High Cost Claim Indemnity Scheme

Under this scheme the government funds 50% of the amount of claims exceeding the appropriate threshold, up to the limit of a medical practitioner’s indemnity.

You need to know

About the High Cost Claim Indemnity Scheme

This information will assist you to fill out a Medical Indemnity payment application form under the High Cost Claim Indemnity Scheme (HCCS).

The Australian Government introduced the HCCS legislation on 1 January 2003.

The legislation was developed following recommendations by the Medical Indemnity Policy Review Panel. The panel’s concern was that medical practitioners wouldn’t be able to pay for run off cover when they no longer earned an income from medical practice.

The HCCS funds 50% of the cost of payouts by Medical Defence Organisations (MDOs) and Medical Indemnity Insurers (MIIs). The costs must be greater than the threshold amount that applies when the MDO or MII is notified of the claim, up to the limit of a medical practitioner’s indemnity cover.

Relevant legislation

The following legislation applies to HCCS:

  • Acts Interpretation Act 1901
  • Medical Indemnity Act 2002
  • Medical Indemnity Regulations 2003

Finding out more

For more information see Medical Indemnity for insurers or contact us.  

Eligibility

To be eligible for the High Cost Claim Indemnity Scheme (HCCS) you must meet certain criteria.

The HCCS covers incidents:

  • if the date the incident was first notified by the member or policy holder to the Medical Defence Organisations or Medical Indemnity Insurers was on or after 1 January 2013
  • the claim exceeds the applicable threshold amount

High Cost Claims Scheme thresholds

Notification date HCCS threshold
1 January 2003 to 21 October 2003 (inclusive) $2,000,000
22 October 2003 to 31 December 2003 (inclusive) $500,000
1 January 2004 to 30 June 2018 (inclusive) $300,000
On or after 1 July 2018 $500,000

A HCCS claim may be eligible if the:

  • claim is or was made against a practitioner
  • claim relates to an incident or a series of related incidents in the course of, or in connection with, the practice by the practitioner of a medical profession
  • incident or a series of related incidents occurs or occurred in Australia or it’s external territory

Claiming

Claiming under the HCCS

You need to fill out an application to submit a claim.

Read more about claiming under the HCCS.

Apportionment arrangements

Apportionment is how liability between parties to a claim are decided.

Read more about apportionment arrangements

Cost sharing arrangements

Cost sharing arrangements apply if there’s an agreement between parties to share the costs or disbursements.

Read more about cost sharing arrangements

Settlement and judgment costs

You need to take settlement and judgment costs into account in your claim.

Read more about settlement and judgment costs

Plaintiff costs

Plaintiff costs are the legal costs for the person who has brought the action against the medical practitioner.

Read more about Plaintiff costs

Request to aggregate payments

A MDO and a MII may aggregate amounts paid or amounts payable for the same claim against a member or policy holder.

Read more about request to aggregate payments

Request for information

Under section 38 of the Medical Indemnity Act 2002 the Chief Executive Medicare may ask you for more information.

Read more about requesting information

Returning your Medical Indemnity payment application

You can send us your application and supporting documents by post or email.

Read more about Returning your Medical Indemnity payment application

When we’ll pay your claim

We’ll pay you before the end of the month immediately following the month we get your application.

Read more about when we’ll pay your claim

Recovering payments

We can recover overpayments and incorrect payments.

Read more about recovering payments

Resolving conflict

The internal review is an administrative service that we provide to any MDO or MII.

Read more about resolving conflict

Managing

Letting us know if things change

You must let us know if circumstances change after we’ve made a payment to an applicant.

Read more about letting us know if things change

Your right to privacy

You have a right to have your personal information kept private.

Read more about your right to privacy

Resources

Insurance Statistics Australia specialty codes

The below list of Insurance Statistics Australia (ISA) specialty codes can be used in your Medical Indemnity payment application.

Read more about Insurance Statistics Australia specialty codes

Glossary for Medical Indemnity

Some terms used in Medical Indemnity insurance claims have specific meanings depending on which scheme they apply to.

Read more about the Glossary for Medical Indemnity

Page last updated: 5 July 2018