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| Code | Text | Instructions | Option |
|---|---|---|---|
| 001 | Death Certificate not Provided | You have indicated that the Injured Party is deceased. However, no death certificate has been provided. Please provide an official death certificate for the Injured Party. | BOTH |
| 005 | Original Lawsuit State not Provided | Please provide the address and/or state of the court where the original lawsuit regarding this claim was filed. | BOTH |
| 006 | Original Lawsuit Date not Provided | Please provide the date on which the original lawsuit regarding this claim was filed. | BOTH |
| 007 | Date of Alleged Diagnosis and/or Alleged Injury not Provided | You failed to designate an alleged asbestos-related injury and/or the date of diagnosis for the injury. Please provide the alleged injury and at least the month and year in which a physician first diagnosed the injury. | BOTH |
| 009 | First and Last Dates of Exposure Not Provided | Your submission regarding the Injured Party's exposure to asbestos does not include complete information. Please provide the dates on which exposure began and ended for each work site where exposure is being alleged. | BOTH |
| 010 | Industry and Occupation not Provided | Your Claim Form failed to provide the industry and occupation of the Injured Party. Please do so for each work ship/plant/site where asbestos exposure is being alleged. | BOTH |
| 011 | Incomplete Personal Representative Information | You have failed to specify the personal representative's name, address, city, state, zip, phone, email, and or relationship. Before this claim can be processed, you must complete the Personal Representative section of the Claim Form with all required information. | BOTH |
| 013A | SSN is inconsistent with Claim Form | Please submit the correct Social Security Number or provide an explanation as to why there is a discrepancy. | BOTH |
| 013B | Date of Birth is inconsistent with Claim Form | Please submit the correct Date of Birth or provide an explanation as to why there is a discrepancy. | BOTH |
| 013C | Date of Death is inconsistent with Claim Form | Please submit the correct Date of Death or provide an explanation as to why there is a discrepancy. | BOTH |
| 013D | Name is inconsistent with Claim Form | Please submit the correct name or provide an explanation as to why there is a discrepancy. | BOTH |
| 014 | Attachments Not Provided | In your Claim Form, you referenced additional information included as an attachment and/or affidavit, but no such information was found with the claim, or you failed to provide any medical records to support your claim as required by the Trust. | BOTH |
| 016 | Death Certificate for Wrong Party | The death certificate provided is not for the Injured Party of this claim. Please provide an official death certificate for the Injured Party. | BOTH |
| 017 | Death Certificate is Incomplete | Please provide an official death certificate for the Injured Party that is legible and complete. | BOTH |
| 019 | Litigation Page Failure to Elect Jurisdiction | You failed to provide the jurisdiction in which you would have elected to file a lawsuit. | BOTH |
| 026 | Duplicate Financial Dependent | One or more of the financial dependents as indicated in the dependent section of the claim form appears to be a duplicate. Please review the dependent section of the claim form to ensure that no duplicate dependent information is provided. | IR |
| 033 | Incomplete Exposure Information | You have failed to complete at least one line of exposure information which includes, Site, City, State where exposure occurred and/or dates of alleged exposure. Before this claim can be processed, you must have at least one complete line of exposure in the Exposure section of the Claim Form with all required information. | BOTH |
| 034 | Incomplete Secondary Exposure Information | The Secondary Exposure information is incomplete. Before this claim can be processed, you must provide the OEP first and last name, OEP start and end dates of exposure, relationship to claimant, OEP SSN and exposure description on the Secondary Exp section of the Claim Form. | BOTH |
| 035 | Failure to Answer Litigation Received Money | You have failed to specify whether you have received money previously from HAL or HW. Before this claim can be processed, you must complete the Litigation section of the Claim Form with all required information. | BOTH |
| 036 | Failure to Answer Litigation Final Judgment | You have failed to specify whether a final judgment was entered against HAL or HW. Before this claim can be processed, you must complete the Litigation section of the Claim Form with all required information. | BOTH |
| 038 | Incomplete Financial Dependant Information | One or more of the financial dependents as indicated in the dependent section of the Claim Form is incomplete. Before this claim can be processed, you must complete the Dependent section of the Claim Form with all required information. | IR |
| 040 | Incomplete Extraordinary Information | You have filed this claim as an Extraordinary claim but the Extraordinary information is incomplete. Before this claim can be processed, you must complete the Extraordinary Claims section of the Claim Form with all required information. | IR |
| 041 | Incomplete Litigation Information | You have failed to complete all litigation information. Before this claim can be processed, you must complete all litigation records in the Litigation section of the Claim Form with all required information | BOTH |
| 042 | Failure to Answer Question 2.3 | You have failed to provide a response to Question 2.3 on the Claim Form indicating whether the claimant was ever previously diagnosed with a Scheduled Disease. Before this claim can be processed, you must provide a response indicating whether the claimant was ever previously diagnosed with a Scheduled Disease. | BOTH |
| 104 | Latency Period does not Qualify | The medical records provided in support of the alleged injury provide a date of diagnosis that does not satisfy the Trusts 10-year latency period. This is the period from first exposure to asbestos to diagnosis of an applicable disease. Please provide any additional or amended reports. | BOTH |
| 105 | No Proof of Alleged Asbestos-Related Injury | The medical records provided allege and/or support a claim for an injury or disease not recognized as asbestos-related by the Trust. The Trust can only compensate injuries that are asbestos-related. Please refer to the TDP, which can be found on the Trust's website, for a list of diseases compensated by the Trust. | BOTH |
| 110 | PFT Report not Provided | In order to fully substantiate your claim, please submit a qualifying PFT report. | BOTH |
| 113 | PFT Disputes or Conflicts with Earlier Report | The most recent PFT report that was provided disputes an earlier qualifying report. Please provide a more recent qualifying PFT report that meets the criteria established in the TDP. | BOTH |
| 114 | Most Recent PFT Scores do not Qualify | The most recent PFT scores that were provided do not qualify. In order to fully substantiate your claim, please submit a qualifying PFT report that meets the criteria established in the TDP. | BOTH |
| 116 | PFT is from an Unacceptable Facility | The PFT report provided with the claim was performed by a facility that is currently unacceptable. Please provide a qualifying PFT report from an acceptable facility. Please refer to the Trust's website for additional information. | BOTH |
| 117 | PFT does not meet ATS Standards | The PFT results provided with the claim do not meet the American Thoracic Society (ATS) standards for acceptability and reproducibility. Please provide a PFT report that adheres to ATS standards. Please provide a full report, as opposed to a summary. | BOTH |
| 118 | Full PFT Report is Required | We are unable to determine whether the PFT report provided with the claim was conducted in compliance with the standards set by the American Thoracic Society ('ATS'). Please provide the full report of the testing (as opposed to a summary report). | BOTH |
| 120 | Medical Report not by a Qualified Physician | The physical examination provided was either not performed by a qualified physician, or the Trust was unable to determine the physicians qualifications. Please provide a physical examination performed by a qualified physician, or provide the qualifications of the physician who performed the previously provided physical examination. | BOTH |
| 121 | Chest x-ray Report does not Identify the Physician | The medical records provided contain chest x-ray findings; however, the Trust was unable to determine the identity of the physician who performed the reading of the chest x-ray. Please provide a chest x-ray report in which the physician's name is clearly identified. | BOTH |
| 122 | Certified translation of foreign document required | One or more the documents in the claim are in a foreign language. In order to be considered by the Trust, the foreign language document(s) must be translated in their entirety by a certified translator. The original foreign language document(s) together with the certified translation and the translators CV must be provided before the claim can be reviewed further. | BOTH |
| 128 | No Medical Documents Provided | Medical documentation in support of this claim has not been provided to the Trust. Solution text: Please provide complete medical documents for the injured party which support the disease alleged on the claim form. | BOTH |
| 129 | Medical Report does not Qualify as a Physical Exam | The medical report provided does not provide a diagnosis from the physician who performed the physical examination. The Trust does not accept medical reviews of physical examinations. Please submit a medical report for the alleged disease based on a physical examination of the Injured Party by the physician providing the diagnosis of the asbestos-related disease. | BOTH |
