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Medical Indemnity Act 2002
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Administered by
Department of Health, Disability and Ageing
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C2024C00534 (C23)
14 October 2024
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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 Eligible related claims
8B Treatment of deductibles for the exceptional claims indemnity scheme and the allied health exceptional claims indemnity scheme
9 External Territories
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Part 2—Commonwealth payments
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Division 1—IBNR (incurred but not reported) indemnity scheme
Subdivision A—Introduction
10 Guide to the IBNR indemnity provisions
Subdivision C—Incidents covered by the IBNR indemnity scheme
14 Incidents covered by the IBNR indemnity scheme
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
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
Subdivision F—Regulations may provide for payments
27A Regulations may provide for payments in relation to IBNR claims
27B The Chief Executive Medicare may request information
Subdivision G—IBNR exposure
27C Process for annually reassessing IBNR exposure
Division 2—High cost claim indemnity scheme
Subdivision A—Introduction
28 Guide to the high cost claim indemnity provisions
29 High cost claim threshold
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
Subdivision C—Regulations may provide for payments
34AA Regulations may provide for payments in relation to high cost claims
34AB The Chief Executive Medicare may request information
Division 2A—Exceptional claims indemnity scheme
Subdivision A—Introduction
34A Guide to the exceptional claims indemnity provisions
34D Interaction with high cost claim indemnity scheme and run off cover indemnity scheme
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 the exceptional claims 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
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 exceptional claims 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?
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
Subdivision E—Regulations may provide for payments
34X Regulations may provide for payments in relation to exceptional claims
34Y The Chief Executive Medicare may request information
Subdivision F—Miscellaneous
34Z Modifications and exclusions
Division 2B—Run off cover indemnity scheme
Subdivision A—Introduction
34ZA Guide to the run off cover indemnity provisions
34ZB Eligible run off claims
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
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
Subdivision D—Regulations may provide for payments
34ZN Regulations may provide for payments in relation to run off claims
34ZO The Chief Executive Medicare may request information
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 support payments
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
Division 2C—Allied health high cost claim indemnity scheme
Subdivision A—Introduction
34ZY Guide to the allied health high cost claim indemnity provisions
34ZZ Eligible MDOs and eligible insurers
34ZZA Allied health high cost claim threshold
Subdivision B—Allied health high cost claim indemnity
34ZZB Circumstances in which allied health high cost claim indemnity payable
34ZZC Aggregating amounts paid or payable by an MDO and insurer
34ZZD Exceptions
34ZZE Payment partly related to treatment of public patient in public hospital
34ZZF Amount of allied health high cost claim indemnity
Subdivision C—Regulations may provide for payments
34ZZG Regulations may provide for payments in relation to allied health high cost claims
34ZZH The Chief Executive Medicare may request information
Division 2D—Allied health exceptional claims indemnity scheme
Subdivision A—Introduction
34ZZI Guide to the allied health exceptional claims indemnity provisions
34ZZJ Interaction with allied health high cost claim indemnity scheme
Subdivision B—Certification of qualifying allied health claims
34ZZK When may the Chief Executive Medicare certify a claim as a qualifying allied health claim?
34ZZL What is the relevant allied health threshold?
34ZZM Setting the allied health termination date
34ZZN Application for a qualifying allied health claim certificate
34ZZO Time by which an application must be decided
34ZZP Obligation to notify the Chief Executive Medicare if information is incorrect or incomplete
34ZZQ Revocation and variation of qualifying allied health claim certificates
Subdivision C—Allied health exceptional claims indemnity
34ZZR When is an allied health exceptional claims indemnity payable?
34ZZS Qualifying allied health liabilities
34ZZT Treatment of a claim that partly relates to a public patient in a public hospital
34ZZU Treatment of a claim that relates to a series of incidents some of which occurred after the allied health termination date
34ZZV The amount of allied health exceptional claims indemnity that is payable
34ZZW How allied health exceptional claims indemnity is to be applied
34ZZX Who is liable to repay an overpayment of allied health exceptional claims indemnity?
Subdivision D—Payments that would have reduced the amount paid out under the contract of insurance
34ZZY Amounts paid before payment of allied health exceptional claims indemnity
34ZZZ Amounts paid after payment of allied health exceptional claims indemnity
34ZZZA Obligation to notify the Chief Executive Medicare that amount has been paid
34ZZZB The Chief Executive Medicare to notify of amount of debt due
34ZZZC Penalty imposed if an amount is repaid late
Subdivision E—Regulations may provide for payments
34ZZZD Regulations may provide for payments in relation to allied health exceptional claims
34ZZZE The Chief Executive Medicare may request information
Subdivision F—Miscellaneous
34ZZZF Modifications and exclusions
Division 3—Administration of the indemnity schemes
Subdivision A—Introduction
35 Guide to this Division
Subdivision B—Applications for, and payment of, indemnity scheme payments
36 Application for IBNR indemnity, high cost claim indemnity, run off cover indemnity or allied health high cost claim indemnity
37 Payment date for IBNR indemnity, high cost claim indemnity, run off cover indemnity or allied health high cost claim indemnity
37A Application for exceptional claims indemnity or allied health exceptional claims indemnity
37B Payment date for exceptional claims indemnity or allied health exceptional claims indemnity
Subdivision C—Information gathering and record keeping
38 Chief Executive Medicare may request information
39 Main record keeping obligations
40 Certain insurers and MDOs to keep additional records
Subdivision D—Overpayments of the indemnities
41 Recovery of overpayments
Subdivision E—Recovery of repayment or overpayment debt
42 Chief Executive Medicare may collect money from a person who owes money to a person
Division 4—Medical indemnity premium subsidy scheme
43 Regulations may provide for subsidy scheme
44 Chief Executive Medicare may request information
44B Chief Executive Medicare may notify run off cover credits
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
Division 6—Finance
48 Appropriation
Division 7—Reinsurance contracts
49 Indemnity scheme payments disregarded for purposes of reinsurance contracts
Division 8—Monitoring
50 Insurers may be required to provide information
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Part 2A—Universal cover obligation
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Division 1—Introduction
51 Guide to the universal cover obligation provisions
51A Winding up of medical indemnity insurer
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Division 2—Requirements in relation to providing professional indemnity cover
52 Division applies for the purposes of the AFCA scheme
52A Universal cover obligation
52B Medical indemnity insurer to notify of refusal
52C Risk surcharge requirements
52D Medical indemnity insurer may be required to offer interim cover until complaint is finalised
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Division 3—Records, reporting and information
53 Records
53A Failing to keep and retain records
53B Medical indemnity insurer must report annually
53C Failing to report
53D Secretary may request information
53E Failing to give information
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Part 3—Payments towards the cost of providing indemnities
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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 3—Administration of the run off cover support payments
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Subdivision A—Introduction
60 Guide to this Division
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Subdivision B—Payment and collection of run off cover support payments
61 When run off cover support payment must be paid
65 Late payment penalty
66 Method of paying certain amounts
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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
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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
76A Chief Executive Medicare may use computer programs to take administrative action
76B Delegation by Secretary
77 Officers to observe secrecy
78 Act not to apply in relation to State insurance within a State
78A Evaluation of medical indemnity market
79 Regulations
80 Rules
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Endnotes
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
