Dd form 2527 2013-2019-2025

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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 the implications of failing to provide requested information. The form requires details about the injury, its cause, and any legal representation involved.

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Click ‘Get Form’ to open the dd form 2527 in the editor.
Begin with Section I - General Information. Fill in the sponsor's social security number, the injured patient's name and address, date of injury, and approximate time of injury.
Proceed to Section II - Type and Cause of Injury. Select the appropriate option that describes your situation, such as traffic accident or slip/fall, and provide detailed information as requested.
In Section III - Miscellaneous, list any military medical facilities that provided care for the injury along with treatment dates. Indicate whether you have hired a lawyer or have insurance by checking 'Yes' or 'No' and providing necessary details.
Finally, sign and date the form at the bottom before submitting it through our platform for processing.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (154 Votes)
2019	4.3 Satisfied (74 Votes)
2013	4.3 Satisfied (49 Votes)
2008	4.1 Satisfied (50 Votes)
2004	4.4 Satisfied (65 Votes)
1994	4 Satisfied (52 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

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.

Does TRICARE pay for car accident injuries?

TRICARE will cover your car accident medical care until you can receive a settlement check from the responsible drivers insurance company. TRICARE works the same as any other medical or health insurance provider in that it must be reimbursed for the costs that it has already paid once you get a settlement.

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.

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 is third party liability recovery?

The Third Party Liability provisions of the Plan entitle the Fund to collect, directly from any responsible third party or insurance carrier, or from you, any money it advances to pay benefits relating to injuries you sustained and for which a third party is legally obligated to pay.

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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.

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.

Dd form 2527 2013-2019-2025

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How to use or fill out dd form 2527 2013-2019 with our platform

See more dd form 2527 2013-2019 versions

Complete this form in 5 minutes or less

Got questions?

What is a third party liability letter?

Does TRICARE pay for car accident injuries?

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

What is a TRICARE DD form 2527?

What is third party liability recovery?

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Can TRICARE drop you without notice?

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