Boy Scout Settlement – Hilliard Law

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Case ID(Required)

Please be as thorough as possible and make sure to press the 'Submit' button at the bottom when finished. If you do not, your answers will not be recorded.

If you have any photos or documentation to support your claim or your time in scouting please email the photos and/or documents to BSOA@hilliard-law.com immediately.

Are you sending documents or photos to BSOA@hilliard-law.com?(Required)

Elect Which Claims Process to Use

There are two options.

Option #1 is called Trust Claim Submission Claimants who elect this option will have their Claim valued by the Trustee in accordance with the range of values that are defined in the settlement papers. Claims that are allowed by the Trustee could be valued at amounts between $3,500 to $2,700,000 according to criteria that are spelled out in detail in the settlement papers. Claimants who choose this option must fully complete this Questionnaire.

Option #2 is called Independent Review Option Claimants who elect this option will have an independent, neutral third party (a retired judge with tort experience) make a settlement recommendation to the Trustee after participating in a fact-finding process (like a trial). Claimants who elect this option must pay a fee to participate in this process: they must pay $10,000 at the time they elect the option, and an additional $10,000 immediately before the neutral’s review process begins. Claimants who choose this option must fully complete this Questionnaire and pay the fees.The deadline to select this option (Independent Review Option) is October 19, 2023.

WE RECOMMEND YOU CHOOSE THE TRUST CLAIM SUBMISSION. IF YOU ARE INTERESTED IN THE INDEPENDENT REVIEW OPTION PLEASE CALL US IMMEDIATELY.

Which claims process option do you choose?(Required)

Note that under either Option #1 or Option #2, a Claimant may not receive payment of the full value that the Trustee assigns to his/her Abuse Claim. This is because the settlement documents require that all Claimants receive the same percentage recovery on their Allowed Abuse Claims. In turn, the percentage of each Allowed Abuse Claim that will be paid depends on the amount of available funds in the Trust and the aggregate amount of all Allowed Abuse Claims.

Exigent Health Circumstances. The rules of the settlement consider exigent health circumstances when determining the order in which Claims are evaluated. You may qualify for an Exigent Health Claim if you can provide a declaration under penalty of perjury from a physician who has examined you within 120 days of the declaration in which that physician states that there is substantial medical doubt that you will survive beyond six months from the date of the declaration.

IF YOU BELIEVE YOU HAVE AN EXIGENT HEALTH CIRCUMSTANCE PLEASE REACH OUT TO US AT BSOA@hilliard-law.com or call 361-882-1612 so we can discuss this with you in more detail.

Reviewing information provided on Proof of Claim form

Information we already have.

If you would like to tell us more about what you wrote on the Proof of Claim form, please explain here. This question is optional, you may skip it if you would like.

If you’d like to upload a handwritten or typed narrative to respond to this question, please email it to BSOA@hilliard-law.com.

Note that the response to this question must be in the Claimant’s own words.

Additional Proof Of Claim Information

We Are Asking for More Detailed Information

The Proof of Claim form that you filed with Omni in 2020 contained some basic information about your Claim. This Questionnaire asks for more detailed information about your Claim so we can evaluate your Claim against all the rules of the settlement. Please complete this Questionnaire in full to enable us to process your Claim.

Basic Identification Information.

Basic Identification Information. This section asks for information about the Claimant (the person who experienced the sexual abuse). If the Claimant is represented by a lawyer, we will generally communicate with the Claimant through their lawyer – however, if we are unable to reach the lawyer, we will contact the Claimant directly. We will communicate directly with Claimants who are not represented by lawyers.

First Name(Required)

Middle Name

Last Name(Required)

Name previously used, including during period of sexual abuse. Note: If you have not previously used another name, please answer “None”.(Required)

Full Social Security Number(Required)

Date of Birth (mm/dd/yyyy)(Required)

Email Address(Required)

Phone Number(Required)

Address

Street 1(Required)

Street 2

City(Required)

State(Required)

Zip(Required)

Country

Preferred method of contact(Required)

Any particular concerns about how we should contact you?

