Gen 3 Form

What can I claim on my GEN 3 Form?

You may file a Claim for all costs incurred while trying to establish a Claim, including the following:

• meals
  
• mileage (not gas)
  
• parking
  
• photocopies
  
• fees charged by Commissioner of Oaths for TRAN 3 or HEMO 3 Forms
  
• fees charged by treating physician for completing TRAN 2 or HEMO 2 Forms

The Administrator will not reimburse you for your lawyer's fees if you asked a lawyer to fill out the Claim Forms on your behalf.

All your Claims for reimbursement must be accompanied with receipts, and proof that you saw your doctor on the particular day in question. Travel expenses have to be HCV-related meaning you went to the doctor, hospital or laboratory.

In order to obtain proof of your visits, you can have your doctor sign the logbook provided with this Form. Your doctor can also write a letter indicating which dates of visits were HCV-related. You can also obtain hospital records proving that you were at the hospital for treatment on the day in question.

How do I file a Claim for mileage?

On the log Form, insert the date of your visit, the name of the doctor and his or her specialty. Also, please indicate how many kilometres it is from your home to the HCV-related destination. Please also indicate the distance roundtrip. Have your doctor or his/her nurse sign or stamp the logbook. This will show proof that the visit was HCV-related.

How do I file a Claim for Uninsured Treatments and Medications?

Please include your receipts for uninsured treatments or medications with the GEN 3 Form, along with the following:

• the date of purchase; AND
  
• the name or a description; AND
  
• the total cost; AND
  
• the amount paid by your insurance, or other health plan; AND
  
• the amount claimed.

Receipts must be submitted, along with a letter from the treating physician approving the items claimed.

If you are not aware of what medications are HCV-related, make a list of the medications you are using, bring the list to your doctor, and have him/her indicate which ones are HCV-related.

Example:

What if I no longer have the receipts?

If you do not have your receipts for your initial Claim, contact your doctor's office and get them to send us a list of visit dates and to confirm that these visits were HCV-related. You can try to obtain a printout from your pharmacy for any past medications purchased. You can also provide copies of credit card receipts or insurance payments.

You must have receipts for any and all Claims made after your initial claim for Uninsured Medications.