| 130 | Physical Exam Report not Provided | A physical examination report, pathology report, or autopsy report has not been provided with the claim. Please provide a medical report that documents the diagnosis of the injury alleged on the Claim Form. The report must be dated, signed by a qualified physician, and must include a diagnosis based on a physical examination. A pathology report (if the Injured Party is deceased) or autopsy report is acceptable if it provides the appropriate diagnosis. | BOTH |
| 131 | Medical Report Unacceptable Diagnosis | The most recent physical examination report, pathology report, or autopsy report does not provide an acceptable diagnosis for the alleged injury. Please provide a medical report that documents the diagnosis of the injury alleged on the Claim Form. The report must be dated, signed by a qualified physician, and must include a diagnosis based on a physical examination. A pathology report (if the Injured Party is deceased) or autopsy report is acceptable if it provides the appropriate diagnosis. Please do not send duplicates of previously submitted reports. | BOTH |
| 132 | Medical Report Disputes and/or Conflicts with Earlier Reports | The most recent physical examination report, pathology report, or autopsy report provided disputes an earlier report(s) and does not provide an acceptable diagnosis for the alleged injury. Please provide a more recent medical report that documents the diagnosis of the injury alleged on the Claim Form. The report must be dated and signed by a qualified physician, and must include a diagnosis based on a physical examination. A pathology report (if the Injured Party is deceased) or autopsy report is acceptable if it provides the appropriate diagnosis. Please do not send duplicates of previously submitted reports. | BOTH |
| 133 | Medical Report for Wrong Party | The physical examination report, pathology report, or autopsy report submitted is not for the Injured Party of this claim. Please provide a medical report for the Injured Party that documents the diagnosis of the injury alleged on the Claim Form. The report must be dated, signed by a qualified physician, and must include a diagnosis based on a physical examination. A pathology report (if the Injured Party is deceased) or autopsy report is acceptable if it provides the appropriate diagnosis. | BOTH |
| 134 | Medical Report is Incomplete | The physical examination report received is not acceptable because it is illegible or otherwise incomplete. Please provide a complete medical report that documents the diagnosis of the injury alleged on the Claim Form. | BOTH |
| 135 | Pathologist not Board-Certified | The pathology report provided with the claim does not indicate that it was performed by a board-certified pathologist, or the pathologist was not board- certified at the time of the report. Please provide documentation of the pathologist's certification, or provide a pathology report from a board-certified pathologist who diagnosed the injury alleged on the Claim Form. | BOTH |
| 136 | Medical Report is Unacceptable, Final Request | This is the final request for an acceptable medical report providing evidence of a physical examination by a physician with an acceptable diagnosis of the alleged injury. A pathology report (if the Injured Party is deceased) is acceptable if it provides the appropriate diagnosis. | BOTH |
| 137 | Medical Report is from an Unacceptable Physician | The physical exam provided with the claim was performed or relies upon a physical exam performed by an unacceptable physician. Currently reports from these physicians are not acceptable. Please submit a physical exam that diagnoses the injury alleged and was performed or relies upon an acceptable physician's diagnosis. Please refer to the Trust's website for more information. | BOTH |
| 138 | Medical Report is from an Unacceptable facility | The physical examination report provided with the claim was performed at an unacceptable facility. Currently reports from these facilities are not acceptable. Please submit a report from an acceptable facility or physician with an acceptable diagnosis. Please refer to the Trust's website for more information. | BOTH |
| 139 | Chest X-ray was not read by a Qualified Physician | The chest x-ray or CT scan provided does not indicate if it was read by a Qualified Physician, or the physician who read the chest x-ray or CT scan was not board-certified at the time of the reading. Please provide documentation of the physician's certification or provide a chest x-ray or CT scan that was read by a Qualified Physician. The physician must be board-certified at the time of the reading. | BOTH |
| 140 | Chest X-ray Report Not Provided | A chest x-ray, CT scan, or B-reader report has not been provided with the claim. The chest x-ray or CT scan must be read by a Qualified Physician. Please submit a report based on the review of a chest x-ray, CT scan, or a B-reader report evidencing bilateral asbestos-related nonmalignant disease. | BOTH |
| 141 | Chest X-Ray Report Unacceptable Diagnosis | The most recent chest x-ray, CT scan, or B-reader report does not provide an acceptable diagnosis. Please submit a report based on the review of a chest x-ray, CT scan, or a B-reader report evidencing bilateral asbestos-related nonmalignant disease. The chest x-ray or CT scan must be read by a Qualified Physician. Please do not send duplicates of previously submitted reports. | BOTH |
| 142 | Chest X-Ray Report Disputes or Conflicts with Earlier Reports | The most recent chest x-ray, CT scan, or B-reader report disputes an earlier report and does not provide an acceptable diagnosis. Please submit a more recent report based on the review of a chest x-ray, CT scan, or a B-reader report evidencing bilateral asbestos-related nonmalignant disease. The chest x-ray or CT scan must be read by a Qualified Physician. | BOTH |
| 143 | Chest X-Ray Report is for the Wrong Party | The chest x-ray, CT scan, or B-reader report provided is not for the Injured Party of this claim. Please provide a report for the Injured Party based on the review of a chest x-ray, CT scan, or a B-reader report evidencing bilateral asbestos-related nonmalignant disease. The chest x-ray or CT scan must be read by a Qualified Physician. | BOTH |
| 144 | CXR Report is Incomplete or the CXR is Not of Acceptable Quality | The chest x-ray, CT scan, or B-reader report is not acceptable because it is illegible, otherwise incomplete, or is not of acceptable quality. Please submit a complete report based on the review of a chest x-ray, CT scan, or a B-reader report evidencing bilateral asbestos-related non-malignant disease. The chest x-ray or CT scan must be of acceptable quality and read by a board-certified physician. | BOTH |
| 145 | Chest X-Ray Report Findings are not Bilateral | The chest x-ray, CT scan, or B-reader report provided does not show bilateral findings. Please submit a report based on the review of a chest x-ray, CT scan, or a B-reader report evidencing bilateral asbestos-related nonmalignant disease. The chest x-ray or CT scan must be read by a Qualified Physician. | BOTH |
| 146 | Chest X-Ray Report is Unacceptable, Final Request | This is the final request for an acceptable chest x-ray, CT scan, or B-reader report. Please submit a report based on the review of a chest x-ray, CT scan, or a B-reader report evidencing bilateral asbestos-related nonmalignant disease. The chest x-ray or CT scan must be read by a Qualified Physician. | BOTH |
| 147 | Chest X-Ray Report is from an Unacceptable Physician | The chest x-ray, CT scan, or B-reader report provided with the claim was evaluated by an unacceptable physician. Currently reports from these physicians are not acceptable. Please submit a chest x-ray, CT scan, or B-reader report from an acceptable physician. The report must provide evidence of bilateral asbestos-related nonmalignant disease. The chest x-ray or CT scan must be read by a Qualified Physician. Please refer to the Trust's website for more information. | BOTH |
| 148 | Chest X-Ray Report is from an Unacceptable Facility | The chest x-ray or CT scan report provided with the claim was performed by an unacceptable facility. Currently reports from these facilities are not acceptable. Please submit a report based on a review of a chest x-ray or CT scan that was performed by an acceptable facility. The report must provide evidence of bilateral asbestos-related nonmalignant disease. The chest x-ray or CT scan must be read by a Qualified Physician. Please refer to the Trust's website for more information. | BOTH |
| 149 | Severe Asbestosis (Disease Level IV)/ILO Score does not Qualify | Severe Asbestosis (Disease Level IV) requires either an ILO of 2/1 or greater or pathologic evidence of asbestosis. The most recent ILO reading and/or pathology report does not meet these requirements. Please submit either a B-reading of a more recent chest x-ray or a pathology report that provides acceptable findings for asbestosis. The B-reading and/or pathology report must meet the requirements as outlined in the TDP. | BOTH |
| 150 | Pathology Report not Provided | A pathology report has not been provided. Please provide a pathology report from a board-certified pathologist that documents the diagnosis of the injury alleged on the Claim Form. | BOTH |
| 151 | Pathology Report for Wrong Injury | A pathology report has been provided but it is not for the alleged injury. Please provide a pathology report from a board-certified pathologist that documents the diagnosis of the injury alleged on the Claim Form. | BOTH |
| 152 | Pathology Report is not for a Primary Site | The pathology report provided does not indicate that the alleged cancer was the primary cancer site. In order for the Trust to establish that the alleged malignancy was a primary site, a physician's report expressly stating that the malignancy was a primary site is required. Please submit any additional or amended reports relating to this issue. | BOTH |
| 153 | Pathology Report is Incomplete | The pathology report provided is not acceptable because it is illegible or is otherwise incomplete. Please provide a complete pathology report that documents the diagnosis of the injury alleged on the Claim Form. | BOTH |
