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.
The following legislation applies to HCCS:
- Acts Interpretation Act 1901
- Medical Indemnity Act 2002
- Medical Indemnity Regulations 2003
Finding out more
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 under the HCCS
You need to fill out an application to submit a claim.
Apportionment is how liability between parties to a claim are decided.
Cost sharing arrangements
Cost sharing arrangements apply if there’s an agreement between parties to share the costs or disbursements.
Settlement and judgment costs
You need to take settlement and judgment costs into account in your claim.
Plaintiff costs are the legal costs for the person who has brought the action against the medical practitioner.
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.
Request for information
Under section 38 of the Medical Indemnity Act 2002 the Chief Executive Medicare may ask you for more information.
Returning your Medical Indemnity payment application
You can send us your application and supporting documents by post or email.
When we’ll pay your claim
We’ll pay you before the end of the month immediately following the month we get your application.
We can recover overpayments and incorrect payments.
The internal review is an administrative service that we provide to any MDO or MII.
Insurance Statistics Australia specialty codes
The below list of Insurance Statistics Australia (ISA) specialty codes can be used in your Medical Indemnity payment application.
Glossary for Medical Indemnity
Some terms used in Medical Indemnity insurance claims have specific meanings depending on which scheme they apply to.