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.

Read more about Medicare compensation payments

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.

Read more about paying back Medicare compensation care costs

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.

Read more about when your Medicare compensation claim reaches judgement

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.

Read more about your Medicare history statement

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.

Read more about asking for a review

Related subjects

Related payments and services

Page last updated: 12 October 2017