Subrogation Touchpoint

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 Blue Cross and Blue Shield of Alabama'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 Blue Cross and Blue Shield of Alabama's subrogation interest and reimbursement interest in this matter, but I request that Blue Cross and Blue Shield of Alabama accept the fee agreed to in the attached contingency fee agreement.
  I agree not to disburse the proceeds of any settlement before I resolve Blue Cross and Blue Shield of Alabama's interest.
  I refuse to protect Blue Cross and Blue Shield of Alabama's subrogation interest and reimbursement interest in this matter. My client does not want Blue Cross to reduce its interest by my contingency fee.