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.

Premier Clients

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TESTIMONIALS

I wanted to pass my highest recommendation to Synergy who we routinely get involved in cases when Medicare issues come up, especially when dealing with Medicare Set Asides. Synergy went beyond the call of duty in a recent case that was settled and dealt one-on-one with our clients and their family. They spent time on the phone with them to be sure they got all their questions answered and did a fantastic job dealing with Medicare.

J. Daniel Clark
Clark Martino, P.A.

"I have been very impressed by the results achieved by Synergy Lien Resolution Services. They saved my client over $108,000 in reducing a difficult ERISA lien. Their expertise was invaluable and resulted in a very happy client. Best money I ever spent. I wholeheartedly recommend them. You are doing your client a disservice if you don’t hire them to help you with your liens."

Armando Payas, Esq.
Payas Law

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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