How to Fill Out and Submit DD Form 2527: Statement of Personal Injury

DD Form 2527, the Statement of Personal Injury — Possible Third Party Liability, arrives when TRICARE suspects someone else may be responsible for the injury behind your medical bills. To fill out DD Form 2527 correctly, work through it in order: sponsor and patient identification, accident details, accident-type checkboxes, insurance and third-party information, any workplace or malpractice fields that apply, attorney contact information, and your signature. Then return it to the TRICARE claims processor that sent it to you within 35 calendar days of the date on the accompanying letter.¹

Why TRICARE Sent You This Form

TRICARE flags medical claims that look like they resulted from an accident rather than an illness. When the diagnosis codes point to trauma, your regional contractor sends DD Form 2527 to find out whether a third party or another insurer should be paying for your care.²

The authority behind the request is the Federal Medical Care Recovery Act, 42 U.S.C. § 2651, which gives the federal government an independent right to recover medical costs from anyone whose negligence caused the injury. That right exists whether or not you file your own lawsuit.³

Common triggers are motor vehicle accidents, slip-and-falls on someone else’s property, on-the-job injuries covered by workers’ compensation, medical malpractice, product-related injuries, and recreational incidents where another person was at fault.

The 35-Day Deadline Comes First

The moment TRICARE flags the case, it suspends payment on every claim tied to the injury. You have 35 calendar days from the date on the cover letter to return the form. Miss that window and the suspended claims — plus any future claims connected to the same injury — get denied, which can leave you personally responsible for bills TRICARE would otherwise have paid.¹

The form itself says providing the information is technically voluntary, but skipping it produces delays, denials, or both.⁴ If the 35 days have already passed, submit it anyway and call your regional contractor to ask about reopening the claims. A late submission with an explanation beats no submission.

What to Gather Before You Start

Pulling your documents together first turns a frustrating form into a short one. You’ll want:

The police report, if one was filed, and the report number.
Your own auto or homeowner’s insurance cards.
Whatever you know about the other party’s insurer (name, address, policy number).
Your employer’s contact information and workers’ comp carrier, if the injury happened at work.
Your attorney’s name, address, and phone number, if you’ve hired one.
Any correspondence you’ve received from another party’s insurance company.

Working Through the Form Section by Section

Sponsor and Patient Identification

Enter the sponsor’s Social Security number and the injured patient’s full name and address. “Sponsor” means the service member or retiree whose eligibility covers the beneficiary. If you’re both the sponsor and the injured person, fill in both fields anyway. A wrong SSN here disconnects the form from your medical claims, so double-check it.¹

Accident Details

Fields 3 and 4 ask for the date of the injury in YYYYMMDD format, the approximate time, and the city and state where it happened. Be specific about location. An intersection name or a business address beats a bare city name. Then describe how the injury occurred in your own words: what you were doing, what the other party did, and how you were hurt. Keep it plain and factual. This is not a legal brief.¹

Accident-Type Checkboxes

Check every box that applies: motor vehicle accident, on-the-job injury, medical malpractice, product liability, premises liability, and any others listed. A car crash that happened during a work errand gets both the motor vehicle and on-the-job boxes. The categories tell TRICARE which legal framework governs its recovery effort.

Insurance and Third-Party Information

This is the section the form is really built around. Provide names, addresses, and policy numbers for every insurer that might be involved: your own auto policy and the other driver’s, any homeowner’s or renter’s policy if the injury happened on someone’s property, and your employer’s workers’ comp carrier if the injury was work-related. For a motor vehicle accident, add the police report number and the investigating agency so TRICARE can cross-reference the official account.¹

Medical Malpractice and On-the-Job Injuries

Field 12 covers malpractice: the date you first learned about it, the provider’s name, and where it happened. Field 10 covers workplace injuries: your employer’s name, address, and how the injury occurred. These fields help TRICARE decide whether workers’ compensation or a malpractice insurer should be the primary payer instead.¹

Attorney Information

Field 15 asks whether you’ve retained a lawyer. If yes, give the attorney’s name, address, and phone number. Once TRICARE has that, it routes correspondence about the claim, including any lien on a future settlement, through the attorney. Hire a lawyer after you send the form? Call your regional contractor and update the file.¹

Signature

Sign and date the form. An unsigned form is an incomplete form, and TRICARE will treat it as if you never returned it.

Where to Send It

Return the form to the TRICARE claims processor that sent it. The notification letter includes a mailing address and sometimes a pre-addressed envelope. If you’ve lost the letter, send it to the claims processor for the state or country where you received care. The Health Benefits Advisor at your nearest military installation can give you that address.¹

Stateside, the two regional contractors are Humana Military in the TRICARE East Region⁵ and TriWest Healthcare Alliance in the TRICARE West Region.⁶ Some contractors accept the form through a secure online portal; others require mail. Follow the directions your contractor gives you. If you mail it, use certified mail or a tracked service so you can prove the date you sent it. The 35-day clock is unforgiving.

Need a fresh blank because the original was lost or damaged? Download the PDF from the Department of Defense forms portal at esd.whs.mil.¹

What Happens After You Submit

Your regional contractor reviews the form and decides whether to open a recovery case. Viable claims may be referred to a Judge Advocate General office or a specialized recovery contractor for further investigation. Respond quickly to any follow-up questions, because delays at that stage slow your own claims processing.

Assuming you returned the form on time, TRICARE keeps paying covered claims for the injury while its recovery case is open. It also tracks every dollar it spends on your care from that incident. If you or the at-fault party’s insurer later reach a settlement, TRICARE will assert a lien against the proceeds for the amount it paid.

How the Form Affects a Personal Injury Settlement

If you’re pursuing a personal injury claim against whoever hurt you, DD Form 2527 puts the government on notice and starts its own clock. Under 42 U.S.C. § 2651, the federal government has an independent right to recover from the responsible party. It can intervene in your lawsuit or bring its own action if you haven’t filed one within six months of the first TRICARE-covered treatment.³

Because that right operates under federal law, state “made whole” rules that protect injured people from being shortchanged by their own insurers generally don’t apply to TRICARE’s claim. Your attorney needs to account for TRICARE’s lien when negotiating a settlement, because ignoring it can bring the government after the proceeds directly. Get your attorney’s information onto the form early so TRICARE routes lien correspondence through them from the start.

Be Accurate on the Form

The Privacy Act statement on DD Form 2527 notes that the information you provide may be shared with the Department of Justice and other agencies for matters involving fraud and civil or criminal litigation related to TRICARE operations.¹ Knowingly making a false statement on a federal form can be prosecuted under 18 U.S.C. § 1001, which carries fines and up to five years in prison.⁷

The more common consequence is quieter. If TRICARE later finds that you concealed an at-fault party or misstated the circumstances, it can deny your injury-related claims retroactively, leaving you responsible for bills that were already paid. Reporting that someone else caused your injury doesn’t stop TRICARE from covering your care. It tells the government who should ultimately pay the bill.

1
Defense Health Agency. DD Form 2527 – Statement of Personal Injury – Possible Third Party Liability
2
TRICARE. Third-Party Liability
3
Office of the Law Revision Counsel. 42 USC 2651 – Recovery by United States
4
TRICARE. Why Did I Get a Third Party Liability Form?
5
TRICARE. East Region
6
TRICARE. West Region
7
Office of the Law Revision Counsel. 18 US Code 1001 – Statements or Entries Generally