Medical Indemnity Refund

Sometimes there’s a need to recover money from payments made under the Medical Indemnity Schemes.

You need to know

About the Medical Indemnity Refund

This information will assist you to fill out a Medical Indemnity Refund application for payments received under the Medical Indemnity Scheme.

We may sometimes need to recover money for payments made under the following Medical Indemnity Schemes:

  • Incurred But Not Reported Indemnity (IBNR) Scheme
  • High Cost Claim Indemnity Scheme (HCCS)
  • Run off Cover Indemnity Scheme (ROCS)
  • Exceptional Claims Indemnity Scheme (ECS)

Audit and compliance may ask to recover payments if a previously assessed application is:

  • found to be incorrect, or
  • is contrary to legislation

A Medical Defence Organisation (MDO) or Medical Indemnity Insurer (MII) may apply for a refund for money claimed but not spent.

We have power under section 41 of the Medical Indemnity Act 2002 to recover an incorrect payment.

Unless we tell you otherwise, we’ll offset all recoveries against a future claim for payment.

Relevant legislation

The following legislation applies to the refund of Medical Indemnity Scheme payments:

  • Medical Indemnity Act 2002
  • Medical Indemnity Regulations 2003

Finding out more

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

Recovering payments

Under the Medical Indemnity Act 2002 and associated legislation we can recover overpayments and incorrect payments.

There are a number of reasons why we might recover debt including:

  • a Department of Human Services audit and compliance direction, or
  • when monies previously assessed as payable are found to be incorrectly assessed or contrary to legislation

Recoveries may be initiated by us or by the MDO or MII.

If we initiate the recovery, the MDO or MII will be asked to clarify the situation which led to the recovery. Should the MDO or MII not be able to explain adequately, we’ll recover the monies.

If an MDO or MII identify an overpayment of any type, you must notify us using the Medical Indemnity refund application form.

Circumstances where an overpayment may arise include:

  • the MDO or MII recovering from a third party an amount paid which relates to the amount paid to the MDO or MII by the Department of Human Services
  • the judgment or order becomes subject to an appeal or stay
  • if the MDO or MII withdraws support for the member or policy holder
  • if the amount paid is later found to be not payable under the terms of the schemes

We may recover payments made under the Medical Indemnity schemes by offsetting all recoveries against a future claims for payments under the scheme unless we tell you otherwise.

 

 

Claiming

Claiming a Medical Indemnity Refund

You need to submit an application to claim.

You must apply for a Medical Indemnity Refund using the approved Medical Indemnity Refund application.

If you’re making a claim against several members or policy holders, you’ll need to make a separate application for each member or policy holder.

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

  • verify your claim
  • assess whether the claim is payable

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

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 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 Refund application

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

Check that you’ve answered all the questions you need to answer and signed and dated the form.

  • Post to:

Department of Human Services
The Director
Medical Indemnity
PO Box 1001
Tuggeranong DC ACT 2901

We’ll let you know we have your claim and that it’s being assessed.

 

Refunding a Medical Indemnity payment

We’ll offset a Medical Indemnity refund application we get against claim payments.

Where a request for information has been sent the payment date will change.

Example dates for Medical Indemnity refund payments

Date we get the claim Date extra information requested Date we get extra information  Date payment must be recovered by
28 June 2018 - - 31 July 2018
28 June 2018 5 July 2018 1 August 2018 30 September 2018

Resolving conflict

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

Read more about resolving conflict

Managing

Your right to privacy

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

Read more about your right to privacy

Resources

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: 11 July 2018