Do we have your permission to leave a message at (or send a message to) your preferred method of contact?(Required)

Sex of Claimant (on birth certificate)

Current sex of Claimant

Please explain current identification with preferred pronouns

Preferred Pronouns

Other Pronouns

Address during period of sexual abuse as best you can remember

Street 1

Street 2

City

State

Zip

Country

Background About Your Life

Are you currently in jail or prison?(Required)

Name or Location of Jail/Prison?

Claimant Jail/Prison Identification Number

Are you currently experiencing homelessness?(Required)

Did you serve in the military?(Required)

Did you seek medical treatment related to the abuse?(Required)

If you sought medical treatment related to the abuse, please select your state(s) of residence at the time of the treatment.

Criminal History Involving Financial Fraud

In the past 10 years have you been convicted of or did you plead guilty to a crime(s) that involved taking or attempting to take money or other property that belonged to someone else? Examples include theft of money or property, forgery, counterfeiting, identity theft, shoplifting, burglary, robbery, welfare fraud or arson.(Required)

For which crime(s) were you convicted or did you plead guilty?

In what year(s) were you convicted, or did you plead guilty?

Please tell us what year(s) you entered jail or prison and what year(s) you were let out for each time you were incarcerated.

In the past 10 years have you been convicted of or did you plead guilty to a crime(s) that involved perjury or making false statements?(Required)

For which crime(s) were you convicted or did you plead guilty?

Please tell us what year(s) you entered jail or prison and what year(s) you were let out for each time you were incarcerated.

In what year(s) were you convicted, or did you plead guilty?

Has Claimant Sued a Chartered Organization?

Have you filed a lawsuit or made a claim against any entity about the childhood sexual abuse that is the subject of this Claim?(Required)

Have you sued a "Chartered Organization?" For example, this could be a school or a church that sponsored a troop. "Chartered Organization" means any civic, faith-based, educational, business, or governmental entity or organization or any group of people that is or was authorized by the Boy Scouts of America to operate, sponsor, or otherwise support one or more Scouting unit.

Please provide the name of the Chartered Organization(s) that you sued.

Resolution of Claim in previous litigation

If you have any photos or documentation to support your claim or your time in scouting please email the photos and/or documents to BSOA@hilliard-law.com immediately.

To the best of your knowledge, has there been any previous resolution of this Claim of childhood sexual abuse (this Claim) in litigation or settlement, or have you received a prior settlement payment and/or signed a release relating to this Claim (for example, from an insurance company)?(Required)

Please describe the previous resolution:

Please provide the name of the case:

Please provide the date of the resolution: (mm/dd/yyyy)

For Person Submitting on Behalf of Claimant.

The Claimant is the person who experienced childhood sexual abuse. If the Claimant is deceased, or is a minor, or is legally incapacitated, or gave to another the legal power to speak for the Claimant, then the Claimant or the Claimant’s estate will have some type of Representative. That Representative should complete this section. In this section, “You” refers to the Representative. If a lawyer represents the Claimant’s interests in this Claim, we will generally communicate with the lawyer. We are collecting the Representative’s contact information in case we are unable to get in touch with the lawyer.

If you have any photos or documentation to support your claim as a representative, please email the photos and/or documents to BSOA@hilliard-law.com immediately.

Are you a Representative submitting on behalf of the Claimant for some reason, including due to the Claimant's death or incapacity?

Who is the Representative submitting on behalf of the Claimant?

First Name

Middle Name

Last Name

Full Social Security Number

Date of Birth (dd/mm/yyyy)

Email Address

Phone Number

Street 1

Street 2

City

State

Zip

Country

Preferred method of contact

Any particular concerns about how we should contact you?'

Do we have your permission to leave a message at (or send a message to) your preferred method of contact?

What is your relationship to the Claimant?

What is the Representative's legal authority to submit this Abuse Claim on behalf of the Claimant?

If the Claimant is deceased, what was the Claimant’s date of death? (dd/mm/yyyy)

Please Explain

Your Connection to Scouting.

