How to complete the forms:
Please complete this form by writing your name and address as well as signing and dating where indicated. Please leave the “To” section of this blank for our office to complete.
Private Health Fund Information
If you did not hold private health insurance at the time of your implant surgery or since please disregard this section.
If you held private health insurance at the time of your implant surgery or have taken it out since, please complete and return the enclosed Group Member Private Health Fund document. Please provide the name/s of all private health funds that you were a member as well as the dates of membership and membership number if known. Please complete this even if you believe you have provided this information previously.
We have already completed part of the form for you. Please complete questions 2 through to 7, as well as question 15 and 17.
In relation to question 8, please leave this blank for our office to complete.
Please email the completed forms back to firstname.lastname@example.org
or return by post to
Shine Lawyers – Class Actions
PO Box 12011
GEORGE STREET QLD 4003
Reminder & Important Notices
Social Media Usage
As part of a class closure application in our Johnson and Johnson class action, the Respondents provided evidence of Facebook screenshots related to women’s mesh injuries and the proceedings.
We again remind you to please be cautious and conscious of any information you are publishing on social media or other public forums regarding your personal situation in relation to the vaginal mesh implants. It is not possible to guarantee the audience you are posting to even within ‘closed’ groups or how that information may be used in the future.
Cold Calls & Scams
We have received reports of cold calls being received in relation to this matter and other legal proceedings requesting payment of outstanding fees. Please note that Shine Lawyers has not asked any person to provide a payment of money in relation to these proceedings. Please be mindful of providing personal information to third parties. Please report any calls you suspect to be scams to ACCC’s ScamWatch through www.scamwatch.gov.au.
Potential claims against treating medical providers
This class action is only a claim against AMS. We are aware that some women may have claims against the surgeon who implanted or removed their implant/s.
We confirm that we have not considered whether you may have any other claims against medical providers, however we are aware that law firms other than Shine Lawyers are currently investigating such claims. We wanted to take this opportunity to clarify the issue of whether a group member can remain a member of this class action and also pursue a claim against a treating medical provider.
The position is as follows:
- a group member will not be required to “opt out” of the class action in order to explore or commence a claim against a treating medical provider;
- if the class action is successful at judgment or a settlement is achieved, a group member who has also pursued a claim against a treating medical provider may still be entitled to compensation as part of the class action but it depends upon the terms of any approved settlement agreement;
- however, any compensation a group member may have received as part of a claim against a treatment medical provider will be taken into consideration when assessing their entitlement to compensation pursuant to any class action settlement scheme so as to ensure that a group member is not compensated twice for the same damage
In most cases, health providers need to keep medical records for a minimum of 7 years (this timeframe may be longer depending on your state or territory). After this time, these records may be destroyed and therefore will not be able to be requested at a later date. We do not know what records will be required to support your claim should we be successful; however, records may be important.
We suggest that you contact your hospital, surgeon or treatment provider and request that they do not destroy your medical records. Alternatively, you may wish to obtain a copy of these records yourself to ensure they are not destroyed. Shine does not request complete medical records for all potential group members.
We remind you that if you are having surgery or further surgery to have your mesh or tape implant (or any part of it) removed, please let us know as soon as possible so we can contact your surgeon to ensure that any material or surgical specimens removed are retained and not destroyed.
Should you have any questions please do not hesitate to contact Danielle Joseph on (07) 3837 8489 or by email at email@example.com