Medicare Compensation Recovery Notice of past benefits request form (MO026)

Use this form to get a copy of your Medicare history and care services statement, to find out what benefits and subsidies we will recover from your compensation.

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 Notice of past benefits request form.

The injured person, claimant, authorised third party or the person paying your compensation can request a statement be issued. This form is the first step in requesting a Notice of past benefits under Section 21 of the Health and Other Services (Compensation) Act 1995.

Page last updated: 7 June 2025.
QC 19706