Please explain your connection to Scouting. In what parts of Scouting did you participate (Cub Scouts, Boy Scouts, Venturing, Sea Scouts, Exploring)? For each part of Scouting you participated in, please fill out the table below to tell us approximately which years you participated in Scouting, what Troop number(s) you were in, what were the name(s) of your Local Council(s), and was your Troop associated with another Sponsor or Charter organization (like a school or church)?

Cub Scouts

Cub Scouts Approximately Which Years?

Cub Scouts What Troop #

Cub Scouts What was your local council's name?

Cub Scouts If your troop was associated with another sponsor or charter organization (like a school or a church), what organization was it associated with?

Cub Scouts Comments

Boy Scouts (Scouts BSA)

Boy Scouts (Scouts BSA) Approximately Which Years?

Boy Scouts (Scouts BSA) What Troop #

Boy Scouts (Scouts BSA) What was your local council's name?

Boy Scouts (Scouts BSA) If your troop was associated with another sponsor or charter organization (like a school or a church), what organization was it associated with?

Boy Scouts (Scouts BSA) Comments

Venturing

Venturing Approximately Which Years?

Venturing What Troop #

Venturing What was your local council's name?

Venturing If your troop was associated with another sponsor or charter organization (like a school or a church), what organization was it associated with?

Venturing Comments

Sea Scouts

Sea Scouts Approximately Which Years?

Sea Scouts What Troop #

Sea Scouts What was your local council's name?

Sea Scouts If your troop was associated with another sponsor or charter organization (like a school or a church), what organization was it associated with?

Sea Scouts Comments

Exploring

Exploring Approximately Which Years?

Exploring What Troop #

Exploring What was your local council's name?

Exploring If your troop was associated with another sponsor or charter organization (like a school or a church), what organization was it associated with?

Exploring Comments

Other Organization

Other (Please explain in Comments) What Troop #

Other (Please explain in Comments) Approximately Which Years?

Other (Please explain in Comments) What was your local council's name?

Other (Please explain in Comments) If your troop was associated with another sponsor or charter organization (like a school or a church), what organization was it associated with?

Other (Please explain in Comments) Comments

Describe the Abuse.

Please describe the abuse in detail in your own words. Please tell us everything you can remember, from the beginning to the middle to the end. Please don't leave anything out. We encourage you to answer this question, but it is optional. We will ask some very detailed follow-up questions later in this Questionnaire to make sure that we have all the information we need to assess your Claim according to the settlement rules. Note that the response to this question must be in the Claimant's own words.

If you have any photos or documentation to support your claim or abuse, please email the photos and/or documents to BSOA@hilliard-law.com immediately.

Please describe the abuse

Type of Abuse We need to ask exactly what type of abuse happened to you. Here is a list of the types of abuse listed in the settlement rules. Please check the boxes for the types that happened to you.

Penetration
Anal or vaginal penetration – includes anal or vaginal sexual intercourse, anal or vaginal digital penetration, or anal or vaginal penetration with a foreign, inanimate object.

Oral Contact
Oral Contact Includes oral sexual intercourse, which means contact between the mouth and penis, the mouth and anus, or the mouth and vulva or vagina.

Masturbation
Includes touching of the male or female genitals that involves masturbation of the Abuser or Claimant.

Touching
(Unclothed) Touching of the sexual or other intimate parts (unclothed).

Touching (Clothed)
Touching of the sexual or other intimate parts (clothed), regardless of who is touching whom and not including masturbation.

Child Pornography
Exploitation for child pornography. Abuser took picture(s) or video of the sexual abuse activity and/or of certain parts of the Claimant's body (genitals, anus, pubic area, or breasts) when the Claimant was younger than 18 years old.

Sexual Abuse, No Touching
Generally, involves sexually explicit words or actions without touching that arouses sexual feelings in the Claimant or the Abuser.

Adult Abuse Claim
Adult Abuse Claim Abuse between an adult and a non-consenting adult.

Identity of the abusers

Abuser 1 Do you know the name of this person who abused you?

Abuser 1 What is this Abuser’s name?

