Claiming under the IBNR
You need to submit an application to claim.
You’ll need a separate Medical Indemnity payment application for each member subject to the same claim.
We’ll give your Medical Indemnity payment application a unique claim reference number. You must use the claim reference number for all claims or correspondence relating to this claim.
Submit 1 application if a member is part of multiple claims for the same patient or plaintiff and incident. For example, there might be a coronial inquest and a civil claim.
What you can’t claim under IBNR
You can’t put in an IBNR claim for:
- incidents that occur when a public patient is being treated in a public hospital - if only part of a treatment is for a public patient in a public hospital, reduce the application payment proportionately
- claims for members who have received an exemption 5, 8 or 9 from the United Medical Protection Support Payment program (UMP SP)
- incidents or a series of related incidents notified to the applicant before 1 July 2002
- incidents or a series of related incidents that occurred when a member didn’t hold incident occurring based cover on 30 June 2002
- incidents or a series of related incidents that occurred on or after 1 July 2002
- incidents or a series of related incidents which didn’t occur within the course of, or in connection with, a person’s practice as a medical practitioner
- incidents that wouldn’t normally be covered in the ordinary course of business for the MDO
- payments received from another source, for example, third party contribution.
Amounts you can’t claim
In the Medical Indemnity payment application you need to deduct any amounts:
- for which other parties are responsible
- that relate to incidents or claims not payable under IBNR
- insurer to insurer payments.
Claiming High Cost Claim Indemnity as part of IBNR
Where the total cost of the Medical Indemnity payment application exceeds the relevant High Cost Claims Scheme (HCCS) threshold, complete the IBNR Medical Indemnity payment application only.
High Cost Claims Scheme thresholds
|Notification date||HCCS threshold|
|1 January 2003 to 21 October 2003 (inclusive)||$2,000,000|
|22 October 2003 to 31 December 2003 (inclusive)||$500,000|
|1 January 2004 to 30 June 2018 (inclusive)||$300,000|
|On or after 1 July 2018||$500,000|
Read more about the High Cost Claim Indenity Scheme.
Filling out the application
You must apply for IBNR using the approved Medical Indemnity payment application form.
You must use the same Department of Humans Services’ claim reference for all subsequent claims or correspondence about the same claim.
You must attach supporting documents to your Medical Indemnity payment application.
There’s a checklist on the Medical Indemnity payment application to remind you of what we need to:
- verify IBNR eligibility
- assess whether the claim is payable.
Send us the necessary supporting documents to prevent delays in assessing your application.
Page last updated: 29 October 2019
This information was printed 28 May 2020 from https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/incurred-not-reported-indemnity-scheme/claiming/claiming-under-ibnr. 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.