Medicare Compensation Recovery

If you get more than $5,000 compensation, the payer will tell us so we can check if you get other benefits for your injury.

You need to know

Compensation payments

You could get money if someone injures you or makes you ill. We call this compensation.

The payment is to recognise your loss or suffering because of your injury or illness.

You may get your payment from an insurance company, an individual or another company.

When to tell us

Your compensation payer must tell us in writing if:

  • your compensation claim reaches judgement or settlement, and
  • is more than $5,000, including all costs

To do this, they need to complete a Medicare Compensation Recovery Notice of Judgment or Settlement form. Your compensation payer has 28 days from judgement or settlement to send us this form.

Your compensation payer should read Medicare Compensation Recovery information for insurers.

When you don’t need to tell us

You don’t need to tell us if:

  • your compensation is less than $5,000, including all costs, or
  • within 6 months of making your compensation claim, you have an arrangement to be reimbursed for medical expenses

You don’t need to repay any past benefits or subsidies including:

  • Medicare
  • nursing home
  • residential care, or
  • home care

Your compensation payer should read Medicare Compensation Recovery information for insurers.

Paying back care costs

When your claim reaches settlement or judgment and is more than $5,000 including legal costs, you must repay all care costs relating to your injury or illness.

Care costs include:

  • nursing home benefits,
  • residential care subsidies, and
  • home care subsidies

You must tell us if these care costs relate to your compensation claim. We’ll send a declaration form with your Medicare history statement.

You must tell us on the declaration:

  • if you used a nursing home, residential care, or received home care for your injury or illness, and
  • the name of the care facility

Reviews

If you disagree with the care costs amount on your notice of past benefits, you can ask for a review by writing to the Medicare Compensation recovery team.

Your doctor may need to give evidence that:

  • the care costs don’t relate to your compensation, or
  • only a percentage of care costs relates to your injury or illness

Paying back Medicare benefits

When you get compensation for an injury or illness, you aren’t eligible to also receive benefits that relate to that injury or illness.

Read more about paying back Medicare benefits

Affect to your income support payments

Money you get for your injury or illness counts as income. Find out how this could affect your income support payments if you get them.

Read more about Centrelink Compensation Recovery.

First steps

When your compensation claim reaches judgment or settlement

You’ll get a compensation payment when your claim reaches judgment or settlement.

If you have a valid notice of past benefits on the date of judgment or settlement, the compensation payer must:

  • send the amount on the notice to us, and
  • send the remaining amount to you

If your claim settles and your notice of past benefits has expired, you have 3 options.

Option 1

We’ll send you a new Medicare history statement when we receive the notice of judgment or settlement from your compensation payer. This will let you identify any benefits or subsidies you’ve used since the last notice of past benefits. Send it to the address on the form.

We’ll send you a new notice of past benefits. This will include a new amount for your compensation payer to pay us.

Option 2

Confirm you haven’t had any benefits or subsidies since your last notice of past benefits.

To do this, fill in a Section 23A statement and declaration with the settlement documents. Send it to the address on the form.

Option 3

Your compensation payer can pay us a 10% advance of your compensation payment. They pay the remaining 90% to you. If the amount owing is more than the 10%, you must pay the outstanding amount.

If this option is not chosen, the compensation payer can’t give you any money until they pay us the money you owe in full.

Advance payment

Your compensation payer can pay us a 10% advance of your compensation payment if your:

  • notice of past benefits expired before the date of judgment or settlement, and
  • your compensation is more than $5,000, including all costs

We must get this advance within 28 days of judgment or settlement.

If the compensation payer makes an advance payment, they must tell you in writing:

  • how much they will pay us
  • why the Government can keep some or all the advance payment
  • if the advance payment doesn’t cover the owing amount, you must pay the rest

When we get the advance payment, we’ll send you a Medicare history statement. You must complete and send the statement back within 28 days so we can work out how much you need to pay.

If the amount due is less than the advance payment, we’ll refund you the difference. This can take up to 3 months from the time we get your advance payment and completed documents.

The refund may take longer than 3 months if you’ve been:

  • granted an extension, or
  • asked to review your Medicare history statement

Your compensation payer should read Medicare Compensation Recovery information for insurers.

Sharing your information

You must give us written permission before we can share your information with someone else.

Complete the Medicare Compensation Recovery third party authority form and send it to us. Then we can talk to a third party about your claim.

Contacting us

You’ll need to submit forms to us about your compensation. To do this, post, email or fax them to us. You can also make enquiries about your compensation claim this way.

Existing customers

If we disagree with your Medicare history statement

We’ll ask you to review your Medicare history statement if we think you haven’t listed services used for your injury or illness.

If we ask, you must fill in another Medicare history statement and return it to us within 28 days.

If you don’t or we still disagree with the services you’ve listed, all used services will count as part of your claim. You’ll need to pay us back for all the listed services.

Asking for a review of your repayment amount

You may ask for a review if we have told you that you have to repay all the services listed on your Medicare history statement. You have 2 years from the date your compensation case settled to ask for a review of your repayment.

To request a review, write, email or fax the Medicare Compensation Recovery team.

You may need to tell us why:

  • we didn’t get the Medicare history statement, and
  • other services in the notice of past benefits don’t relate to your claim

We’ll send you a new:

  • Medicare history statement to complete and send back to us within 28 days

After you return your Medicare history statement, we’ll send you a new notice of past benefits with your new repayment amount.

You may get a refund if your new payment amount is less than what you’ve already paid.

If you don’t agree with our decision, you can ask for a review by contacting:

The Administrative Appeals Tribunal
GPO Box 9955
In your capital city

 

Related subjects

Related payments and services

Page last updated: 7 September 2017