| 154 | Pathology Report has an Unacceptable Diagnosis | The pathology report provided does not provide an acceptable diagnosis for the alleged injury. Please provide a pathology report from a board-certified pathologist that documents the diagnosis of the asbestos-related injury alleged on the Claim Form. | BOTH |
| 156 | Failure to Choose Description for Significant Occupational Exposure (Disease levels III, IV, V & VII only) | Your submission regarding the injured Party's circumstances of asbestos exposure was incomplete OR YOU SELECTED BOX 5, "NONE", AND FAILED TO PROVIDE ANY DESCRIPTION OF EXPOSURE. Your claim can not be processed until this information is received. Please select the description which best illustrates the injured Party's exposure to asbestos or asbestos-containing products. | BOTH |
| 158 | Failure to Provide Evidence of Union Employment | Although the claim form indicates that you worked out of a union, please provide evidence of Union employment, such as a verified work history, affidavit, union card, union employment records or discovery responses that verifies you were a Union employee. | BOTH |
| 159 | B-reader/ILO report based on Review of Digital X-ray is Unacceptable. | You have provided a B-reader report that is based on a review of a digital chest x-ray. The Trust will not accept a B-reading of a digital x-ray. Please submit a B-reader report that is not based on a review of a digital chest x-ray. | BOTH |
| 160 | PFT for Wrong Party | The PFT you provided is for the wrong party. Please submit a PFT for the Injured Party. | BOTH |
| 161 | PFT is Incomplete | The PFT provided is not acceptable because it is illegible or otherwise incomplete. Please provide a complete PFT that meets the requirements of the TDP. | BOTH |
| 162 | Underlying Link to Asbestos Disease is not Provided | In order to qualify your cancer claim, please submit evidence of the link to the underlying asbestos disease. | BOTH |
| 163 | Pathology Report for Wrong Party | The pathology report provided is for the wrong party. Please submit a pathology report for the Injured Party. | BOTH |
| 165 | PFT Facility not Provided | The PFT report provided does not provide the name of the facility that performed the PFTs. In order to resolve this deficiency, please submit a complete qualifying PFT report (with all trials and tracings) that identifies the name of the facility, or submit a signed "PFT Facility Verification" affidavit, which can be found on the Trust's website, verifying that the PFTs were not performed at a facility deemed unacceptable by the Trust. | BOTH |
| 168 | Smoking History Does Not Match Medicals | The information you provided in the Claim Form regarding the Injured Party's smoking history is inconsistent with the smoking history in the medical reports. Please provide an explanation with evidence that the information stated in the Claim Form is correct, or amend the Smoking History section of the Claim Form so that it is consistent with the smoking history in the medical reports. | IR |
| 170 | Chest X-ray Diagnosis Unacceptable for Asbestosis | The chest x-ray, CT scan, or B-reader report submitted with the claim either identifies p, q, or r shaped opacities, describes small rounded opacities, or provides a diagnosis of silicosis. Please submit a more recent chest x-ray, CT scan, or B-reader report that supports a diagnosis of asbestosis. | BOTH |
| 171 | The Physical Exam Diagnosis Disputes Chest X-Ray Findings | The diagnosis in the physical exam report disputes the findings in the most recent chest x-ray, CT scan, or B-reader report. Please provide a more recent medical report in which the diagnosis agrees with the chest x-ray, CT scan, or B-reader findings. | BOTH |
| 172 | Chest X-Ray was not Read by a Qualified Physician | For deceased claimant, the chest x-ray or CT scan was not read by a qualified physican. Please provide a chest x-ray or CT scan that was read by a qualified physician. The report must provide evidence of bilateral asbestos-related non-malignant disease. | BOTH |
| 173 | No Causation Statement Provided | No causation statement provided. The medical reports provided in support of your claim fail to indicate a correlation between the injury alleged and asbestos exposure. | BOTH |
| 174 | Causation Statement is Incomplete | The Causation Statement provided is either for the wrong party, illegible, not dated, missing pages, or otherwise incomplete. | BOTH |
| 175 | Causation-Doctor not Qualified/Unacceptable Doctor | The medical report submitted with your claim documenting a correlation between the alleged injury and asbestos exposure is unacceptable because it was not authored by a qualified physician, or the qualified doctor providing the link to asbestos exposure relies upon medical records from a physician deemed unacceptable by the trust. Please submit a medical report documenting the correlation between the alleged injury and asbestos exposure from a qualified physician that does not rely upon medical records from an unacceptable physician. | BOTH |
| 180 | Meso Medical Documentation Needed | The Trust has reviewed the medical documentation submitted, and due to the number of years past the date of the injured party's Mesothelioma diagnosis, the Trust is requiring more recent treatment or medical documentation regarding the alleged disease. | BOTH |
| 182 | Meso Diagnosed by Cytology | You have submitted a Mesothelioma ("meso") claim that contains only a cytology report as the diagnosing medical document. If you have a tissue pathology, please submit that report. If you have no tissue pathology, please be advised that the Trust does not accept a diagnosis of meso solely from a cytology report. In order for a diagnosis from cytology to be considered, please provide CT/PET/imaging scans AND treating records for the meso diagnosis. If no such records are available, advise the Trust that no other medical records are available for the injured party for this disease. | BOTH |
| 210 | Duplicate Financial Dependent | One or more of the financial dependents as indicated in the dependent section of the claim form appears to be a duplicate. Please review the dependent section of the claim form to ensure that no duplicate dependent information is provided. | IR |
| 212 | Description for SOE does not meet Criteria (Disease levels III,IV, V & VII Only) | One or more occupations in the industries that you have submitted do not meet the Trust's eligibility criteria for Significant Occupational Exposure. Absent further information substantiating asbestos exposure, duties and responsibilities involved in the described occupation, this claim will not be capable of further review. | BOTH |
| 228 | Significant or Cumulative Occupational Exposure is Insufficient | Five qualifying years of Significant or Cumulative Occupational Exposure, two years of which must be prior to 12/31/1982, are required to satisfy the Trust's criteria for compensation. The exposure information you have provided has been evaluated and does not provide an adequate exposure time period. Please send additional supporting documentation for the appropriate time frame. | BOTH |
| 229 | Exposure is all Post 1982 | You have failed to provide exposure information prior to December 31, 1982. Exposure must have occurred prior to December 31, 1982. Please resubmit your exposure page with additional exposure information. | BOTH |
| 231 | Pre-1983 Significant Occupational Exposure is Insufficient | You must indicate that you have had at least two (2) years of Significant Occupational Exposure prior to December 31, 1982. Please resubmit your exposure page with additional exposure information. | BOTH |
| 269 | Check Box for Previously Submitted Physical Examinations | You have not provided an acceptable Physical Examination performed by the diagnosing doctor as required by the TDP. If you checked the box on the injury page in error, please uncheck the box. If you have a Physical Examination that meets the TDP requirements, please provide. | BOTH |
| 270 | Incomplete or No Vessel Service History Provided (Maritime) | You have not included a Vessel Service History showing the number of days the Injured Party spent aboard each ship. Please provide the amount of on-board time the Injured Party spent on each ship on which you have alleged asbestos exposure. | BOTH |
| 276 | Entity/Site Relationship Inconsistent | The relationship between the claimed Entity and site do not correspond. Please verify that the site of claimed exposure is a Halliburton site for Halliburton claims or a Harbison-Walker site for Harbison-Walker claims. | BOTH |
| 277 | Site Code | The code for a site on the Documented Site List is missing. Please provide the code for the site(s) of each exposure. Refer to the Trust's website at www.diiasbestostrust.org to access the Exhibit A list of sites. | BOTH |
| 279 | Undocumented Site Information not Provided | Please provide the name, address (including city and state) of the undocumented site. | BOTH |
| 281 | Entity/Product Relationship Inconsistent | The relationship between the claimed Entity and Product does not correspond. Please verify the names of either the Entity or the Product, ensuring that both are Halliburton or Harbison-Walker asbestos-containing products or operations. | BOTH |
| 292 | Related Claim Discrepancy | Please provide documentation that will reconcile the discrepancies between the exposure information identified between the related claims. This documentation may be an affidavit or complete deposition from the injured party, a co-worker, or a family member with personal knowledge regarding the exposure information of the injured party or complete interrogatories. | BOTH |
| 401 | Exposure Information does not Match Claim Form | The information that you have submitted regarding the industry, occupation, work site, employer and/or the years of exposure of the Injured Party, is inconsistent with information provided in the medical reports, attachments, affidavits, depositions, and/or other supporting documents submitted with the claim. Please provide supporting documentation or an explanation with evidence that the information stated on the Claim Form is correct. | BOTH |
