The case number, contract number and/or accident date you've entered does not match our records. Please try again. If you do not know this information, please contact us at 205-220-7725 or fax your request to 205-220-6354.
Are you reporting a new case?If so, please call ☎ 205-220-7725
To submit an inquiry about an existing case:
You can upload up to 3 files with a maximum file size of 5MB for each file. Acceptable formats are .pdf, .jpg, .jpeg, .png, .gif, .bmp, .tif, .txt, .doc, .docx, .xls and .xlsx
By submitting this request, I attest that I am the individual named above (or their authorized representative).
I further acknowledge that:
As authorized representative, I agree to protect 's subrogation interest and reimbursement interest in this matter, and I agree to the standard contingency fee of 25% if settled or 33 1/3% if tried, exclusive of costs.
As authorized representative, I agree to protect 's subrogation interest and reimbursement interest in this matter, but I request that accept the fee agreed to in the attached contingency fee agreement.
I agree not to disburse the proceeds of any settlement before I resolve 's interest.
I refuse to protect 's subrogation interest and reimbursement interest in this matter. My client does not want Blue Cross to reduce its interest by my contingency fee.
Blue Cross and Blue Shield of Alabama is an independent licensee of
the Blue Cross and Blue Shield Association.