Abuser 1 Was this Abuser an adult or youth?

Abuser 1 In what way did this Abuser abuse you? What type of abuse did they inflict on you? Check all that apply:

Abuser 1 Penetration

Abuser 1 Oral Contact

Abuser 1 Masturbation

Abuser 1 Touching of sexual or other intimate parts (unclothed)

Abuser 1 Touching of sexual or other intimate parts (clothed)

Abuser 1 Exploitation for child pornography

Abuser 1 Sexual Abuse, No touching

Abuser 1 Adult Abuse Claim

Abuser 1 If you do not know this Abuser’s name, can you provide any information that will help us to identify this Abuser? Please provide any identifying information you can.

Abuser 1 Can you provide a physical description?

Abuser 1 Description please explain

Abuser 1 Do you know what this Abuser's job was?

Abuser 1 Job Please Explain

Abuser 1 Do you know what relationship, if any, this Abuser had to Scouting?

Abuser 1 Please provide the troop number(s) this Abuser was associated with.

Abuser 1 Please explain the Abuser's relationship to Scouting

Abuser 1 Do you know whether this Abuser also abused other people?

Abuser 1 How many other people did this Abuser abuse?

Abuser 1 Please provide details about how many other people they abused, how you know this information, and who they abused (If you can share that).

Your Relationship to this Abuser. What relationships, if any, did you have with this Abuser outside of Scouting?

Abuser 1 Was this Abuser a family member of yours?

Abuser 1 Please describe the family relationship with this Abuser.

Abuser 1 Was this Abuser a family friend?

Abuser 1 Please describe the family friend relationship with this Abuser.

Abuser 1 Did you initially meet your Abuser through Scouting?

Abuser 1 Please tell us how and when you met your Abuser.

Abuser 1 Did you have a relationship with this Abuser in an organization outside of Scouting? Perhaps through church, or school, or through sports?

Abuser 1 Please describe the relationship with this Abuser, including describing in what organization you came to know the Abuser.

Abuser 1 Was the first abuse incident related to a Scouting event?

Abuser 1 First incident please explain.

Abuser 1 Were there later abuse incidents that were related to Scouting?

Abuser 1 Later abuse please explain.

Abuser 1 Were there any abuse incidents that happened outside of Scouting?

Abuser 1 incidents outside of Scouting please explain.

Abuser 2

There was a 2nd abuser

Abuser 2 Do you know the name of this person who abused you?

Abuser 2 What is this Abuser’s name?

Abuser 2 Was this Abuser an adult or youth?

Abuser 2 In what way did this Abuser abuse you? What type of abuse did they inflict on you? Check all that apply:

Abuser 2 Penetration

Abuser 2 Oral Contact

Abuser 2 Masturbation

Abuser 2 Touching of sexual or other intimate parts (unclothed)

Abuser 2 Touching of sexual or other intimate parts (clothed)

Abuser 2 Exploitation for child pornography

Abuser 2 Sexual Abuse, No touching

Abuser 2 Adult Abuse Claim

Abuser 2 If you do not know this Abuser’s name, can you provide any information that will help us to identify this Abuser? Please provide any identifying information you can.

Abuser 2 Can you provide a physical description?

Abuser 2 Description please explain

Abuser 2 Do you know what this Abuser's job was?

Abuser 2 Job Please Explain

Abuser 2 Do you know what relationship, if any, this Abuser had to Scouting?

Abuser 2 Please provide the troop number(s) this Abuser was associated with.

Abuser 2 Please explain the Abuser's relationship to Scouting

Abuser 2 Do you know whether this Abuser also abused other people?

Abuser 2 How many other people did this Abuser abuse?

Abuser 2 Please provide details about how many other people they abused, how you know this information, and who they abused (If you can share that).

Abuser 2 Was this Abuser a family member of yours?

Abuser 2 Please describe the family relationship with this Abuser.

Abuser 2 Was this Abuser a family friend?

Abuser 2 Please describe the family friend relationship with this Abuser.

Abuser 2 Did you initially meet your Abuser through Scouting?

