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Medical Indemnity Act 2002
In force
Administered by
Department of Health, Disability and Ageing
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C2017C00070 C19
01 March 2017
-
30 June 2020
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Part 1—Preliminary
1 Short title
2 Commencement
3 Objects of this Act and the medical indemnity payment legislation
4 Definitions
5 Medical defence organisation (MDO)
6 Member of an MDO
7 Incident-occurring based cover
8 IBNR exposure of an MDO
8A Net IBNR exposure of an MDO
9 External Territories
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Part 2—Commonwealth payments
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Division 1—IBNR (incurred but not reported) indemnity scheme
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Subdivision A—Introduction
10 Guide to the IBNR indemnity provisions
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Subdivision B—Participating MDOs
11 Participating MDO
12 Minister may determine that MDO not a participating MDO
13 Process for determining whether a determination should be made under section 12
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Subdivision C—Incidents covered by the IBNR indemnity scheme
14 Incidents covered by the IBNR indemnity scheme
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Subdivision D—IBNR indemnity
15 IBNR indemnity may be payable under either section 16 or 17
16 IBNR indemnity for payment made by MDO or insurer
17 IBNR indemnity for MDO or insurer in external administration
18 Clarification of circumstances in which IBNR indemnity payable
19 Exceptions
20 Payment partly related to treatment of public patient in public hospital
21 Amount of the IBNR indemnity
22 Minister to determine unfunded IBNR factor for a participating MDO
23 Process for determining unfunded IBNR factor under section 22
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Subdivision E—Recovery of amount paid to MDO or insurer after IBNR indemnity paid
24 Recovery if certain amounts paid to MDO or insurer after IBNR indemnity paid
25 MDO or insurer to inform Chief Executive Medicare of certain amounts
26 Chief Executive Medicare to notify MDO or insurer of repayable amount
27 Penalty imposed if an amount is repaid late
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Subdivision F—The IBNR Claims Protocol
27A Minister may determine a protocol dealing with various matters
27B The Chief Executive Medicare may request information
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Division 2—High cost claim indemnity scheme
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Subdivision A—Introduction
28 Guide to the high cost claim indemnity provisions
29 High cost claim threshold
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Subdivision B—High cost claim indemnity
30 Circumstances in which high cost claim indemnity payable
31 Aggregating amounts paid or payable by an MDO and insurer
32 Exceptions
33 Payment partly related to treatment of public patient in public hospital
34 Amount of high cost claim indemnity
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Subdivision C—The High Cost Claims Protocol
34AA Minister may determine a protocol dealing with various matters
34AB The Chief Executive Medicare may request information
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Division 2A—Exceptional claims indemnity scheme
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Subdivision A—Introduction
34A Guide to the exceptional claims indemnity provisions
34B Definitions
34C Treatment of deductibles
34D Interaction with high cost claim indemnity scheme and run-off cover indemnity scheme
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Subdivision B—Certification of qualifying claims
34E When may the Chief Executive Medicare certify a claim as a qualifying claim?
34F What is the relevant threshold?
34G Setting a termination date
34H Application for a qualifying claim certificate
34I Time by which an application must be decided
34J Obligation to notify the Chief Executive Medicare if information is incorrect or incomplete
34K Revocation and variation of qualifying claim certificates
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Subdivision C—Exceptional claims indemnity
34L When is an exceptional claims indemnity payable?
34M Qualifying liabilities
34N Treatment of a claim that partly relates to a public patient in a public hospital
34O Treatment of a claim that relates to a series of incidents some of which occurred after the termination date
34P The amount of exceptional claims indemnity that is payable
34Q How exceptional claims indemnity is to be applied
34R Who is liable to repay an overpayment of exceptional claims indemnity?
