What is the Waiver of Liability statement, and where can I find it?

The Waiver of Liability statement confirms that the member won’t be held financially responsible if you lose the appeal. A signed Waiver of Liability must be included with the appeal file you submit to us.

If the signed form isn’t received within the appeal timeframe, the appeal will be forwarded to the Independent Review Entity (IRE), MAXIMUS Federal Services, Inc., for dismissal.

You can find the Waiver of Liability statement in the appeal materials we provide or with the appeal instructions for the specific case.