or attempt to service my LG Refrigerator following a No-Cooling Event that occurred within 5 years of purchase.

Select one of the following:

4

Payment for Parts
I paid out-of-pocket for parts related to the cooling system of an LG Refrigerator (including a compressor, condenser, connection tube, drier, and evaporator) that were used to repair my LG Refrigerator following a No-Cooling Event.

Select one of the following:

5

Replacement of LG Refrigerator
I disposed of or replaced my LG Refrigerator because it could not be repaired following a No-Cooling Event that occurred within 5 years of purchase.

Select one of the following:

Examples of acceptable proof include call records, invoices, bills, repair estimate records, payment records, etc.

6

Property Loss or Damage
I experienced property loss or damage related to a No-Cooling Event with my LG Refrigerator (including the value of spoiled food, beverages, medicine, or other perishables, or the value of damage to property such as from leaking or repairs) when the No-Cooling Event occurred within 5 years of purchase.

You can include and add up Property Loss or Damage from multiple No-Cooling Events.

Select one of the following:

IV. PREVIOUS COMPENSATION FOR NO-COOLING EVENTS

If you previously received compensation from LG, its retailers or insurers for No-Cooling Events on your LG Refrigerator, please enter the amount of compensation you received, who provided the compensation, and the date received.

V. DOCUMENTATION

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

File List: No Files Selected

    VI. VERIFICATION AND ATTESTATION UNDER OATH

    By signing below and submitting this Qualified Claim Form, I hereby swear under oath that I am the person identified above and the information provided in this Claim Form is, to the best of my knowledge, true and correct, and that I have not submitted another claim in connection with this Settlement and know of no other person having done so on my behalf.

    REMINDER CHECKLIST

    1. Please check and make sure you answered all the questions on the claim form as requested.
    2. Please check and make sure that you signed and dated the claim form.
    3. If you are requesting payment for items requiring proof, then please remember to enclose copies of the supporting documentation. Supporting proof may include receipts, invoices, photographs, payment card records, inspection records, insurance records, or other reasonable proof.
    4. Please keep a copy of your completed claim form and any supporting documentation for your own records.
    5. If you move or change addresses while your claim is pending, or if the Notice of Settlement was sent to you at an old or incorrect address, please make sure you provide the settlement administrator with your correct updated address to make sure you receive any payment owed to you under the Settlement.
    6. If you have any questions, please first refer to the Frequently Asked Questions page. You may also contact the settlement administrator by calling the toll-free number, 1-855-918-4661, by email to info@lgfridgesettlement.com, or by writing via U.S. mail addressed to LG Fridge Settlement c/o Administrator, 1650 Arch Street, Suite 2210, Philadelphia, PA 19103.

    Your Claim Form has been submitted successfully.

    HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: Info@LGFridgeSettlement.com.

    Please print this page for your records.

    Your Claim Details

    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    City
    State
    Zip Code
    Email Address
    Home Phone
    Cell Phone
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@LGFridgeSettlement.com