If you don’t have a valid Notice, we’ll send you a Medicare history and care services statement and Declaration.
You’ll need to identify any related benefits you’ve used since the date of injury. You’ll also need to tell us about any related benefits you’ve used since your last Notice of past benefits.
Send the completed statement and declaration to the address on the form by the due date on the letter. We’ll send you a Notice of charge.
The compensation payer will use the Notice of charge, Notice of past benefits, or make an advance payment to pay us back first. Then they’ll pay the rest of the compensation amount to you.