| 402a | Name of Site or Plant not provided. | Please provide the name of the Site, Plant or Ship where the Injured Party's exposure occurred. | BOTH |
| 402b | Various Sites Provided. | Please provide the name(s) of each Site, Plant or Ship, including city and state, where the Injured Party's exposure to Trust product occurred. | BOTH |
| 402c | City not provided. | Please provide the name of the city where the Injured Party's exposure occurred. | BOTH |
| 402d | State not provided. | Please provide the name of the state where the Injured Party's exposure occurred. | BOTH |
| 404 | Company Exposure Insufficient | The information that you have provided regarding the Injured Party's exposure to Company products is insufficient to satisfy the Trust's 6-month criteria for compensation. Please send additional supporting documentation that includes beginning and ending dates to support Company exposure. | BOTH |
| 407 | Incomplete Work History Verification | The work history verification provided is incomplete. The Trust must have sufficient evidence to confirm that the page(s) submitted as the verified work history is in fact the document verified in the discovery responses. You can either submit entire discovery responses or at a minimum sufficient pages from the discovery responses to evidence the connection. | BOTH |
| 409 | Need Information for Occupationally Exposed Person | You have filed a claim alleging an asbestos-related injury resulting from contact with an occupationally exposed person. The information you have provided about the occupationally exposed persons exposure is incomplete or insufficient to meet the Trusts eligibility criteria for compensation. Please completely fill out the exposure page for the occupationally exposed person. | BOTH |
| 418 | Exposure to Occupationally Exposed Person is Inadequate | Your submission regarding the Injured Party's exposure to an occupationally exposed person is incomplete. Either you failed to describe how the Injured Party was exposed to the occupationally exposed person in a legal verified document, or you failed to provide the Injured Party's beginning and/or ending dates of exposure to the occupationally exposed on the Claim Form. | BOTH |
| 424 | Exposure Dates not Provided | You have not provided beginning and/or ending dates of exposure. Please provide the dates on which exposure began and ended for each employer, occupation, and/or work site claimed. A separate page for each employer and/or work site must be completed. | BOTH |
| 425 | Separate the Years of Exposure at Each Site | Separate the years of exposure for each employer and/or work site. Please provide the dates on which exposure began and ended for each employer, occupation, and/or work site claimed. A separate page for each employer and /or work site must be completed. | BOTH |
| 430 | Pre-1983 Exposure is Insufficient | The exposure information for pre-December 31, 1982 company exposure does not satisfy the minimum exposure criteria as required under the TDP. | BOTH |
| 432 | Exposure Dates Outside Recognized Range | The dates of exposure at the claimed site are not within the date range identified by the Trust as the period when asbestos-containing products or operations were present. In order to cure this deficiency, you must provide a verified document (affidavit, discovery responses, deposition testimony or work history) signed by the Injured Party or a co-worker identifying the specific asbestos-containing products or operations to which the Injured Party was exposed or exposure documentation for a different site. | BOTH |
| 433 | Occupationally Exposed Person's Name and/or Social Security Number | You have alleged contact to asbestos through an occupationally exposed person. Please provide the name and/or social security number of the occupationally exposed person. | BOTH |
| 437 | Company product was not specified, is generic or is not recognized | Please provide an affidavit, invoice of sale, contemporaneous records or other sworn statement which includes the specific Company asbestos-containing product(s) to which you were exposed. | BOTH |
| 438 | Affidavit contains multiple company products and/or multiple sites. | The affidavit provided contains multiple company products and/or multiple sites. Please identify the specific company products to which you are claiming exposure. If multiple sites are identified, please match the company product(s) to the specific site(s) at which the exposure occurred. | BOTH |
| 450 | No Verified Company Exposure Provided | The exposure site(s) on the claim form are not known for Company products, nor has documentation which places a Company product at the site been provided. | BOTH |
| 451 | Verified Company Exposure is Insufficient | The affidavit provided in support of the claimant's proof of asbestos exposure is insufficient because it fails to properly identify one of the following: 1) missing site, city and/or state of exposure; 2) is undated, unsigned or is otherwise incomplete; 3) a Co-worker affidavit was submitted and the exposure years of the Co-worker do not match claimant's exposure years at the worksite; 4) a Co-worker affidavit was submitted for a site that does not match the claimant's site of exposure. | BOTH |
| 457 | Change of Occupation | Additional information is required to demonstrate change in occupation. You have recently updated/changed the occupation provided on the claim form. Please provide sufficient documentation to support the change in occupation. | BOTH |
| 467 | Secondary Exposure/Foreign Claim Process | We are unable to process Secondary Exposure Claims or Foreign Claims through Expedited Review. You must resubmit your claim choosing the Individual Review Process. | BOTH |
| 471 | Company Exposure Insufficient (Maritime) | The information that you have provided regarding the Injured Party's number of days on-board is insufficient to satisfy the Trust's criteria for compensation. Please send additional supporting documentation for the appropriate time frame. | BOTH |
| 473 | Intermittent or On and Off Exposure | You have indicated exposure that was either 'intermittent' or 'on and off.' The Trust does not accept exposure time that is not specific to that site or product. Please provide the dates on which exposure began and ended for each employer, occupation, and/or work site claimed, or an explanation as to why more specific dates cannot be provided. | IR |
| 474 | Extraordinary Exposure | Extraordinary Exposure was claimed as an IR factor and one or more of the following items needs attention: the exposure percentage did not meet at least 75% of the Injured Party's total asbestos exposure; or the 'Other' Entity selected is not a known Halliburton or Harbison-Walker Entity; or the certification is not executed properly; or the extraordinary exposure claimed conflicts with the exposure(s) claimed on the Claim Form. Please review your submission and respond accordingly. | IR |
| 475 | Proof of Economic Loss Not Provided or Insufficient | Your Claim Form indicated Economic Loss; however, insufficient supporting documents were provided. If you would like the Trust to consider the previously asserted Economic Loss for the Injured Party, you must provide an economic report and/or the necessary documentation which explains and substantiates the asserted loss. If no further documentation is provided to the Trust within 120 days, the claim will be valued without any consideration for Economic Loss. | BOTH |
| 477 | Affidavit Signed by POA/ Need POA | With respect to proof of Company exposure for the Injured Party, you submitted an affidavit signed by the Injured Party's POA (Power of Attorney). The affidavit provided cannot be used to complete the review of the claim. In order to resolve this deficiency, please provide the documentation appointing the POA. | BOTH |
| 478 | Product Dates Outside Recognized Manufacture Dates | The product claimed is a known product; however, the period of claimed exposure does not coincide with the date the product was known to have been in use. In order to cure this deficiency, you must provide additional exposure information. | BOTH |
| 480 | Undocumented Site Information - Products/Operations not Provided | The site of exposure identified on the claim form is not on the Documented Site List, and no documentation attempting to place a recognized Company product at the site has been submitted with the claim. | BOTH |
| 481 | Improper Jurisdiction Selected | The information you submitted does not support your election of the Claimant's Jurisdiction. Please review section 5.3(b)(2) of the Trust Distribution Procedures to determine the Claimant's Jurisdiction you must or may elect and amend or supplement your claim as necessary. You can obtain a copy of the Trust Distribution Procedures on the Trust's website, www.diiasbestostrust.org, by clicking on 'Trust Documents' in the 'About the Trust' drop down menu. Section 5.3(b)(2) requires a claimant who filed her claim against a Halliburton or Harbison-Walker Entity in the tort system before the Halliburton or Harbison-Walker Petition Date to elect the state in which the claim was filed as the Claimant's Jurisdiction. If you intend to rely on this requirement to cure this deficiency, you must provide the Trust with a date-stamped copy of your complaint or petition showing that a Halliburton or Harbison-Walker Entity was sued. Merely updating your claim form with litigation information is not sufficient to cure this deficiency. | BOTH |
| 484 | Affidavit for Company Exposure is not acceptable. | For proof of Company exposure, you submitted an affidavit from a family member of the claimant or an unknown party that cannot be identified. The Trust will not accept an affidavit from a family member who did not work at the site or from an unknown party where the provided unknown partys affidavit and signature do not match. In order to cure this deficiency, you must provide credible evidence of Company exposure. This may be established by documentation including, but not limited to, the following: a signed affidavit by a co-worker, discovery responses, deposition testimony, invoices of sale, construction or similar records. | BOTH |
