Medical indemnity for insurers

To strengthen the availability of medical services in Australia, in 2002 the government introduced medical indemnity legislation.

The legislation provides a package of financial assistance which helps keep medical indemnity insurance premiums at an affordable level. It does this by providing financial support to medical defence organisations (MDOs) and medical indemnity insurers (MIIs).

Legislation

The Medical Indemnity Act 2002 (the Act) enables participating MDOs and MIIs to make claims under four medical indemnity schemes which are administered by us.

All MDOs and MIIs (incorporated in Australia) may make an application for an indemnity scheme payment under the High Cost Claim Indemnity Scheme, Run-Off Cover Indemnity Scheme and Exceptional Claims Indemnity Scheme providing the claim meets the relevant criteria.

Applications for indemnity payments must be lodged by the MDO/MII on our approved form.

More information about medical indemnity claims is available through the Department of Health website.

Incurred But Not Reported (IBNR) Indemnity Scheme

The IBNR scheme is designed to fund the IBNR liabilities of medical defence organisations where they do not have adequate reserves to cover their liabilities. Under the Act, medical defence organisations that existed on 30 June 2002 may participate in the IBNR scheme unless the Minister determines otherwise. To date, the Minister has determined that United Medical Protection Limited is the only medical defence organisation to actively participate in the IBNR indemnity scheme.

High Cost Claim Indemnity Scheme (HCCS)

The HCCS enables the government to fund 50% of the cost of payouts by medical defence organisations and medical indemnity insurers that are greater than the applicable threshold amount, up to the limit of a practitioner’s indemnity cover.

Run-Off Cover Indemnity Scheme (ROCS)

The ROCS assists medical defence organisations and medical indemnity insurers to cover claims made against medical practitioners who have retired, have a permanent disability, are on maternity leave, or who have permanently left private medical practice in Australia.

Exceptional Claims Indemnity Scheme (ECS)

The ECS assists medical defence organisations and medical indemnity insurers where settlement amounts of claims exceed a practitioner's indemnity insurance contract limit.

Prior to submitting an application under the ECS you should contact us at the Medical Indemnity contact centre.

Request to aggregate payments

If you want to aggregate payments for the same claim, complete the form Request to aggregate payments for the same claim form.

Debt recovery process

Money may be recovered from payments made under the IBNR, HCCS, ROCS and ECS indemnity schemes. Debt recovery will be undertaken for a number of reasons:

  • audit and compliance may direct the recovery of monies if a previously assessed application is found to be incorrectly assessed or contrary to legislation
  • the application (medical defence organisation or medical indemnity insurer) may apply for a refund if they have recovered, or identified, money claimed but not expended

The debt recovery process may be instigated by either:

Applying

Insurers must complete the relevant form for the scheme they are applying for.

A checklist in the application form allows insurers to check that they have provided the required documentation to support their claim.

Send applications for medical indemnity payments, along with supporting documentation to:

Medical Indemnity
Department of Human Services
PO Box 1001
Tuggeranong DC ACT 2901

Or scan and email to the medical indemnity team.

You will receive a notification with advice that we have received your claim and that it is under assessment. You will also be sent a letter to notify you of the outcome of your claim.

More information

For additional assistance, go to Medical Indemnity on the contact us page.

Page last updated: 25 October 2016

This information was printed Friday 9 December 2016 from humanservices.gov.au/health-professionals/services/medicare/medical-indemnity-insurers It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.