Medicare Compensation Recovery Section 23A statement form (MO023)

Use this form to declare you received no benefits, or received no further benefits since your most recent expired notice, for your compensable injury or illness.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

Download and complete the Medicare Compensation Recovery Section 23A statement form.

The injured person, claimant or authorised third party may give this statement to us only if:

  • Declaring that a Notice of past benefits has never been issued in relation to the case for compensation or
  • a Notice of past benefits has previously been issued, but had expired at the time of judgment or settlement.
Page last updated: 28 October 2024.
QC 19956