| 485 | The Site(s) of Exposure Listed on Claim Form does not Match the Site Code selected. | The known or documented site selected does not match the exposure site on the claim form. | BOTH |
| 486 | Additional Information for Financial Dependents | You have indicated that the Injured Party has more than 2 financial dependents. Please provide the Trust with the Injured Party's most recent tax return. | IR |
| 487 | SOL Deficient | Based on the information and documentation submitted, your claim fails to meet the required Statute of Limitations (SOL). You can review the SOL, as well as possible cures for failed SOL, in Section 5.1(a)(2) of the TDP and in the SOL definition. Both of these documents are located in the Trust Documents section of the Trust's website at www.diiasbestostrust.org. In order to cure the deficiency, you must provide the Trust with a date-stamped copy of the Complaint showing that a DII entity was named in the underlying litigation. Simply updating the claim form with litigation information is not sufficient to cure the deficiency. | BOTH |
| 488 | Failure to Provide a Verified Work History or Work History is Incomplete | The Trust requires a verified work history which supports the injured party's exposure as submitted on the claim form. A verified work history has not been submitted on this claim. | BOTH |
| 489 | Affidavit not Notarized or Does not Otherwise Meet the State Requirements | The deficiency has been assigned because the affidavit provided has not been properly notarized accordingly to the notary requirements for the state in which it was executed. | BOTH |
| 491 | Audit Document Not Provided | A required document in response to an audit has not been provided. | BOTH |
| 493 | Medical Report Language is Unacceptable | The provided medical report contains language that is 'consistent with' or 'compatible with.' That language standing alone will not support a diagnosis. Please provide a medical report in which the physician clearly diagnoses the alleged injury. | BOTH |
| 494 | Medical Report Disputes and/or Conflicts with Earlier Reports | The most recent physical examination report provided disputes an earlier report(s) and does not provide an acceptable diagnosis for the alleged injury. Please provide a more recent medical report that documents the diagnosis of the injury alleged on the Claim Form. Please do not send duplicates of previously submitted reports. The report must be dated, signed by a physician and must include a diagnosis based on a physical examination by the physician making the diagnosis. A pathology report from a board-certified pathologist (if the claimant is deceased or for Disease Levels V-VIII) is acceptable if it provides the appropriate diagnosis. | BOTH |
| 495 | Chest X-Ray Report Disputes or Conflicts with Earlier Reports | The most recent chest x-ray, CT scan, or B-reader report disputes an earlier report and does not provide acceptable diagnosis for the alleged injury. Please submit a more recent report based on the review of a chest x-ray, CT scan, or a B-reader report indicating the alleged injury. The chest x-ray or CT scan must be read by a board-certified physician (defined in Footnote 3 of TDP). The report must be dated and signed by the radiologist or physician and must include information identifying the injured party. | BOTH |
| 496 | Failure to Specify Length of Company Exposure Prior to 12/31/1982. | The legal verified document provided in support of the claimants proof of company exposure is insufficient because it fails satisfy the minimum exposure criteria as required under the TDP prior to 12/31/1982. | BOTH |
| 497 | Additional Information Required for Other Cancer Claim | The claim you have filed is an Other Cancer with a diagnosis other than primary colo-rectal, laryngeal, esophageal, pharyngeal, or stomach cancer. In order to process this claim any further, the Trust requires the submission of medical peer reviewed research which establishes a sufficient link between asbestos exposure and the cancer in question. In absence of such supporting medical evidence, the claim will be disallowed by the Trust. | BOTH |
| 498 | Industry and/or Occupation does not match Site. | The industry and/or occupation that you have submitted does not correlate with the site/plant name submitted on the Claim Form. Please provide documentation supporting the industry/occupation selected or amend the Claim Form to indicate the proper industry/occupation. | BOTH |
| 499 | Injured Party's Exposure Begins as an Adolescent | The information that you have submitted regarding the Injured Party's exposure indicates that he/she was employed in the stated industry/occupation as an adolescent. Please provide supporting documentation or an explanation with evidence that the exposure information stated on the Claim Form is correct. | BOTH |
| 801 | Exposure Information does not Match Claim Form | The information that you have submitted regarding the industry, occupation, work site, employer and/or the years of exposure of the Injured Party, is inconsistent with information provided in the medical reports, attachments, affidavits, depositions, and/or other supporting documents submitted with the claim. Please provide supporting documentation or an explanation with evidence that the information stated on the Claim Form is correct. | BOTH |
| 802a | Name of Site or Plant not provided. | Please provide the name of the Site, Plant or Ship where the Injured Party's exposure occurred. | BOTH |
| 802b | Various Sites Provided. | Please provide the name(s) of each Site, Plant or Ship, including city and state, where the Injured Party's exposure to Trust product occurred. | BOTH |
| 802c | City not provided. | Please provide the name of the city where the Injured Party's exposure occurred. | BOTH |
| 802d | State not provided. | Please provide the name of the state where the Injured Party's exposure occurred. | BOTH |
| 804 | Company Exposure Insufficient | The information that you have provided regarding the Injured Party's exposure to Company products is insufficient to satisfy the Trust's 6-month criteria for compensation. Please send additional supporting documentation that includes beginning and ending dates to support Company exposure. | BOTH |
| 807 | Incomplete Work History Verification | The work history verification provided is incomplete. The Trust must have sufficient evidence to confirm that the page(s) submitted as the verified work history is in fact the document verified in the discovery responses. You can either submit entire discovery responses or at a minimum sufficient pages from the discovery responses to evidence the connection. | BOTH |
| 809 | Need Information for Occupationally Exposed Person | You have filed a claim alleging an asbestos-related injury resulting from contact with an occupationally exposed person. The information you have provided about the occupationally exposed persons exposure is incomplete or insufficient to meet the Trusts eligibility criteria for compensation. Please completely fill out the exposure page for the occupationally exposed person. | DCP |
| 818 | Exposure to Occupationally Exposed Person is Inadequate | Your submission regarding the Injured Party's exposure to an occupationally exposed person is incomplete. Either you failed to describe how the Injured Party was exposed to the occupationally exposed person in a legal verified document, or you failed to provide the Injured Party's beginning and/or ending dates of exposure to the occupationally exposed on the Claim Form. | DCP |
| 824 | Exposure Dates not Provided | You have not provided beginning and/or ending dates of exposure. Please provide the dates on which exposure began and ended for each employer, occupation, and/or work site claimed. A separate page for each employer and/or work site must be completed. | BOTH |
| 825 | Separate the Years of Exposure at Each Site | Separate the years of exposure for each employer and/or work site. Please provide the dates on which exposure began and ended for each employer, occupation, and/or work site claimed. A separate page for each employer and /or work site must be completed. | BOTH |
| 830 | Pre-1983 Exposure is Insufficient | The exposure information for pre-December 31, 1982 company exposure does not satisfy the minimum exposure criteria as required under the TDP | BOTH |
| 832 | Exposure Dates Outside Recognized Range | The dates of exposure at the claimed site are not within the date range identified by the Trust as the period when asbestos-containing products or operations were present. In order to cure this deficiency, you must provide a verified document (affidavit, discovery responses, deposition testimony or work history) signed by the Injured Party or a co-worker identifying the specific asbestos-containing products or operations to which the Injured Party was exposed or exposure documentation for a different site. | BOTH |
| 833 | Occupationally Exposed Person's Name and/or Social Security Number | You have alleged contact to asbestos through an occupationally exposed person. Please provide the name and/or social security number of the occupationally exposed person. | DCP |
| 837 | Company product was not specified, is generic or is not recognized | Please provide an affidavit, invoice of sale, contemporaneous records or other sworn statement which includes the specific Company asbestos-containing product(s) to which you were exposed. | BOTH |
| 838 | Affidavit contains multiple products and/or sites. | The deficiency has been assigned because the affidavit provided is insufficient for one of the following reasons: 1) the affidavit lists multiple sites and products, but is not specific as to which products were used at each site, or 2) based on a review of the affidavits provided from your firm, many affidavits contain the same product from individuals working in various industries and occupations. | BOTH |
