Medicare Compensation Recovery information for claimants
Tell us about your compensation claim
Your insurer, or the person who is paying you, must tell us about your payment if it’s for more than $5,000 including all costs.
Your insurer must tell us, in writing, within 28 days from the date your compensation claim was settled or a judgment was made.
You cannot get your compensation payment until the department has received an advanced payment or been repaid in full.
When you have an injury or illness you may get Medicare benefits, nursing home benefits, residential care or home care subsidies.
If you were paid benefits for your injury, and you also get a compensation payment of more than $5,000 including all costs, the department must recover all the benefits paid to you.
The person who pays you the compensation, usually your insurer, must tell us about your payment if it is for more than $5,000 including all costs.
When we are told about your compensation payment we will contact you to find out if any money needs to be repaid to us.
You cannot get your compensation payment related to your claim until we have been repaid for all:
- Medicare benefits
- nursing home benefits
- residential care, or
- home care subsidies
This program is called Medicare Compensation Recovery. Your responsibilities and the requirements under this program are defined by law.
Information for compensation payers and insurers is included in the business section of our website.
Centrelink Compensation Recovery
If you are getting Centrelink benefits, you also have to tell us about your compensation payment, no matter what the amount. Recovery of Centrelink benefits is managed differently. Visit the Centrelink Compensation Recovery webpage to find out more.
You Need to Know
A compensation payment is an amount of money paid to someone because they have an injury or illness caused by the negligence or lack of care by another person. The payment is usually made by an insurance company, but it can also be made by an individual or another company.
How to tell us about your compensation payment
Your insurer, or the person paying you, must tell us, in writing, within 28 days from the date your compensation claim was settled or a judgment was made, if the payment is for more than $5,000 including all costs. They can do this by sending us a Notice of judgment or settlement form.
You must sign this form unless you’ve given us written authority for someone else to sign it for you.
Detailed information for compensation payers is included in the business section of our website.
When you don't need to tell us about a compensation payment
If the compensation amount is less than $5,000, including all costs, or the date the reimbursement arrangement was made is less than 6 months from the date your claim was made, you don’t need to tell us. You don’t need to repay any past Medicare benefits, nursing home benefits, residential care or home care subsidies to us.
Paying back nursing home benefits, residential care or home care subsidies
Nursing home benefits, residential care or home care subsidies related to your compensation injury must be repaid to us.
Before you accept your compensation payment
You can find out the amount of Medicare benefits, nursing home benefits, residential care or home care subsidies that will need to be repaid before you accept a compensation payment, called a settlement.
When we disagree with your returned Medicare history statement
When you return your completed Medicare history statement, we must confirm that the correct services have been identified.
If we think that you may have missed services for your injury or illness, we are required by law to send you a letter asking you to review your Medicare history statement again and return it to us within 28 days. If we don’t receive a revised statement back from you by the due date, or if we think the services relating to your injury or illness have still not been identified, then all services on the Medicare history statement will be counted or ‘deemed’ as relating to the injury.
‘Deemed’ means that all services listed on your Medicare history statement are considered as being related to your compensation claim and you will need to repay the amount of all the listed services to us.
When your compensation claim reaches judgment or settlement
When your claim reaches judgment or settlement, you will receive a compensation payment for your injury or illness.
An Advance Payment (AP) is a payment made by the compensation payer which is equal to 10% of the total amount of compensation paid by judgment or settlement.
This option can only be taken when there is no valid Notice of past benefits at the time of judgment or settlement, and when the compensation payment is more than $5,000 (including all costs).
By law, this must be sent to the department within 28 days of judgment or settlement. If the compensation payer chooses to use the AP, they must tell you in writing:
- the amount that will be sent to us
- why the Australian Government can retain some or all of the AP
- that you are responsible for paying the difference between the AP and the amount due to the Australian Government if the AP doesn’t cover the amount payable
When the advance payment is taken, we’ll send you a Medicare history statement. You must complete and return the statement within 28 days so we can calculate the amount, if any, to be repaid.
If the amount due to the Australian Government is less than the advance payment amount, we’ll refund the balance to you. This will generally be within 3 months of receiving the advance payment and completed documents from the compensation payer, whichever is received last.
It may take longer than 3 months to refund any balance to you if you’ve been:
- granted an extension, or
- asked to review your Medicare history statement
More information for compensation payers is included in the business section of our website
Compensation and Centrelink payments
Most Centrelink income support payments are affected by compensation. This includes a range of supplementary payments you can get on income support. Read more about Centrelink Compensation Recovery.
When to tell us about a compensation payment
By law, the person paying the compensation, usually the insurance company, must tell us in writing when a claim for compensation reaches judgment or settlement, but only if the amount is more than $5,000 including all costs.
- tell us in writing within 28 days of the date of judgment or settlement
- give us a completed and signed Notice of judgment or settlement form
Approval to give out your compensation case information
You must give us written permission if you want information about your compensation case, including Medicare benefits or the amount to be repaid to the department, sent to a third party, such as your solicitor.
You must also give us written authority if you want a third party to sign a document, such as the Notice of judgment or settlement form, on your behalf.
Complete the Third party authority form and send it to us, so that we can talk to a third party about your compensation case.
Submitting a form or enquiry about your compensation case
Submit a form or enquiry about compensation claims to the address or email address below:
Medicare Compensation Recovery
Department of Human Services
GPO Box 4104
Sydney NSW 2001
Notifying Medicare after judgment or settlement
You have two options available to you if the department is notified after judgment or settlement has been reached. If you don’t know the amount to be repaid when judgment or settlement is reached, and we haven’t given you a Notice of past benefits, you, your solicitor or insurer can:
- ask us to give you a Medicare history statement so that you can identify the amount you need to pay to us. You can’t be paid your compensation until this amount is known, or
- the person paying your compensation can choose to make an advance payment to us, which is currently 10% of the final settlement amount and the remaining 90% can then be given to you – if the amount to be repaid to us is more than the 10% advance payment, you will be responsible for paying the extra amount
Asking for a review of a deemed amount
If a deemed Notice of past benefits has been sent to you, you have 2 years from the date your compensation case settled to ask for a review of a deemed amount. To request a review, call us on 132 127 or write to:
Medicare Compensation Recovery
Department of Human Services
GPO Box 4104
Sydney NSW 2001
We may ask you to confirm why:
- all of the services listed in the Notice of past benefits weren’t related to your compensable injury or illness, and
- the Medicare history statement wasn’t completed and given to us as required under the Health and Other Services (Compensation) Act 1995
If the department is satisfied that a review can be done, a new Medicare history statement will be issued to you to complete and return within 28 days for assessment.
A new Notice of past benefits will be issued to you telling you the new amount to be paid. If this is less than what has already been paid then a refund will be made.
If at the time your compensation case settled:
- an advance payment was received, any refund will be made directly to you
- the deemed Notice of past benefits was valid, and the amount on the notice was paid by the compensation payer, any refund will be made to the compensation payer, unless they’ve authorised us to return it to you
If you are not happy with our decision or if we don’t accept your request for review, you can choose to apply to the Administrative Appeals Tribunal for a review of our decision. You should contact the Administrative Appeals Tribunal to discuss your situation. The Tribunal can be contacted at:
The Administrative Appeals Tribunal
GPO Box 9955
In your capital city