Medical indemnity request to aggregate payments for the same claim form (MO008)

Use this form if you elect to aggregate amounts paid or payable in respect of the same claim.

This is in accordance with Section 31 (High Cost Claim Indemnity Scheme) and Section 34ZE (Run-off Cover Indemnity Scheme) of the Medical Indemnity Act 2002.

An authorised representative of the insurer must complete and sign this form. It must accompany a ROCS or HCCS Medical Indemnity payment application form.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 13 February 2019

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