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Subdivision D—Payments that would have reduced the amount paid out under the contract of insurance
34S Amounts paid before payment of exceptional claims indemnity
34T Amounts paid after payment of exceptional claims indemnity
34U Obligation to notify the Chief Executive Medicare that amount has been paid
34V The Chief Executive Medicare to notify of amount of debt due
34W Penalty imposed if an amount is repaid late
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Subdivision E—The Exceptional Claims Protocol
34X Minister may determine a protocol dealing with various matters
34Y The Chief Executive Medicare may request information
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Subdivision F—Miscellaneous
34Z Modifications and exclusions
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Division 2B—Run-off cover indemnity scheme
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Subdivision A—Introduction
34ZA Guide to the run-off cover indemnity provisions
34ZB Eligible run-off claims
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Subdivision B—Run-off cover indemnities
34ZC Circumstances in which run-off cover indemnities are payable
34ZD MDOs and medical indemnity insurers that are Chapter 5 bodies corporate
34ZE Aggregating amounts paid or payable by an MDO and medical indemnity insurer
34ZF Clarification of circumstances in which run-off cover indemnities are payable
34ZG Exceptions
34ZH Amount of run-off cover indemnities
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Subdivision C—Payments that would have reduced the amount of run-off cover indemnity
34ZI Amounts paid before run-off cover indemnity
34ZJ Amounts paid after payment of run-off cover indemnity
34ZK Obligation to notify the Chief Executive Medicare that amount has been paid
34ZL The Chief Executive Medicare to notify of amount of debt due
34ZM Penalty imposed if an amount is repaid late
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Subdivision D—The Run-off Cover Claims and Administration Protocol
34ZN Minister may determine a protocol dealing with various matters
34ZO The Chief Executive Medicare may request information
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Subdivision E—Effect of terminating the run-off cover indemnity scheme
34ZP Commonwealth’s obligations on termination of the run-off cover indemnity scheme
34ZQ Affected medical practitioners
34ZR Payments in relation to affected medical practitioners
34ZS Total run-off cover credits
34ZT Medical indemnity insurers must provide information attributing run-off cover payments
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Subdivision F—Miscellaneous
34ZU Chief Executive Medicare must be notified of a person ceasing to be covered by the run-off cover indemnity scheme
34ZV Invoices for medical indemnity cover
34ZW Reports on the run-off cover indemnity scheme
34ZX Modifications and exclusions
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Division 3—Administration of the indemnity schemes
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Subdivision A—Introduction
35 Guide to this Division
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Subdivision B—Applications for, and payment of, indemnity scheme payments
36 Application for IBNR indemnity, high cost claim indemnity or run-off cover indemnity
37 Payment date for IBNR indemnity, high cost claim indemnity or run-off cover indemnity
37A Application for exceptional claims indemnity
37B Payment date for exceptional claims indemnity
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Subdivision C—Information gathering and record keeping
38 Chief Executive Medicare may request information
39 Main record keeping obligations
40 Participating MDOs to keep additional records
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Subdivision D—Overpayments of the indemnities
41 Recovery of overpayments
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Subdivision E—Recovery of repayment or overpayment debt
42 Chief Executive Medicare may collect money from a person who owes money to a person
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Division 4—Medical indemnity premium subsidy scheme
43 Minister may formulate subsidy scheme
44 Chief Executive Medicare may request information
44A Chief Executive Medicare may notify medical indemnity insurers or MDOs of UMP support payments
44B Chief Executive Medicare may notify run-off cover credits
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Division 5—Offences
45 Failing to give information
46 Failing to notify
47 Failing to keep and retain records
47A Failing to include required information in invoices
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Division 6—Finance
48 Appropriation
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Division 7—Reinsurance contracts
49 Indemnity scheme payments disregarded for purposes of reinsurance contracts
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Part 3—Payments towards the cost of providing indemnities
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Division 1—UMP support payment
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Subdivision A—Introduction
50 Guide to the UMP support payment provisions
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Subdivision B—Who pays UMP support payment
51 Who is liable to pay the UMP support payment
52 Exemptions
53 Comprehensive insurance cover determination
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Subdivision C—Determining amount of UMP support payment
54 Annual subscription for base year
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Subdivision D—Annual reassessment of participating MDO’s IBNR exposure
55 Object of this Subdivision
56 Process for annually reassessing IBNR exposure
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Division 2—Run-off cover support payment
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Subdivision A—Introduction
57 Guide to the run-off cover support payment provisions
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Subdivision B—Who pays run-off cover support payment
58 Who is liable to pay the run-off cover support payment
59 Exemptions
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Division 2A—Competitive advantage payment
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Subdivision A—Introduction
59A Guide to the competitive advantage payment provisions
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Subdivision B—Who pays competitive advantage payment
59B Who is liable to pay the competitive advantage payment
59C Exemptions
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Subdivision C—Annual reassessment of participating MDO’s net IBNR exposure
59D Object of this Subdivision
59E Process for annually reassessing net IBNR exposure
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Division 3—Administration of the medical indemnity payments
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Subdivision A—Introduction
60 Guide to this Division
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Subdivision B—Payment and collection of medical indemnity payments
61 When medical indemnity payment must be paid
62 Deferral of payment day for UMP support payment
65 Late payment penalty
66 Method of paying certain amounts
66A Collection of UMP support payments by medical indemnity insurers and MDOs
66B Late payment penalty for medical indemnity insurers and MDOs
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Subdivision C—Refunds
67 Refund of overpaid amounts
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Subdivision D—Recovery of payment debt
68 Recovery of payment debt
69 Chief Executive Medicare may collect money from a person who owes money to a person
70 Evidentiary certificates
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Subdivision E—Information gathering processes
71 Chief Executive Medicare may request information
72 Chief Executive Medicare must be notified of a change in circumstances etc.
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Division 4—Offences
73 Failing to give information
74 Failing to notify
74A Failing to comply with requirements for collecting UMP support payments
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Part 4—Miscellaneous
75 General administration of this Act and medical indemnity payment legislation
76 Additional functions of the Chief Executive Medicare
77 Officers to observe secrecy
78 Act not to apply in relation to State insurance within a State
79 Regulations
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Endnotes
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history