Vincent N. Micone, III, v. UMR, INC.
UMR UDS-ER Settlement
Civil Action No. 23-cv-00513

Frequently Asked Questions

 

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  • UMR, Inc. (“UMR”) is a third-party administrator of employer-sponsored health benefit plans. The Acting Secretary of the U.S. Department of Labor (“DOL”) filed suit against UMR, alleging that two types of health benefits were improperly denied. First, DOL alleged that claims for emergency room (“ER”) visits were improperly denied because it was determined that the participant or beneficiary was not experiencing a medical emergency. Second, DOL alleged that claims for urinary drug screening (“UDS”) were improperly denied because it was determined that the participant’s or beneficiary’s drug screening was not medically necessary. DOL is called the “Plaintiff,” and UMR is referred to as the “Defendant.”

    Although UMR disputes DOL’s allegations, UMR and DOL have agreed to settle their dispute through a Consent Order and Judgment (“Consent Judgment”). The Consent Judgment provides payment to participants and beneficiaries for certain health benefit claims for ER visits (“Covered ER Claims”) and UDS treatment (“Covered UDS Claims”).

    A complete copy of the Consent Judgment is available on the Important Documents page of this website.

  • The Consent Judgment is a legally binding settlement agreement between UMR and DOL, which is approved by the Court.  Participants and beneficiaries are not parties to the Consent Judgment and are not able to ask the Court to take any action to enforce the Consent Judgment.  However, the Consent Judgment provides for cash payment to participants and beneficiaries for Covered ER Claims and Covered UDS Claims, as described in Questions 3 and 4 below.

    A complete copy of the Consent Judgment is available on the Important Documents page of this website.

  • Covered ER Claims refers to certain health benefit claims for emergency room visits that were denied because it was determined that the participant or beneficiary was not experiencing a medical emergency.

    If you were a participant or beneficiary of an employer-sponsored health plan that was formerly administered by UMR, and you have a Covered ER Claim, you may be eligible for a Proven ER Payment of up to $353.22 per Covered ER Claim. Using the Unique ID and PIN you received in the Notice of Settlement, you may check the Review Your Covered Claims page of this website to see if you have any Covered ER Claims.

    You must complete a Claim Form, sign a Release of ER Claims, and submit supporting documentation showing that you paid out-of-pocket to your medical provider to receive payment for a Covered ER Claim. The claims submission portal is available on the File a Claim page of this website.

  • Covered UDS Claims refers to certain health benefit claims for urinary drug screenings that were denied by UMR because it determined that the participant or beneficiary’s drug screening was not medically necessary.

    If you have a Covered UDS Claim, you may be eligible for a payment of up to $172.12 per Covered UDS Claim. Using the Unique ID and PIN you received in the Notice of Settlement, you may check the Review Your Covered Claims page of this website to see if you have any Covered UDS Claims.

    All eligible participants or beneficiaries with a Covered UDS Claim were issued a Baseline UDS Payment of $68.85 for each Covered UDS Claim.  No action is necessary to be issued a Baseline UDS Payment.  By cashing the check for the Baseline UDS Payment, you acknowledge that you have read, understood, and agree to the Release, as explained in Question ‎11 below.

    In addition, if you have documentation that you paid more than $68.85 out-of-pocket for a Covered UDS Claim, you can submit a Claim Form along with that documentation, which may entitle you to an Additional UDS Payment of up to $103.27 per Covered UDS Claim, for a total of up to $172.12 per Covered UDS Claim.

    You must complete a Claim Form, sign a Release of UDS Claims, and submit supporting documentation showing that you paid out-of-pocket to your medical provider in an amount above $68.85 to receive an Additional UDS Payment for a Covered UDS Claim. The claims submission portal is available on the File a Claim page of this website.

  • The Consent Judgment provides payment to participants and beneficiaries whose health plans are or were administered by UMR for certain health claims for Covered ER Claims and Covered UDS Claims, as described in Questions ‎3 and ‎4 above.

    If, after reading through this webpage, you are still not sure whether you may be eligible for payment under the Consent Judgment, you may call the Settlement Administrator toll-free at 1-877-930-8068. You may also send questions via e-mail to info@UDSERSettlement.com, or via regular mail to: UMR UDS-ER Settlement, c/o JND Legal Administration, P.O. Box 91226, Seattle, WA 98111.

  • Yes. If UMR no longer administers your employer-sponsored health plan, you may still be eligible to receive payment under the Consent Judgment for both Covered ER Claims and Covered UDS Claims. For additional information, please see Questions 3 and 4 above.

  • The Consent Judgment provides for cash payments to participants and beneficiaries for Covered ER Claims and Covered UDS Claims.

    If you have a Covered UDS Claim, you may be eligible for two different payments:

    • Baseline Payment: all eligible participants or beneficiaries will receive a Baseline UDS Payment of $68.85 for each Covered UDS Claim.  No additional action is necessary to receive a Baseline UDS Payment.
    • Additional UDS Payment: if you have documentation that you paid more than $68.85 out-of-pocket for a Covered UDS Claim, you may provide that documentation, which may entitle you to an Additional UDS Payment of up to $103.27 per Covered UDS Claim, for a total of up to $172.12.

