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Your assigned file number is located at the bottom of the questionnaire we mailed you.
If you don't have an assigned file number, don't fill out this form. Instead, you may choose to fill out a subrogation questionnaire (PDF) for a new case.
Has the patient recently been treated by a doctor for an accidental injury? (required)
Was the patient treated for injuries related to: (Check all that apply.)
Please select your state.
Was anyone at fault?
Did you file a claim against the liable party?
(Please email a copy of any claim-related forms to SubrogationUnit@bcbsm.com)