Fields marked with an asterisk (*) are required. Requestor Information Your Name Firm Phone # Email Services Requested (Check all that apply) Report of WC Claim to Medicare SS/Medicare Releases for Status; Medicare Lien Verification Medical Care Cost Projections with Informal MSA MSA Allocation/Arrangement — Standard MSA Allocation/Arrangement — Complex MSA Allocation/Arrangement — Extraordinarily Complex … Continue reading WCMSA Request Form