Medicare Compensation Recovery Program - information for insurers
Tell us about a compensation payment
If you’re paying someone compensation of more than $5 000 (including all legal costs) you are responsible for telling us about it.
You must tell us, in writing, within 28 days from the date the compensation claim was settled or a judgment was made.
You cannot pay the claimant their compensation money until the department has received an advanced payment or been repaid in full.
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When a person has an injury or illness they may get Medicare benefits, nursing home benefits or residential care subsidies.
If you’re paying someone compensation of more than $5,000 (including all legal costs) you’re required to tell the department within 28 days of settlement so we can check if the person you are paying (the claimant) has also been receiving benefits from us.
You cannot pay the claimant their compensation money until the department has been repaid for any Medicare benefits, nursing home benefits and residential care subsidies related to the claim.
You or the claimant may be responsible for repaying us. This will depend on the conditions of judgment or settlement and/or the time it takes you to tell us about the settlement.
This program is called the Medicare Compensation Recovery Program. Your responsibilities and the requirements under this program are defined by law.
Information for claimants is included in the customer section of our website.
Centrelink Compensation Recovery
If the claimant is also getting Centrelink benefits, you have to tell us about the compensation payment, no matter what the amount. Recovery of Centrelink benefits is managed differently. Visit the Centrelink Compensation Recovery page to find out more.
Information you need to know
How to tell us about a compensation payment
To tell us about a compensation payment of more than $5,000 (including all legal costs) you can send us a Notice of judgment or settlement form.
The form must be signed by you, and the claimant or their authorised representative, and sent to us within 28 days from the date the compensation claim was settled or a judgment was made.
If the claimant’s representative signs the form, you must also send us evidence, in writing, that the claimant has authorised the representative to sign the document on their behalf. You can choose to use the Third party authority form to do this. More information is included in the customer section of our website.
Send the completed and signed form to the address or email address for the state or territory in which the injured person lives:
-
ACT and NSW
Medicare Compensation Recovery Program
Department of Human Services
Reply Paid 4104
Sydney NSW 2001
Email nsw.comp.mgr@humanservices.gov.au
-
NT, Qld, SA, Tas, Vic and WA
Medicare Compensation Recovery Program
Department of Human Services
Reply Paid 2436
Brisbane QLD 4001
Email qld.comp.mgr@humanservices.gov.au
If you need help completing the form:
- call us on 132 127, or
- email compensation.recovery@humanservices.gov.au
When you don’t need to tell us about a compensation payment
If the compensation amount is less than $5,000 (including all legal costs) you don’t need to tell us about the payment. The claimant won’t need to repay any past Medicare benefits, nursing home benefits or residential care subsidies to us.
Finding out how much needs to be repaid
The person paying the compensation, the claimant or the claimant’s solicitor can find out the amount of benefits that need to be repaid by requesting a Medicare history statement.
A deemed amount
‘Deemed’ means that all services listed on the Medicare history statement are considered as being related to the compensation claim, and all listed services will need to be payed to us.
More information on this process for claimants, including what happens if we disagree with a returned Medicare history statement, is included in the customer section of our website.
Confirming the amount to be repaid to us
A Notice of past benefits shows the amount, if any, the claimant needs to repay when the claim is settled. It lists each service the claimant told us relates to their compensable injury or illness, or every service if the notice is deemed.
A Notice of past benefits is valid for six months from the date we send it to the claimant.
More information for claimants is included in the customer section of our website.
Notifying us of your reimbursement arrangement
Where a reimbursement arrangement is entered into more than six months after a claim is lodged with you, you must notify us within 28 days of the arrangement being made. You should complete the Notice of reimbursement arrangement form and send it to the address listed under the ‘Sending a form or enquiry about a compensation case’ section on this page.
Paying the department when a claim reaches judgment or settlement
What you must do when a claim reaches judgment or settlement and there is a valid Notice of past benefits at the time of settlement.
If judgment or settlement is reached and the department has not been notified
There are two courses of action if the department is not notified until after judgment or settlement has been reached.
If you don’t know the amount to be repaid and we haven’t given the claimant a Notice of past benefits:
- you, the claimant, or the claimant’s solicitor can ask us for a Medicare history statement so that the amount that needs to be paid to us can be identified. You cannot pay the claimant their compensation money until we have been repaid in full
- you can choose to make an advance payment to us, which is currently 10 per cent of the final settlement amount. The remaining 90 per cent can then be given to the claimant.
More information on this can be found under the Paying the department when a claim reaches judgment or settlement section on this page.
Sending a form or enquiry about a compensation case
Send your forms or enquiries about compensation claims to the address or email address for your state or territory in which the claimant lives:
ACT and NSW
Medicare Compensation Recovery Program
Department of Human Services
Reply Paid 4104
Sydney NSW 2001
Email nsw.comp.mgr@humanservices.gov.au
NT, Qld, SA, Tas, Vic and WA
Medicare Compensation Recovery Program
Department of Human Services
Reply Paid 2436
Brisbane QLD 4001
Email qld.comp.mgr@humanservices.gov.au.
If you need help completing forms or would like to speak to a service officer:
- call us on 132 127, or
- email compensation.recovery@humanservices.gov.au
How to register
Compensation and Centrelink payments
Most Centrelink payments are affected by compensation. This includes a range of supplementary payments made to people getting income support. Read more about Centrelink Compensation Recovery.