MSA Evaluation Intake Form

Please fill out the form below.


  • *Please submit all intake documents and copy of advanced fee.
  • Claim Information

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Injury Victim Information

  • Date Format: MM slash DD slash YYYY
  • Plaintiff Counsel

  • Defendant/Insurance Carrier

  • Step 1: SSDI/Medicare

    *VERY IMPORTANT – please completely fill out this section
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • 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

“Synergy is our guiding light for deferring our contingent legal fees and planning for retirement. The lawyers at Panter Panter & Sampedro, myself included, have been working with them for over ten years using different methods to defer comp and plan for retirement.”

Brett Panter
Panter, Panter & Sampedro

"I don't think I've directly said "thank you" for helping us with Bridgett’s case. We sent the reduced payment to Medicaid and called Bridgett's mom to tell her approximately how much money was going to be left for Bridgett and she broke down over the telephone. Given only $25k of insurance and a $850k medical bill from the hospital she didn't think Bridgett would ever see a penny."

Tom L. Copeland
Jeffrey Meldon & Associates, P.A.

Hospital "Liens" vs. "Debts": A Distinction With a BIG Difference ​​​​​​​Third Thursday Webinar Series

Join Director of Synergy Medical Bill Clinic, Michael Walrath, Esq. as he delves into the differences between “direct provider liens” and mere “medical debts.” In this webinar, he will describe how and why these important distinctions impact the lien resolution process and expected outcomes, while also dictating the various ethical and legal exposures faced by Plaintiffs’ Lawyers, post-settlement. A 15 minute Q&A will follow the presentation.

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