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.

Page last updated: 12 July 2018