You need to know

Information to 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 either:

  • found to be incorrect
  • 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 either:

  • a Department of Human Services audit and compliance direction
  • 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.

Page last updated: 22 October 2019