DD Form 2527, Statement of Personal Injury - Possible Third Party Liability, April 2013-2025

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The document is a TRICARE Management Activity form (DD Form 2527) used to collect information regarding personal injuries that may involve third-party liability. It outlines the process for submitting claims related to medical care resulting from such injuries, including instructions for completing the form, privacy statements, and potential consequences of not providing the requested information. The form aims to facilitate TRICARE's recovery of medical expenses from liable parties.

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What is the third party liability rule?

Third-party liability refers to bodily injury caused to a person because of a negligent or reckless third partys actions or omissions. Third-party liability may arise when an individual or entity that is separate from the employer causes the workplace accident.

Can TRICARE drop you without notice?

Youll be notified if and when you lose eligibility for TRICARE. Each person in your family enrolled in TRICARE will receive a notice.

What is a third party liability letter?

Third Party Liability (TPL) refers to the legal obligation of third parties (for example, certain individuals, entities, insurers, or programs) to pay part or all of the expenditures for medical assistance furnished under a Medicaid state plan.

What is a TRICARE DD form 2527?

Your regional contractor will send you the Statement of Personal Injury-Possible Third Party Liability (DD Form 2527) if a claim is received that appears to have third-party liability involvement. You must complete and sign this form within 35 calendar days.

What does a third party liability claim mean?

A third-party claim is a claim filed by someone other than the policyholder or insurance company. If youre in a car accident that someone else causes, you can file a third-party claim with the other drivers insurance for your covered accident-related expenses.

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Why did I receive a DD Form 2527 TRICARE when I just fell at my own home?

Some diagnosis codes may indicate an injury or illness which a third party may have caused. When the TRICARE contractor gets claims with these types of diagnosis codes, the contractor will send you a Statement of Personal Injury Possible Third Party Liability form (DD Form 2527) to fill out.

Why did TRICARE drop me?

Any change in the sponsors status (e.g., active duty to retired, Guard/Reserve deactivation) will cause an automatic disenrollment. If youre still eligible for TRICARE Prime after the status change, you can: Re-enroll in TRICARE Prime. You can re-enroll before the status change occurs to avoid a lapse in coverage.