| 850 | No Verified Company Exposure Provided | No Verified Company Exposure Provided. Please provide an affidavit, invoices of sale, contemporaneous records or other sworn statements to support company exposure at the job site indicated on your Claim Form. | BOTH |
| 851 | Verified Company Exposure is Insufficient | The affidavit provided in support of the claimant's proof of asbestos exposure is insufficient because it fails to properly identify one of the following: 1) missing site, city and/or state of exposure; 2) is undated, unsigned or is otherwise incomplete; 3) a Co-worker affidavit was submitted and the exposure years of the Co-worker do not match claimant's exposure years at the worksite; 4) a Co-worker affidavit was submitted for a site that does not match the claimant's site of exposure. | BOTH |
| 857 | Change of Occupation | Additional information is required to demonstrate change in occupation. You have recently updated/changed the occupation provided on the claim form. Please provide sufficient documentation to support the change in occupation. | BOTH |
| 867 | Secondary Exposure/Foreign Claim Process | We are unable to process Secondary Exposure Claims or Foreign Claims through Expedited Review. You must resubmit your claim choosing the Individual Review Process. | BOTH |
| 871 | Company Exposure Insufficient (Maritime) | The information that you have provided regarding the Injured Party's number of days on-board is insufficient to satisfy the Trust's criteria for compensation. Please send additional supporting documentation for the appropriate time frame. | BOTH |
| 873 | Intermittent or On and Off Exposure | You have indicated exposure that was either 'intermittent' or 'on and off.' The Trust does not accept exposure time that is not specific to that site or product. Please provide the dates on which exposure began and ended for each employer, occupation, and/or work site claimed, or an explanation as to why more specific dates cannot be provided. | IR |
| 874 | Extraordinary Exposure | Extraordinary Exposure was claimed as an IR factor and one or more of the following items needs attention: the exposure percentage did not meet at least 75% of the Injured Party's total asbestos exposure; or the 'Other' Entity selected is not a known Halliburton or Harbison-Walker Entity; or the certification is not executed properly; or the extraordinary exposure claimed conflicts with the exposure(s) claimed on the Claim Form. Please review your submission and respond accordingly. | IR |
| 875 | Proof of Economic Loss Not Provided or Insufficient | Your Claim Form indicated Economic Loss; however, insufficient supporting documents were provided. If you would like the Trust to consider the previously asserted Economic Loss for the Injured Party, you must provide an economic report and/or the necessary documentation which explains and substantiates the asserted loss. If no further documentation is provided to the Trust within 120 days, the claim will be valued without any condsideration for Economic Loss. | BOTH |
| 877 | Affidavit Signed by POA/ Need POA | With respect to proof of Company exposure for the Injured Party, you submitted an affidavit signed by the Injured Party's POA (Power of Attorney). The affidavit provided cannot be used to complete the review of the claim. In order to resolve this deficiency, please provide the documentation appointing the POA. | BOTH |
| 878 | Product Dates Outside Recognized Manufacture Dates | The product claimed is a known product; however, the period of claimed exposure does not coincide with the date the product was known to have been in use. | BOTH |
| 880 | Undocumented Site Information - Products/Operations not Provided | The site of exposure identified on the claim form is not on the Documented Site List, and no documentation attempting to place a recognized Company product at the site has been submitted with the claim. | BOTH |
| 881 | Improper Jurisdiction Selected | The information you submitted does not support your election of the Claimant's Jurisdiction. Please review section 5.3(b)(2) of the Trust Distribution Procedures to determine the Claimant's Jurisdiction you must or may elect and amend or supplement your claim as necessary. You can obtain a copy of the Trust Distribution Procedures on the Trust's website, www.diiasbestostrust.org, by clicking on 'Trust Documents' in the 'About the Trust' drop down menu. Section 5.3(b)(2) requires a claimant who filed her claim against a Halliburton or Harbison-Walker Entity in the tort system before the Halliburton or Harbison-Walker Petition Date to elect the state in which the claim was filed as the Claimant's Jurisdiction. If you intend to rely on this requirement to cure this deficiency, you must provide the Trust with a date-stamped copy of your complaint or petition showing that a Halliburton or Harbison-Walker Entity was sued. Merely updating your claim form with litigation information is not sufficient to cure this deficiency. | BOTH |
| 884 | Affidavit for Company Exposure is not acceptable. | For proof of Company exposure, you submitted an affidavit from a family member of the claimant or an unknown party that cannot be identified. The Trust will not accept an affidavit from a family member who did not work at the site or from an unknown party where the provided unknown partys affidavit and signature do not match. In order to cure this deficiency, you must provide credible evidence of Company exposure. This may be established by documentation including, but not limited to, the following: a signed affidavit by a co-worker, discovery responses, deposition testimony, invoices of sale, construction or similar records. | BOTH |
| 885 | The Site(s) of Exposure Listed on Claim Form does not Match the Site Code selected. | The known or documented site selected does not match the exposure site on the claim form. | BOTH |
| 886 | Additional Information for Financial Dependents | You have indicated that the Injured Party has more than 2 financial dependents. Please provide the Trust with the Injured Party's most recent tax return. | IR |
| 887 | SOL Deficient | Based on the information and documentation submitted, your claim fails to meet the required Statute of Limitations (SOL). You can review the SOL, as well as possible cures for failed SOL, in Section 5.1(a)(2) of the TDP and in the SOL definition. Both of these documents are located in the Trust Documents section of the Trust's website at www.diiasbestostrust.org. | BOTH |
| 888 | Failure to Provide a Verified Work History | Please provide a verified work history. If the Injured Party is living, he must sign the verified work history. If the Injured Party is deceased, a family member or co-worker may verify the work history. The document must verify the site(s) listed on the Claim Form. Sites which are not verified cannot be used to approve the claim. | BOTH |
| 889 | Affidavit not Notarized or Does not Otherwise Meet the State Requirements | The deficiency has been assigned because the affidavit provided has not been properly notarized accordingly to the notary requirements for the state in which it was executed. | BOTH |
| 891 | Audit Document Not Provided | Please submit all outstanding documentation or a letter on firm letterhead explaining that the required document does not exist. | BOTH |
| 893 | Medical Report Language is Unacceptable | The provided medical report contains language in the diagnosis which includes the terms 'consistent with' or 'compatible with.' A diagnosis with this language, standing alone, is not acceptable as a diagnosis after the effective date for the Trust. | BOTH |
| 896 | Failure to Specify Length of Company Exposure Prior to 12/31/1982. | The legal verified document provided in support of the claimants proof of company exposure is insufficient because it fails satisfy the minimum exposure criteria as required under the TDP prior to 12/31/1982. | BOTH |
| 897 | Additional Information Required for Other Cancer Claim | The claim you have filed is an Other Cancer with a diagnosis other than primary colo-rectal, laryngeal, esophageal, pharyngeal, or stomach cancer. In order to process this claim any further, the Trust requires the submission of medical peer reviewed research which establishes a sufficient link between asbestos exposure and the cancer in question. In absence of such supporting medical evidence, the claim will be disallowed by the Trust. | BOTH |
| 898 | Industry and/or Occupation does not match Site. | The industry and/or occupation that you have submitted does not correlate with the site/plant name submitted on the Claim Form. Please provide documentation supporting the industry/occupation selected or amend the Claim Form to indicate the proper industry/occupation. | BOTH |
| 899 | Injured Party's Exposure Begins as an Adolescent | The information that you have submitted regarding the Injured Party's exposure indicates that he/she was employed in the stated industry/occupation as an adolescent. Please provide supporting documentation or an explanation with evidence that the exposure information stated on the Claim Form is correct. | BOTH |
| 1203 | Litigation Date is Prior to the Earliest Alleged Exposure | The litigation date entered for the claim is prior to any alleged exposure in the claim. Please update the litigation information to reflect the proper litigation date. | BOTH |
| 1207 | Failure to Answer Question 3.7 on the Claim Form | You have failed to answer Question 3.7 on the Claim Form indicating whether or not the Injured Party experienced the asbestos exposure identified in Part 3 of the Claim Form during a period of time when the Injured Party was an employee of one of the Halliburton Entities or Harbison-Walker Entities. Please answer 'Yes' or 'No' to this question. | BOTH |
