Claims and amounts not eligible
There are claims and amounts that aren’t eligible under the IBNR.
What incidents you can’t seek payment for
You can’t submit an IBNR application for an incident or a series of related incidents if:
- you were notified about them before 1 July 2002
- the insured person didn’t hold incident occurring based cover on 30 June 2002
- they occurred on or after 1 July 2002
- they didn’t occur as part of a person’s practice as a medical professional
- they aren’t normally covered in the person’s ordinary course of business
- you aren’t liable to make a payment in relation to the claim
- it occurred entirely in the provision of treatment to a public patient is in a public hospital.
What amounts you can’t claim
You can’t claim GST under the IBNR.
You also can’t claim an amount if:
- another party has responsibility to pay it
- the cost wasn’t incurred in relation to the incident
- it’s an insurer to insurer payment
- any portion that related to the treatment of a public patient in a public hospital
- the judgment or settlement amounts are still within the appeal period or have been appealed or stayed.
Page last updated: 26 November 2020
This information was printed 27 February 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/incurred-not-reported-indemnity-scheme-ibnr/what-claims-are-eligible/claims-and-amounts-not-eligible. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.