There are no user files associated with this Intake Form.
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Allowed File Types: pdf,doc,docx,jpg,jpeg,xls,xlsx,txt,png,bmp
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IMPORTANT MESSAGE:
You will NOT be able to return to the portal to upload supporting documentation once you submit your claim;
therefore, it is best for you to upload now all available supporting documentation.
You may attach files supporting this Non-NAS PI Claim. Files may include but are not limited to the following:
- Medical, prescription, etc. records supporting your claim
- Death Certificate and Estate documents or Heirship Declaration for a deceased opioid user
To attach supporting files for the Non-NAS PI Claim, utilize the tool below:
- First, click on "Choose Files" and select the file(s) on your computer that you wish to upload.
- Once selected, click on "Attach Files" to attach them to your Claim.
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If you do not attach files at this time or have additional files that
need to be added later, you will need to provide the documents
utilizing one of the following:
- email to purduepitrust@purduepitrust.com with "Portal Claim Documents" in the subject line, or
- fax to Purdue PI Trust - Portal Claim Documents at 205-716-2364, or
- mail to Purdue PI Trust - Portal Claim Documents at P.O. Box 361930, Hoover, AL 35236-1930
Important Reminder: As previously communicated, failure to timely submit the Non-NAS PI Claim Form along with the required
information outlined under the Eligibility and Claim Requirements section above for receipt by the PI Trust on or before the
PI Claims Deadline of July 28, 2025, may result in the Non-NAS PI Claim being the subject of an objection, disallowance, or denial.
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