    If you have a Covered ER Claim, and you have documentation that you paid an amount out of pocket for Covered ER Claim(s), you may provide that documentation, which may entitle you to a Proven ER Payment of up to $353.22 per Covered ER Claim.

    Please continue reading through the FAQs for additional information regarding your eligibility for payment.

  • All eligible participants or beneficiaries with a Covered UDS Claim were issued a Baseline UDS Payment of $68.85 for each Covered UDS Claim. No action is necessary to be issued a Baseline UDS Payment.

    Using the Unique ID and PIN you received in the Notice of Settlement, you may check the Review Your Covered Claims page of this website to see if you have any Covered UDS Claims. The claims submission portal is available on the File a Claim page of this website.

    By cashing the check for the Baseline UDS Payment, you acknowledge that you have read, understood, and agree to the Release of claims, as explained in Question ‎11 below.

  • If you have documentation showing that you paid out-of-pocket to your medical provider for a Covered ER Claim, you can submit a Claim Form along with that documentation for a Proven ER Payment of up to $353.22 per Covered ER Claim. Using the Unique ID and PIN you received in the Notice of Settlement, you may check the Review Your Covered Claims page of this website to see if you have any Covered ER Claims.

    You must complete a Claim Form, sign a Release of ER Claims, and submit supporting documentation showing that you paid out-of-pocket to your medical provider to receive a Proven ER Payment for a Covered ER Claim. The claims submission portal is available on the File a Claim page of this website.

  • If you have documentation that you paid more than $68.85 out-of-pocket to your medical provider for a Covered UDS Claim, you can submit a Claim Form along with that documentation for an Additional UDS Payment of up to $103.27 per Covered UDS Claim. Using the Unique ID and PIN you received in the Notice of Settlement, you may check the Review Your Covered Claims page of this website to see if you have any Covered UDS Claims.

    You must complete a Claim Form and submit supporting documentation showing that you paid out-of-pocket to your medical provider in an amount above $68.85 to receive an Additional UDS Payment for a Covered UDS Claim. The claims submission portal is available on the File a Claim page of this website.

  • If you cash a check for a Baseline UDS Payment, you cannot sue UMR or be part of any other lawsuit against UMR about the issues in this case.  A full copy of the Release is available on the Important Documents page of this website and describes the claims that you give up if you cash a check for a Baseline UDS Payment.

  • Each participant or beneficiary who submits a Claim Form for a Covered ER Claim will be required to execute a Release of ER Claims. If you sign the Release of ER Claims and receive payment, you cannot sue UMR or be part of any other lawsuit against UMR about the ER issues in this case. A full copy of the Release of ER Claims is available on the Important Documents page of this website and describes the claims that you give up if you sign the Release of ER Claims.

  • Each participant or beneficiary who submits a Claim Form for an Additional UDS Payment for a Covered UDS Claim will be required to execute a Release of UDS Claims.  If you sign the Release of UDS Claims and receive payment, you cannot sue UMR or be part of any other lawsuit against UMR about the UDS issues in this case.  A full copy of the Release of UDS Claims is available on the Important Documents page of this website and describes the claims that you give up if you sign the Release of UDS Claims.

  • You must complete a Claim Form, sign the applicable release, and submit supporting documentation showing that you paid out-of-pocket to your medical provider by September 2, 2025, to receive a payment under the Consent Judgment.  

  • No, submitting a Claim Form and documentation does not automatically entitle you to payment. After you have submitted your claim, there will be a determination of whether you have met the requirements for payment. If the documents you submit demonstrate that you meet these requirements, you will receive either a payment of up to $353.22 for each Covered ER Claim or an Additional UDS Payment of up to $103.27 for each Covered UDS Claim. 

  • To claim a Proven ER Payment, you must submit a Claim Form and all required documentation by September 2, 2025. Claims can be submitted online, on the File a Claim page of this website, or by mail. You can obtain and print Claim Forms for mail submissions by downloading them from this website.

    Submit claims Online: File a Claim

    Submit claims via Mail: UMR UDS-ER Settlement, c/o JND Legal Administration, P.O. Box 91226, Seattle, WA 98111.

    If submitting your Claim Form online, use the Unique ID and PIN listed in the Notice of Settlement you received via mail to access the claims submission portal. Also available on this website is a secure page, Review Your Covered Claims, that will provide you with information regarding your Covered ER Claims, including the claim number(s), claim date(s), and provider name(s).

    You should not wait until close to the deadline to submit your Claim Form. All Claim Forms require information and documentation that you might need time to collect.

    After you have submitted your Claim Form, the Settlement Administrator will review your claim form and supporting documents for completeness and eligibility.

    The following documentation is required to receive a Proven ER Payment:

    • A completed Claim Form;
    • A completed Release of ER Claims;
    • Documentation that you paid out-of-pocket to your medical provider for a Covered ER Claim, which may include copies of canceled checks, credit card statements, bank account statements, receipt(s) for payment(s), or statements from a financial institution.  If you have Covered ER Claims arising from multiple emergency room visits, you should upload the necessary documentation for each claim.
  • To claim an Additional UDS Payment, you must submit a Claim Form and all required documentation by September 2, 2025. Claims can be submitted online, on the File a Claim page of this website, or by mail. You can obtain and print Claim Forms for mail submissions by downloading them from this website.