| 1209 | Failure to Provide Medical Documents in Response to Question 2.3 | Your response to question 2.3 is either not supported by the required medical documentation, or the evidence submitted contradicts the response provided. You must provide either the medical documentation pertaining to the other diagnosis OR the legal documentation (ie, complaint, interrogatory response or Injured Party deposition) to otherwise support your response. | BOTH |
| 1212 | Failure to Provide Complete Deposition | The deposition testimony provided in support of the referenced claim is incomplete. Please provide the full deposition transcript. | BOTH |
| 1213 | Earlier Diagnostic Medical Document | The medical documentation provided references an earlier asbestos-related diagnosis or pathology report. Please provide that diagnosing report. | BOTH |
| 1220 | Documentation to Support ATS Standards | Based on the medical documentation provided, the Trust requires additional verification from both the individual who administered the PFT and from the physician who performed the physical examination confirming ATS standards were met. | BOTH |
| 1222 | Documentation Provided is not Highlighted or Relevant Pages Identified | The deposition, interrogatories, medical reports, or military records submitted in support of the claim are not highlighted, or do not indicate the relevant pages or specific issue for which the documentation has been provided. | BOTH |
| 1223 | Indirect Proof of Claim Form not provided or is incomplete | Please submit a completed Indirect Proof of Claim Form for this claim. The claim form can be found on the Trust's website (www.diiasbestostrust.org) under the 'Forms' section. | BOTH |
| 1225 | Report Rejected | The chest x-ray, CT scan, or B-read submitted with the claim was evaluated by a physician whose x-ray, CT scan and/or B-reader reports are no longer accepted by the Trust. | BOTH |
| 1227 | Medical Provider Trust Research - B-Reader | The Trust must have reasonable confidence that medical evidence provided in support of a claim is credible and consistent with recognized medical standards. The B-read submitted with this claim was evaluated by a physician whose medical evidence is currently being audited by the Trust; the Trust cannot pay claims based on B-reads submitted by this physician unless and until it determines that B-reads from this physician are credible, reliable and consistent with recognized medical standards. | BOTH |
| 4204 | Industry Not Provided | You have not provided the industry where exposure to asbestos occurred. Please specify the type of industry where exposure occurred. | BOTH |
| 4205 | Occupation of Injured Party not Provided | You have not included an occupation for the Injured Party. Please submit information indicating the Injured Party's occupation. | BOTH |
| 4214 | Revisions to Verified Documents | Revisions to one or more legal verified documents in the claim have been made. The Trust will not accept revisions or alterations to legal verified documents. | BOTH |
| 4215 | Change in Response to Question 3.7 | Your response to question 3.7 was changed from 'yes' to 'no'. Please submit evidence to support the 'no' response, or attach a written explanation from the responsible attorney for the change from 'yes' to 'no'. | BOTH |
| 4216 | Incomplete or Changed answer to 5.2g and 5.2h | You have answered 'yes' to 5.2.g. of the claim form, but failed to complete either 5.2.h. or submit the necessary release. Please update 5.2.h. or provide the release. If your 'yes' response to 5.2.g. is incorrect, please update the claim form and attach a written explanation from the responsible attorney for the change from 'yes' to 'no'. | BOTH |
| 4217 | Ship/Shipyard Exposure Conflict | The claim form alleges exposure at a documented shipyard, but the verified work history states the claimant was aboard an undocumented ship during the alleged exposure time frame. The Trust must have credible evidence to confirm the location of and manner in which exposure to HAL/HW products or operations occurred. Please provide evidence of 1) the manner in which the claimant was exposed to asbestos at the Documented Site during the alleged time frame or; 2) HAL/HW exposure on the undocumented ship. | BOTH |
| 4218 | Foreign National | Asbestos exposure is alleged by a Foreign National at a domestic site. An affidavit alone from a Foreign National is not sufficient evidence to confirm the claimant's work history, regardless of whether the alleged exposure location is a Documented or Undocumented Site. The Trust requires additional evidence of the claimant's work history including but not limited to; discovery responses, union records, payroll records, or Human Resource documents. | BOTH |
| 4219 | Insufficient PID Evidence | The affidavit/verified document provided for product identification is not sufficient. If exposure occurred at an undocumented site, or by an Injured Party or co-worker working in an occupation not typically associated with asbestos exposure, you must provide an affidavit or other legal verified document describing how the Injured Party or co-worker knows it was a product of the Debtor at the site(s), how the Debtor's product was used at the site(s), and how the Injured Party would have been exposed to that product. Note that the Trust does not accept checkbox, circled or form affidavits. Please refer to the Trust's Affidavit Guidelines for greater detail. | BOTH |
| 4228 | Environmental Exposure Alleged. | Please provide additional exposure sites to meet the Trust requirements for exposure. Please provide supporting documentation for any exposure updates that are made. | BOTH |
| 4999 | Law Firm Deficiency Pending Update | Law Firm Deficiency Pending Update | BOTH |
| 8204 | Industry Not Provided | You have not provided the industry where exposure to asbestos occurred. Please specify the type of industry where exposure occurred. | BOTH |
| 8205 | Occupation of Injured Party not Provided | You have not included an occupation for the Injured Party. Please submit information indicating the Injured Party's occupation. | BOTH |
| 8214 | Revisions to Verified Documents | Revisions to one or more legal verified documents in the claim have been made. The Trust will not accept revisions or alterations to legal verified documents. | BOTH |
| 8215 | Change in Response to Question 3.7 | Your response to question 3.7 was changed from 'yes' to 'no'. Please submit evidence to support the 'no' response, or attach a written explanation from the responsible attorney for the change from 'yes' to 'no'. | BOTH |
| 8216 | Incomplete or Changed answer to 5.2g and 5.2h | You have answered 'yes' to 5.2.g. of the claim form, but failed to complete either 5.2.h. or submit the necessary release. Please update 5.2.h. or provide the release. If your 'yes' response to 5.2.g. is incorrect, please update the claim form and attach a written explanation from the responsible attorney for the change from 'yes' to 'no'. | BOTH |
| 8217 | Ship/Shipyard Exposure Conflict | The claim form alleges exposure at a documented shipyard, but the verified work history states the claimant was aboard an undocumented ship during the alleged exposure time frame. The Trust must have credible evidence to confirm the location of and manner in which exposure to HAL/HW products or operations occurred. Please provide evidence of 1) the manner in which the claimant was exposed to asbestos at the Documented Site during the alleged time frame or; 2) HAL/HW exposure on the undocumented ship. | BOTH |
| 8218 | Foreign National | Asbestos exposure is alleged by a Foreign National at a domestic site. An affidavit alone from a Foreign National is not sufficient evidence to confirm the claimant's work history, regardless of whether the alleged exposure location is a Documented or Undocumented Site. The Trust requires additional evidence of the claimant's work history including but not limited to; discovery responses, union records, payroll records, or Human Resource documents. | BOTH |
| 8219 | Insufficient PID Evidence | The affidavit/verified document provided for product identification is not sufficient. If exposure occurred at an undocumented site, or by an Injured Party or co-worker working in an occupation not typically associated with asbestos exposure, you must provide an affidavit or other legal verified document describing how the Injured Party or co-worker knows it was a product of the Debtor at the site(s), how the Debtor's product was used at the site(s), and how the Injured Party would have been exposed to that product. Note that the Trust does not accept checkbox, circled or form affidavits. Please refer to the Trust's Affidavit Guidelines for greater detail. | BOTH |
| 8228 | Environmental Exposure alleged. | Please provide additional exposure sites to meet the Trust requirements for exposure. Please provide supporting documentation for any exposure updates that are made. | BOTH |
| 8999 | Law Firm Deficiency Pending Update | Law Firm Deficiency Pending Update | BOTH |
| R01 | Certificate of Official Capacity | You have indicated that this claim is being made on behalf of the injured party or his/her estate. The Trust requires documentation of the representative's authority to act on behalf of the injured party or the injured party's estate. Such documentation might include Powers of Attorney appointing the representative to act on behalf of the injured party in pursuing a claim for asbestos injuries or, where the injured party is deceased, Letters Testamentary or Letters of Administration from a court appointing the representative as executor or administrator of the claimant's estate. This does not include birth certificates, marriage certificates, or Last Will and Testament. 868 2 0 1 You have indicated that this claim is being made on behalf of the injured party or his/her estate. The Trust requires documentation of the representative's authority to act on behalf of the injured party or the injured party's estate. Such documentation might include Powers of Attorney appointing the representative to act on behalf of the injured party in pursuing a claim for asbestos injuries or, where the injured party is deceased, Letters Testamentary or Letters of Administration from a court appointing the representative as executor or administrator of the claimant's estate. This does not include birth certificates, marriage certificates, or Last Will and Testament. | BOTH |
