The following table has terms, abbreviations and their meanings relating to medical and midwife indemnity insurance claims.
Term | Meaning |
---|---|
Aggregation | An amount formed or calculated by the combination of many separate items. An MDO and MII may be able to aggregate costs for the same claim under ROCS, HCCS, AHHCCS and MPIS. You only need to submit one application. |
AHECS | Allied Health Exceptional Claims Scheme. |
AHHCCS | Allied Health High Cost Claim Scheme. |
Ahpra | Australian Health Practitioner Regulation Agency. |
Ahpra registration number | The unique registration number allocated by Ahpra to a practitioner for each profession they’re registered in. |
Allied health professional | A person who practices an allied health profession within the meaning of the Health Practitioner Regulation National Law, other than the medical profession. You can read this legislation on the Ahpra and National Boards website. |
Applicant | The entity applying under the Medical or Midwife Professional Indemnity Schemes. Depending on the scheme, the applicant must be a:
|
Apportionment | The distribution of damages between parties to a claim, proportionate to their legal liability. We need this information in writing to assess an MPIS payment application. |
Apportionment certificate | We issue this certificate. It’s required as part of a MPIS payment application where apportionment hasn’t been specified by a court. When the applicant enters the apportionment details into the relevant payment application form, it’s taken to be an application for an apportionment certificate. |
ARN | Application Reference Number. This is our unique identifier allocated to each medical indemnity application we get. |
Claim | The definition of a claim can include a claim, demand or proceedings of any kind. The claim doesn’t have to involve legal proceedings. Proceedings of any kind could involve:
|
Claim against a person | This includes an inquiry into, or an investigation of, the midwife’s or medical practitioner’s conduct. |
Claim Handling Fee (CHF) | An administrative fee payable to the applicant under the Medical Indemnity ROCS and IBNR schemes. This is currently 5% of the gross claim amount. |
Claim number | A unique system-generated number, created by the MIOC or MPIOC system. |
Costs | The fees, charges, disbursements and expenses for legal work relating to the proceeding. These could be plaintiff costs or defence costs. |
Cost sharing arrangement | Any arrangement in which legal costs and/or disbursements are shared between parties to a claim or proceedings. |
Date of Incident (DoI) | This is the date the incident occurred that gave rise to a claim. If a single significant incident date can’t be identified, the claim must reflect the date range of the incidents. |
Date of Notification (DoN) | The date the applicant was first notified of the claim or incident(s):
|
Defendant | A person against whom the claim was made. |
ECS | Exceptional Claims Scheme. |
HCCS | High Cost Claim Scheme. |
IBNR | Incurred But Not Reported Indemnity Scheme. |
Incident | An act, omission or circumstance that occurs in the course of, or in connection with, provision of a health services. This includes an alleged incident. |
Initial application | This is the first medical or midwife indemnity payment application submitted for a claim that we’ll assess. |
Insured person | The member or policy holder for whom the Medical Indemnity application is made. |
Insured person’s contract limit | The maximum amount payable by the MII under a contract for claims made against a practitioner. Also referred to as policy limit. |
Insurer-to-insurer | A payment that’s made by an MDO or insurer to an MDO or an insurer. The payment isn’t made by the MDO or insurer on behalf of another person. |
Insurance contract | A contract whereby an insurer agrees to indemnify the purchaser up to a specified limit in the event of a claim against them. |
Judgment | The decision by a court, or a court order, for the payment of an amount of compensation, costs or otherwise. A judgment must be in writing and clearly show all the issues have been adjudicated. It must specifically indicate the parties included within it. |
MDO | Medical Defence Organisation. Refer to section 5 of the Medical Indemnity Act 2002 for the full definition on the Federal Register of Legislation website. |
Medical Indemnity Online Claiming Service (MIOC) system | Our online system for submission of medical indemnity scheme payment and refund applications. |
Midwife Professional Indemnity Online Claims (MPIOC) system | Our online system for submission of midwife professional indemnity scheme payment and refund applications. |
MII | Medical Indemnity Insurer. |
MPIS | Midwife Professional Indemnity Scheme. |
MPIROCS | Midwife Professional Indemnity Run-Off Cover Scheme. |
Party or parties | The person(s) or organisation(s) that make or respond to a claim. |
Plaintiff | A person or persons who commence civil action in a court. |
Policy holder | A person who holds a contract of insurance with an insurer. |
Policy limit | The maximum amount payable by the MII under a contract for claims made against a practitioner. |
Private patient | Patients who pay for their hospital costs by private health insurance or their own funds. |
PSS | Premium Support Scheme. |
Public hospital | A recognised hospital within the meaning of the Health Insurance Act 1973 on the Federal Register of Legislation website. |
Public patient | Has the same meaning as in the Health Insurance Act 1973 on the Federal Register of Legislation website. |
QCC | We issue a Qualifying Claim Certificate. It’s required as part of the following payment applications:
The applicant will need to apply for a QCC using the relevant QCC application form. If we don’t issue a QCC, we can’t make a payment under these schemes. |
ROCS | Run-Off Cover Scheme. |
Series of related incidents | A series of incidents that together form the incident which is the basis of the claim. The date of incident is the date range over which the related incidents occurred. |
Subsequent application | An additional application submitted for a claim that we have previously assessed. |
Third party contribution | A payment, made by a party who is not named in the claim, towards damages the insured person is liable for. You can’t claim amounts for which you have received a third party contribution. |
You can read more about each term on the Federal Register of Legislation website:
- Section 4 of the Medical Indemnity Act 2002 lists full definitions for medical indemnity.
- Section 5 of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 lists full definitions for the Midwife Professional Indemnity Schemes.