WCMSA View Attestation Submissions

The WCMSA View Attestation Submissions page shows summary information for your case and each attestation submitted via the WCMSAP for the listed case ID.

Notes: A Medicare beneficiary viewing this page from Medicare.gov will be able to see all attestations submitted via the WCMSAP; self-account and representative users can only see attestations they submitted on the WCMSAP.

The following information will be displayed (as applicable) on this page for the selected case. All fields are read-only.

Table 1: View Attestation Submissions

Field	Description
Case ID	Displays the Case Control Number of the case.
Total MSA	Displays the total approved Medicare Set-Aside (MSA) amount.
Current Balance	Displays the current balance.
Medicare ID	Displays the beneficiary’s Medicare ID (HICN or MBI).
Settlement Date	Displays the effective date of the settlement.
Anniversary Date	Displays the anniversary date of the annual payments.
Name	Displays the beneficiary’s first and last name.
No. of Years	Displays the calculated number of years for the payout schedule.
Payout Method	Displays the method of payout. Possible values: Lump Sum Structured Annuity
Date of Injury	Displays the date of injury.
Initial Deposit	Displays the initial dollar amount of a structured payment schedule. Note: This field is only shown for structured annuities.
Payout Schedule	Displays the schedule of annual payments. Note: This table is only shown for structured annuities.

Table 2: WCMSA Transactions (Structured Annuity and Lump Sum)

Field	Description
Date submitted	Displays the date the attestation was submitted.
Attestation statement	Displays the shortened version of the attestation statement selected by the administrator or set by the system. Possible values: Annual payout Completely exhausted Current Balance Entered by Admin Current Balance Updated Per Service Request Exhausted annual Initial Deposit Lump Sum Payout Prof Admin Transactions Used annual Used monies
Period From	Displays the start date for the attestation.
Period Thru	Displays the end date for the attestation.
Beginning Balance	Displays the balance before the attestation was submitted.
Automatic Deposit	Displays the automatic payout amount for the structured annuity.
Interest Earned	Displays the amount of interest earned.
Medical Expenses	Displays the amount of medical expenses.
Prescription Drug Expenses	Displays the amount of prescription drug expenses.
Taxes Paid on Interest Earned	Displays the amount of taxes paid on interest earned.
Balance	Displays the balance after the attestation is submitted.
Uploaded Documents	Displays the filename of the uploaded document submitted with the attestation.

Click Cancel to return to the WCMSA Account Balance and Attestation Submission page.

WCMSA View Attestation Submissions

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