    Submit claims Online: File a Claim

    Submit claims via Mail: UMR UDS-ER Settlement, c/o JND Legal Administration, P.O. Box 91226, Seattle, WA 98111.

    If submitting your Claim Form online, use the Unique ID and PIN listed in the Notice of Settlement you received via mail to access the claims submission portal. Also available on this website is a secure page, Review Your Covered Claims, that will provide you with information regarding your Covered UDS Claims, including the claim number(s), claim date(s), and provider name(s).

    You should not wait until close to the deadline to submit your Claim Form. All Claim Forms require information and documentation that you might need time to collect.

    After you have submitted your Claim Form, the Settlement Administrator will review your claim form and supporting documents for completeness and eligibility.

    The following documentation is required to receive an Additional UDS Payment:

    • A completed Claim Form;
    • A completed Release of UDS Claims;
    • Documentation that you paid out-of-pocket to your medical provider for a Covered UDS Claim in an amount above $68.85, which may include copies of canceled checks, credit card statements, bank account statements, receipt(s) for payment(s), or statements from a financial institution.  If you have multiple Covered UDS Claims, you should upload the necessary documentation for each claim.  
  • Eligible participants and beneficiaries may submit claims to receive payment for a Covered ER Claim or an Additional UDS Payment for a Covered UDS Claim now.

  • The deadline to submit a claim for a Covered ER Claim or for a Covered UDS Claim is September 2, 2025. All Claim Forms require information and documentation that you might need time to collect. To ensure that you have adequate time to gather the required documentation and complete the Claim Form, you should not wait until the September 2, 2025 deadline approaches.

    Participants and beneficiaries who do not submit a Claim Form and all required documentation by September 2, 2025 will not receive a Proven ER Payment or Additional UDS Payment.

  • To complete your claim, you will be required to submit supporting documentation showing that you paid an out-of-pocket amount to your medical provider for a Covered ER Claim, which may include:

    • Copies of canceled checks; 
    • Credit card statements; 
    • Bank account statements; 
    • Receipt(s) for payment(s); 
    • Statements from a financial institution. 

    If you have multiple Covered ER Claims, you should upload the necessary documentation for each claim.

  • To complete your claim, you will be required to submit supporting documentation showing that you paid an out-of-pocket amount to your medical provider in an amount above $68.85 for each Covered UDS Claim, which may include:

    • Copies of canceled checks; 
    • Credit card statements; 
    • Bank account statements; 
    • Receipt(s) for payment(s); 
    • Statements from a financial institution. 

    If you have multiple Covered UDS Claims, you should upload the necessary documentation for each claim.  
     

  • If you wish to raise any disputes regarding a payment under the Consent Judgment, you must contact the Settlement Administrator within 30 days of receiving the payment or communication that prompts the dispute.

    If the Settlement Administrator requests additional information, the participant or beneficiary must provide that information within 30 days. The Settlement Administrator will then make a decision on the dispute regarding the payment, and there will be no further opportunity for participants or beneficiaries to raise any dispute regarding the Settlement Administrator’s decision on the payment.

  • If you wish to make any changes to your claim(s) after submission, please contact the Settlement Administrator immediately.  Any changes must be submitted before the Settlement Administrator finishes processing your claim.

  • The Settlement Administrator has mailed Baseline UDS Payments on June 17, 2025.  Proven ER Payments and Additional UDS Payments will be sent by January 13, 2026.

  • No, we are the official Settlement Claims Administrator selected to administer this Settlement. If you received a Notice, you were identified as an eligible participant by UMR, Inc. As such, your information was provided to us through Defendant UMR’s records. The Consent Judgement was approved by the United States District Court, Micone v. UMR, Inc., Civil Action No. 23-cv-00513. The Court authorized the Notice to be sent to class members and approved the claim process.

  • Claimants will not be retaliated against for participating in the Settlement, and the Defendant encourages them to participate in the Settlement.

  • You can get copies of the Consent Judgment and Claim Forms on the Important Documents page of this website. You also may call the Settlement Administrator toll-free at 1-877-930-8068 for additional information or send questions via e-mail to info@UDSERSettlement.com or via regular mail to: UMR UDS-ER Settlement, c/o JND Legal Administration, P.O. Box 91226, Seattle, WA 98111.

THE SETTLEMENT ADMINISTRATOR IS READY TO ASSIST YOU. PLEASE DO NOT TELEPHONE OR CONTACT THE COURT, THE CLERK OF THE COURT, OR DEFENDANTS OR DEFENDANTS’ COUNSEL REGARDING THIS CASE. ALL QUESTIONS SHOULD BE DIRECTED TO THE SETTLEMENT CLAIMS ADMINISTRATOR.

For More Information

Visit this website often to get the most up-to-date information.

Mail
UMR UDS-ER Settlement
c/o JND Legal Administration
P.O. Box 91226
Seattle, WA 98111