Abuser 2 Please tell us how and when you met your Abuser.

Abuser 2 Did you have a relationship with this Abuser in an organization outside of Scouting? Perhaps through church, or school, or through sports?

Abuser 2 Please describe the relationship with this Abuser, including describing in what organization you came to know the Abuser.

Abuser 2 Was the first abuse incident related to a Scouting event?

Abuser 2 First incident please explain.

Abuser 2 Were there later abuse incidents that were related to Scouting?

Abuser 2 Later abuse please explain.

Abuser 2 Were there any abuse incidents that happened outside of Scouting?

Abuser 2 incidents outside of Scouting please explain.

Abuser 3

There was a 3rd abuser

Abuser 3 Do you know the name of this person who abused you?

Abuser 3 What is this Abuser’s name?

Abuser 3 Was this Abuser an adult or youth?

Abuser 3 In what way did this Abuser abuse you? What type of abuse did they inflict on you? Check all that apply:

Abuser 3 Penetration

Abuser 3 Oral Contact

Abuser 3 Masturbation

Abuser 3 Touching of sexual or other intimate parts (unclothed)

Abuser 3 Touching of sexual or other intimate parts (clothed)

Abuser 3 Exploitation for child pornography

Abuser 3 Sexual Abuse, No touching

Abuser 3 Adult Abuse Claim

Abuser 3 If you do not know this Abuser’s name, can you provide any information that will help us to identify this Abuser? Please provide any identifying information you can.

Abuser 3 Can you provide a physical description?

Abuser 3 Description please explain

Abuser 3 Do you know what this Abuser's job was?

Abuser 3 Job Please Explain

Abuser 3 Do you know what relationship, if any, this Abuser had to Scouting?

Abuser 3 Please provide the troop number(s) this Abuser was associated with.

Abuser 3 Please explain the Abuser's relationship to Scouting

Abuser 3 Do you know whether this Abuser also abused other people?

Abuser 3 How many other people did this Abuser abuse?

Abuser 3 Please provide details about how many other people they abused, how you know this information, and who they abused (If you can share that).

Abuser 3 Was this Abuser a family member of yours?

Abuser 3 Please describe the family relationship with this Abuser.

Abuser 3 Was this Abuser a family friend?

Abuser 3 Please describe the family friend relationship with this Abuser.

Abuser 3 Did you initially meet your Abuser through Scouting?

Abuser 3 Please tell us how and when you met your Abuser.

Abuser 3 Did you have a relationship with this Abuser in an organization outside of Scouting? Perhaps through church, or school, or through sports?

Abuser 3 Please describe the relationship with this Abuser, including describing in what organization you came to know the Abuser.

Abuser 3 Was the first abuse incident related to a Scouting event?

Abuser 3 First incident please explain.

Abuser 3 Were there later abuse incidents that were related to Scouting?

Abuser 3 Later abuse please explain.

Abuser 3 Were there any abuse incidents that happened outside of Scouting?

Abuser 3 incidents outside of Scouting please explain.

Overall impact of the abuse

We encourage you to answer this question, but it is optional. We will ask some very detailed follow-up questions later in this Questionnaire to make sure that we have all the information we need to assess your Claim according to the settlement rules. Note that the response to this question must be in the Claimant’s own words.

If you have any photos or documentation to support your claim or your time in treatment please email the photos and/or documents to BSOA@hilliard-law.com immediately.

How did the experience of abuse affect you? Please tell us all about all the ways the abuse had an impact on you.

Impact of the Abuse: Mental Health Impact Please tell us about any impact the abuse had on your mental health. This includes substance abuse, anxiety, depression, post-traumatic stress disorder, addiction, embarrassment, fear, flashbacks, nightmares, sleep issues, sleep disturbances, exaggerated startle response, boundary issues, self-destructive behaviors, guilt, grief, homophobia, hostility, humiliation, anger, isolation, hollowness, regret, shame, isolation, sexual addiction, sexual problems, sexual identity confusion, low self-esteem or self-image, bitterness, suicidal ideation, suicide attempts, and hospitalization or receipt of treatment for any of the items in this list.

