MSA Evaluation Intake Form

Please fill out the form below.


  • *Please submit all intake documents and copy of advanced fee.
  • Claim Information

  • Injury Victim Information

  • Plaintiff Counsel

  • Defendant/Insurance Carrier

  • Step 1: SSDI/Medicare

    *VERY IMPORTANT – please completely fill out this section
  • Step 2: Future Care

  • Step 3: Settlement Verdict Details

  • Other Health Care Coverage

  • *Please provide any proposed settlement documents, summary of the case and Medicare card, if applicable.

TESTIMONIALS

"Synergy is an invaluable partner in the mediation process. They have extensive expertise in Medicare, Medicaid and Structured Settlements and the ability to explain the impact of these complex concepts to my clients in simple, clear and understandable language. This allows me to focus on obtaining the best possible result in the settlement process."

Michael J. Winer, Esq.
President Florida Workers Advocates (FWA)

Thank you so much for the services your firm provided to our client. Should the need arise again, we will ALWAYS use Synergy. Your customer service was outstanding and the guidance and instructions your office gave us with our client's Medicare waiver application was instrumental in getting a FULL waiver of his Medicare lien. I know our clients were very grateful for your help, too. And, I just wanted to write and let you know how happy we were with your services. We will always recommend your company to any other plaintiff's attorneys that need help with lien reduction or waivers. Thank you again!

Peggy Rothenberger, Legal Assistant to Henry Moore
Law Offices of Henry Moore

Premier Clients

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Ready to schedule a consultation?

The Synergy Settlements team will work diligently to ensure your case gets the attention it deserves. Contact one of our legal experts and get a professional review of your case today.

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