Fix A Claim | LG Refrigerator Settlement

Deficiency Reasons

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.

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Email Address *

Home Phone

Cell Phone

Work Phone

Please enter your Notice ID # if you received a Notice by mail or email.

* 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).

Model Number of Your LG Refrigerator

Serial Number of Your LG Refrigerator

Date of Purchase of Your LG Refrigerator

Location / Retailer of Purchase of Your LG Refrigerator

Date of First No-Cooling Event on Your LG Refrigerator

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.

Yes

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.	Enter the total number of additional No-Cooling Events you experienced with your LG refrigerator after reporting the first No-Cooling event that was repaired: Select one of the following: Not Applicable I experienced Unsuccessful Repairs as listed below. I claim the default payment. Enter the approximate date of the first No-Cooling Event on your LG Refrigerator that was unsuccessfully repaired: Enter the approximate date of each additional No-Cooling Events on your LG Refrigerator after the first unsuccessful repair: + Add Date Name of the Repair Service Provider: I experienced Unsuccessful Repairs within 5 years of purchasing my refrigerator and am submitting proof for each of the No-Cooling Events listed below. Enter the approximate date of the first No-Cooling Event on your LG Refrigerator that was unsuccessfully repaired: Enter the approximate date of each additional No-Cooling Events on your LG Refrigerator after the first unsuccessful repair (upload an additional page if necessary): + Add Date Name of the Repair Service Provider: 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: Not Applicable I experienced Delayed Service as listed below and claim the default payment. Enter the date that the No-Cooling Event was first reported to LG: Enter the date of repair: Name of the Repair Service Provider: I experienced Delayed Service within 5 years of purchasing my refrigerator as listed below and am submitting proof of more than 10 days of repair delay. Enter the date that the No-Cooling Event was first reported to LG: Enter the date of repair: Name of the Repair Service Provider: 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: Not Applicable I paid for labor for a repair technician following a No-Cooling Event and claim the default payment. Total amount I paid for Labor Costs Paid to: I paid labor for a repair technician following a No-Cooling Event and am submitting proof. Total amount I paid for Labor Costs Paid to:
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: Not Applicable I am submitting additional proof of out-of-pocket Payment for Parts: Total amount I paid for Parts Paid to:
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: Not Applicable I am submitting proof that my LG Refrigerator’s No-Cooling Event could not be repaired, AND consequently, I disposed of or replaced my LG Refrigerator. 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.	Enter the total amount of Property Loss or Damage here: Provide a brief description of the property lost or damaged (for example, groceries, beverages, prescription drugs, damage from leaking, damage to floors, etc.) and the approximate dollar amount of each category of loss or damage (upload an additional page if necessary): Select one of the following: Not Applicable I experienced property loss or damage and claim the default payment (up to the amount of my loss or damage). I am submitting additional proof of Property Loss or Damage.

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.

Amount of compensation received:

I received the compensation from:

Date compensation 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.

Select File for Upload:

File Description:

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.

Signature *

Date

REMINDER CHECKLIST

Please check and make sure you answered all the questions on the claim form as requested.
Please check and make sure that you signed and dated the claim form.
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.
Please keep a copy of your completed claim form and any supporting documentation for your own records.
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.
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.

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

Your Deficiency Response has been submitted successfully.

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