Did the abuse have an impact on your mental health in any of the ways in the list above, or in any other ways?

Please select each mental health impact the abuse caused for you.

Please tell us about the mental health impact(s) of the abuse.

Did you receive any treatment for the mental health impact of the abuse?

Please tell us about the treatment. What was the diagnosis, who treated you, and when, and about how many times, and where?

Impact of the Abuse: Physical Health Impact Please tell us about any impact the abuse had on your physical health. This includes physical manifestations of emotional distress, gastrointestinal issues, headaches, high blood pressure, physical manifestations of anxiety, erectile dysfunction, heart palpitations, sexually transmitted diseases, physical damage caused by acts of abuse, reproductive damage, self-cutting, other self-injurious behavior, and hospitalization or receipt of treatment of any of items in this list.

Did the abuse have an impact on your physical health in any of the ways in the list above, or in any other ways?

Please select each physical health impact the abuse caused for you.

Please tell us about the physical health impact(s) of the abuse.

Impact of the Abuse: Interpersonal Relationships Please tell us about any impact the abuse had on your interpersonal relationships. This includes problems with authority figures, hypervigilance, sexual problems, marital difficulties, problems with intimacy, lack of trust, isolation, betrayal, impaired relations, secrecy, social discreditation and isolation, damage to family relationships, and fear of children or parenting.

Did the abuse have an impact on your interpersonal relationships in any of the ways in the list above, or in any other ways?

Please select each interpersonal relationships impact the abuse caused for you.

Please tell us about the impact of the abuse on your interpersonal relationships.

Impact of the Abuse: Vocational Capacity. Please tell us about any impact the abuse had on your vocational capacity. This includes under- and unemployment, difficulty with authority figures, difficulty changing and maintaining employment, feelings of unworthiness, or guilt related to financial success.

Did the abuse have an impact on your vocational capacity in any of the ways in the list above, or in any other ways?

Please select each vocational impact the abuse caused for you.

Please tell us about the impact of the abuse on your vocational capacity.

Impact of the Abuse: Academic Capacity Please tell us about any impact the abuse had on your academic capacity. This includes school behavior problems.

Did the abuse have an impact on your academic capacity?

Please tell us about the impact of the abuse on your academic capacity.

Did the impact of the abuse on you include school behavior problems?

Please tell us how the impact of the abuse caused you to have school behavior problems

What is the highest level of education you completed?

Please explain the highest level of education you completed

Did the abuse cause you to have legal difficulties (either those mentioned above, or other legal difficulties)?

Did the impact of the abuse on you include

Please tell us about the impact of the abuse on legal difficulties.

Other Claim Information

Do you qualify for an Exigent Health Claim?

Claim Determination Deferral. The rules of the settlement allow you to defer determination of your Allowed Claim Amount if your Claim may be substantially reduced by the statute of limitations scaling factor. This means that under certain states’ laws, people cannot sue about sex abuse events that happened long ago because those states’ “statute of limitations” rules prevent the lawsuit. Some of those states may be in the process of changing their rules. You can decide whether to ask us to put your Claim “on hold” for a certain amount of time while you see what happens in those states. If you elect to defer your determination, you may defer your Claim for up to 12 months or only until April 18, 2024 (twelve months after the Effective Date of the Trust).

Do you elect to defer your determination to see if statute of limitations revival legislation occurs in certain states?

Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific

Substance abuse
Anxiety
Depression
Post-traumatic stress disorder
Addiction
Embarrassment
Fear
Flashbacks
Nightmares
Sleep issues
Sleep disturbances
Exaggerated startle response
Boundary issues
Self-destructive behaviors
Guilt
Grief
Homophobia
Hostility
Humiliation
Anger
Isolation
Hollowness
Regret
Shame
Sexual addiction
Sexual problems
Sexual identity confusion
Low self-esteem or self-image
Bitterness
Suicidal ideation
Suicide attempts
Hospitalization or receipt of treatment for any of the items in this list