| R02 | Personal Representative's Name and/or Relationship not provided. | Please provide the personal representative's name, social security number and/or relationship to the Injured Party. | BOTH |
| R03 | New Personal Representative Information Needed | The Claim Form and release do not have the new Personal Representative's information. Please provide the Personal Representative's full name. | BOTH |
| R04 | Missing Two Witness Signatures | The original release was returned without two witness signatures. Please ensure that all required signatures are obtained and resubmit the release. | BOTH |
| R05 | No Death Certificate | Please provide a copy of the Injured Party's death certificate. | BOTH |
| R06 | No Notary Stamp/Embossed | Please resend or upload the release accompanied by the necessary Notary Stamp/Embossment. | BOTH |
| R07 | Incomplete Release Received/Uploaded | An incomplete release has been received by the Trust. Please resend or upload the completed release to the Trust. | BOTH |
| R08 | Corrected SSN | The release was returned to the Trust with a Social Security number other than what appears on the Claim Form or the Death Certificate submitted for the claimant. Please verify and provide the correct Social Security number for the claimant. | BOTH |
| R11 | POA Papers | Power of Attorney papers appointing the representative to act on behalf of the injured party are required. Please submit the Power of Attorney papers for the person representing the injured party. | BOTH |
| R13 | Missing Releases from all Personal Representatives | Releases signed by all personal representatives required. More than one Personal Representative was identified for this Claim, but Releases were not received for all Personal Representatives. Please either print out another Release from Trust Online, or contact the Trust and a new Release will be generated. The Trust must receive a signed Release from all Personal Representatives before payment can be made for this claim. | BOTH |
| R14 | Incorrect Release Uploaded | The uploaded release does not belong to the claimant listed on the claim form. Please upload the release belonging to the claimant listed on the claim form. The release uploaded to the claim belongs to claimant other than what appears on the claim form. Please upload the correct release for this claim. | BOTH |
| R16 | Notary not complete or missing information | Information other than the stamp or embossment is missing. There is no commission expiration date; no notary signature; or notary is expired. Please provide a new release containing complete notary information. You may also choose to have two witnesses sign the new release in place of a notary. | BOTH |
| R17 | Signature dates do not match on the release | The notary date and the claimant's signature date do not match. The signature dates must match for the release to be complete and acceptable. Please provide a new release with matching signature dates for the claimant and the notary. You may also choose to have two witnesses sign the new release in place of a notary. | BOTH |
| R18 | No claimant signature | Release not signed by claimant. The release is missing the claimant's signature. | BOTH |
| R19 | Missing signature page of release | Release not complete because missing signature page. Cannot verify release without the signature page. The release that was provided did not contain the last page with the claimant signature information. Please send/re-upload the complete release including the completed signature page. | BOTH |
| R20 | Notary stamp/seal not legible | The release that was provided contained a notary stamp/seal that could not be viewed for verification. Please provide a new copy or submit a new release with a notary stamp/seal that is legible. You may also choose to have a witness sign a new release in place of a notary. | BOTH |
| R21 | New release with new PR information needed | The release contains Personal Representative information that is new and not in the claim. Need new PR information completed in Trust Online and Certificate of Official Capacity as required by each state. The submitted release contains Personal Representative information that does not appear in the claim. Please provide the new PR information and a COC is needed depending on your state's requirements. | BOTH |
| R22 | Personal representative is deceased | Original personal representative is now deceased. Information submitted indicates that the original personal representative on the claim form is now deceased. Please provide a copy of the deceased personal representative's death certificate, as well as the new personal representative's full name and a court document assigning him/her as the new legal representative for the injured party's estate. When this information is received we will continue to process the release. | BOTH |
| R23 | Withdrawn Release Returned | Release was withdrawn by Trust because the outstanding offer was not received on or before 5:00 p.m. EDT on Wednesday, October 28, 2009, which was the deadline set by the Trust before the changes to the Scheduled, Average, and Maximum Values, and the Payment Percentage. Please return the new release that was sent after the Trust's updates to the Scheduled, Average and Maximum values and the payment percentage adjustment. | BOTH |
| R25 | Indirect Proof of Claim Form Not provided | Please complete and submit the Indirect Proof of Claim Form which can be found under the forms section of the Trust's website at www.diiasbestostrust.org. The claim cannot be resolved until such time as a completed Indirect Proof of Claim Form has been submitted to the Trust for review and approval. | BOTH |
| R27 | The Electronic Signature that was submitted does not match the Trust’s current claim data. The Electronic Signature must be completed by the claimant or appointed personal representative. | The Electronic Signature that was submitted does not match the Trust’s current claim data. The Electronic Signature must be completed by the claimant or appointed personal representative. Please re-upload the completed Electronic Signature Certification to the Trust. | BOTH |
| R28 | The IP address of the Originator and Signer must be sent from two different IP addresses. | The IP address of the Originator and Signer must be sent from two different IP addresses. Please re-upload the Electronic Signature Certification that includes two different IP addresses. | BOTH |
| Intake Deficient | The claim is missing basic information that is required prior to being sent for review. | A claim is Intake Deficient when it is missing information that is required to process the initial intake. This may include any information on the claim pages, such as a missing Social Security number or choosing an alleged injury. To view the specific Intake Deficiency code, simply login to Trust Online. Enter the desired claim number on the Claims page in the Claim # filter box. Click on the name in the Summary list, which will take you to the Claim Summary page for the chosen claim. From this screen you can view the specific Intake Deficient code. | BOTH |
| Offer Issued | A settlement offer has been issued. | A settlement offer has been made for this claim. You have the option to accept the offer at Trust Online or mail the signed release back to the Trust. If you choose to decline the offer, please notify the Trust. | BOTH |
| Paid | The claim settlement check is issued. | The Expedited Review and the Individual Review settlements are single, cash payments. | BOTH |
| Ready to Re-Review | The claim is awaiting medical and exposure re-review of the alleged injury(s). | To check the claim's place in the re-review queue, simply login to Trust Online. Enter the desired claim number on the Claims page in the Claim # filter box. Click on the name in the Summary list, which will take you to the Claim Summary page for the chosen claim. From this screen click on the Place in Queue field, which will provide the average monthly claims being re-reviewed. Compare this number with the claim's place in queue to determine approximately when it may be re-reviewed. | BOTH |
| Ready to Review | The claim is awaiting medical and exposure review of the alleged injury(s). | To check the claim's place in the review queue, simply login to Trust Online. Enter the desired claim number on the Claims page in the Claim # filter box. Click on the name in the Summary list, which will take you to the Claim Summary page for the chosen claim. From this screen click on the Place in Queue field, which will provide the average monthly claims being reviewed. Compare this number with the claim's place in queue to determine approximately when it may be reviewed. | BOTH |
| Review | The claim is in the review process. | The claim review includes all of the information submitted on the claim form and all attachments. When the review is completed, you will be notified of any deficiencies. If there are no deficiencies, the claim will proceed to the settlement process. | BOTH |
| Review Deficient | The claim has been reviewed for the alleged injury(s) and is missing information necessary to comple | A claim is Review Deficient when it is missing information that is required to confirm it either medically or for exposure based on the alleged injury(s). This may include information such as an unacceptable diagnosis on a submitted physical exam or no occupation listed on the exposure page of the claim form. To view the specific Review Deficiency code, simply login to Trust Online. Enter the desired claim number on the Claims page in the Claim # filter box. Click on the name in the Summary list, which will take you to the Claim Summary page for the chosen claim. From this screen you can view the specific Review Deficient code. | BOTH |
| Withdrawn | The claim is withdrawn. | At your written instruction, the claim has been withdrawn from our system. | BOTH |