You must download our forms to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.
Download and complete the Medicare Compensation Recovery Section 23A statement form.
The injured person, claimant or authorised third party may give this statement to us only if:
- Declaring that a Notice of past benefits has never been issued in relation to the case for compensation or
- a Notice of past benefits has previously been issued, but had expired at the time of judgment or settlement.