Medicare Set-Aside Referral | Workers’ Compensation Claims (including all Longshore & Harbor Workers’ Compensation Act Claims)

Natalie Clark
3414 Peachtree Road, NE
Suite 990
Atlanta, GA 30326
Office: 404-926-4160 x215
Fax: 404-926-4161
Email: Natalie Clark
View Natalie’s Bio

Please find below our Workers’ Compensation Claims (including all Longshore & Harbor Workers’ Compensation Act Claims). If you are looking for our liability form for Liability Medicare Claims (including all Jones Act Matters) click here.

The form below will allow you to provide the requested information so that a team member can contact you regarding your inquiry and advise how to proceed. If the matter has previously been referred to Atlas Settlement Group for Medicare Compliance, please feel free to email Natalie Clark and request an update (a new referral will not be needed).

Turn Around Time & RUSH
Standard turn-around time for all products is 10 business days after the receipt of all file materials needed. Should you need a shorter turn-around time, please select the “Rush” option (on the form) and advise by what date the product will be needed. All time frames will be dependent upon the receipt of requested file materials.

Documentation
Please do not provide any documentation at this time as materials needed will vary depending up service requested. Thus, Atlas will advise further upon receipt of the Referral Information above. Please note that the more information provided at the time of Referral, the faster the process can begin. Finally, if you have any questions regarding the services offered, please do not hesitate to call or email Natalie Clark directly.

Thank you for your kind referral and have a wonderful day.

Preferred Broker:

Claim Type:* (* Required / select all that apply)
Medicare Set-Aside (MSA)
Medical Cost Projection (MCP) / Non-Submit MSA
Settlement Cost Projection (SCP) / Medicare and Non-Medicare Future Medical Projection
Conditional Payment Inquiry / Lien Investigation
Opinion Letter

Referring Contact Information:

State:

<-Required

Claimant Information:

State:

Date of Birth:
Social Security Number*:<-Required (0)
Is the Claimant a current Medicare Beneficiary?
Has the Claimant applied for or is Claimant currently receiving SSD benefits?

Claim Information:

Date of Injury:

Jurisdiction / Venue / State:
Is this a claim that has been denied from the outset (i.e. a fully denied claim)?

Brief Description of Loss Causing Event (two lines max):

Reason for Referral (claim pending settlement, etc.):

Is the Claim expected to settled for an amount in excess of $1 million?
Will the file materials provided for review exceed 1,500 pages?
Is this matter timely – RUSH? If so, Date Requested for Receipt?
Additional Claim: If there are additional claims with this same Claimant that should be addressed here, use the "+" (add) button below to add additional claim(s) information. Also note the "-" (remove) button that appears below for removal of unneeded claim(s) information.

Defense's Counsel:(if applicable)

State:

Claimant's Counsel: (if applicable)

State:

Additional Info: (if needed)

One Last Thing:

To cut down on spam, we'd like to make sure you are human.
What is 11 + 21?

Please Note: There may be a slight delay while your information is sent. A confirmation message will appear above – if a confirmation message does not appear, you may need to retry your submission or contact your Atlas Settlement Consultant for alternate submission methods.

Privacy: We value the privacy of those who visit this website. We think it is important for you to understand when and why we might collect personally identifiable information and how it is used. Rest assured, your personal information will never be shared with, sold to or distributed to any third-party without your express consent.

Medicare Set-Aside Referral | Workers’ Compensation Claims (including all Longshore & Harbor Workers’ Compensation Act Claims)

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