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

"Coincidentally, on the day of a recent Synergy Seminar on Medicare & ERISA lien resolution I received a letter on an ERISA lien. This letter followed much back and forth between myself and the recovery vendor for BCBS. Despite my efforts they were adamant there would be no (zero)(zilch)(nada) reduction and provided case law to support their position. I tried Synergy’s Lien Resolution Services since I had just heard their Director of Lien Resolution speak. Synergy got them to reduce their claim by a third in less than ten (10) days. The result was quick and the fee very reasonable. If you have a tough ERISA lien and your typical efforts don’t work, give Synergy a try."

Michael S. Smith, Esq.
Lesser, Lesser, Landy & Smith, PLLC

"Synergy has been a trusted part of our legal team for many years. They have helped our clients in many cases to understand the benefits of structured settlements. Synergy has protected our clients and us by securing the best annuities on the market with the safest companies available. Our Synergy consultant is a great communicator in explaining the details and benefits of structured settlements to our clients. He has also mentored myself and the other lawyers in our firm in the benefit of Attorney Fee Annuities. Their work with our firm has secured our clients and our financial security and we expect to continue working with him for many years to come."

Brett Panter
Panter, Panter & Sampedro

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