High Cost Claim Indemnity Scheme

Claiming under the HCCS

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

You’ll need a separate Medical Indemnity payment application for each member or policy holder subject to the same claim.

We’ll give your Medical Indemnity payment application a unique claim reference number. You must use the claim reference number for all claims or correspondence relating to this claim.

Submit 1 application if a member or policy holder is part of multiple claims for the same patient or plaintiff and incident. For example, there might be a coronial inquest and a civil claim.

If a member or policy holder is eligible for the Run off Cover Indemnity Scheme (ROCS) or the Incurred But Not Reported Indemnity (IBNR) Scheme and the claim meets the relevant HCCS threshold, you only need to submit the Medical Indemnity payment application for ROCS or IBNR. These forms capture all HCCS information.

What you can’t claim under HCCS

You can’t put in a HCCS claim for the:

  • incident was notified to the MDO or MII before 1 January 2003
  • incident, or a series of related incidents, to which the claim relates occurred in the course of the provision of treatment to a public patient in a public hospital - if only part of a treatment is for a public patient in a public hospital, reduce the application payment proportionately
  • incident occurred outside of Australia or its external territories
  • incidents or a series of related incidents is not normally covered in the ordinary course of business for the MDO or MII
  • MDO or MII hasn’t or isn’t liable to pay a payment in relation to the claim

Amounts you can’t claim

In the Medical Indemnity payment application you need to deduct any amounts:

  • for which other parties are responsible, or
  • that relate to incidents or claims not payable under HCCS

Filling out the application

You must apply for HCCS using the approved Medical Indemnity payment application.

You must use the same Department of Human Services’ claim reference for all subsequent claims or correspondence about the same claim.

Supporting documents

You must attach supporting documents to your Medical Indemnity payment application.

There’s a checklist on the Medical Indemnity payment application to remind you of what we need to:

  • verify HCCS eligibility
  • assess whether the claim is payable

Send us the necessary supporting documents to prevent delays in assessing your application.

Page last updated: 22 February 2019