Get Subrogation Form

Completing the Subrogation Form online is a straightforward process that allows users to acknowledge their understanding of the reimbursement agreement related to their benefits. This guide will walk you through each component of the form, ensuring a clear and effective submission.

Follow the steps to successfully complete the Subrogation Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in your full name in the designated field at the top of the form. Make sure your name matches your identification documents for accuracy.
3. Enter the date of the injury or injuries in the space provided. Use the format MM/DD/YYYY.
4. Read through the reimbursement agreement carefully. Make sure to understand the terms, including the plan's entitlement to reimbursement from any recovery you may receive due to the injuries.
5. Fill in the member identification number, last name, and first name as they appear in your Employee benefits records.
6. If applicable, include the name of any covered family member in the specified field.
7. Sign the form where indicated. Ensure that you date it properly. If a family member is signing, they should also include their signature.
8. Review all information entered to confirm its accuracy before finalizing your entry.
9. Once you have completed the form, you can save changes, download, print, or share the form as needed.

Complete your Subrogation Form online today to ensure your benefits are processed efficiently.