Get Notice Of Proposed Terms Of Settlement

Filling out the Notice Of Proposed Terms Of Settlement online is a vital process for recovering health care costs associated with third-party liability incidents. This guide will provide you with clear and detailed instructions on how to complete each section of the form to ensure an accurate submission.

Follow the steps to fill out the form effectively:

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. In Part A, enter the full name of the beneficiary. Next, provide the date of the incident in the format YYYY / MM / DD. If known, also include the date of birth in the same format and the Personal Health (CareCard) Number.
3. In Part B, fill in the full name of the payor. Provide the complete address, including postal code, contact phone number with area code, and an optional email address.
4. Proceed to Part C and list the name and address of any legal counsel involved. Include their phone number and email address.
5. Identify the name(s) of potential parties to the settlement. Indicate whether this is a class action by selecting 'Yes' or 'No'. If a lawsuit has been filed, choose the appropriate option.
6. Sign the form where indicated, providing the date of trial if known, the registry number, and the location of the trial if applicable. Include a contact phone number, an optional email address, and the full mailing address.
7. Print your name and title of the signatory, and enter the date signed in the format YYYY / MM / DD.
8. To submit the form, if you are using the electronic method, scan the completed document and email it to the provided address. Alternatively, you can send it by registered mail or traceable courier to the specified address.
9. Finally, review your details, save any changes made, and choose to download, print, or share the completed form as needed.

Take action now and complete the Notice Of Proposed Terms Of Settlement online!