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To be eligible you need to have met all of the following. You must have:
- received a Therapeutic Goods Administration (TGA) approved COVID-19 vaccine
- met the definition of harm, like one of the clinical conditions listed in the policy
- been admitted to hospital as an inpatient because of the harm you suffered or seek a waiver
- losses or expenses of $1,000 or more, excluding pain and suffering, due to the COVID-19 vaccination.
When we assess your claim we may need to consult with TGA, the Department of Health and Aged Care or an independent expert panel.
How to meet the definition of harm
To meet the definition of ‘harm’, your doctor must diagnose you with an eligible condition or injury covered by the scheme.
Your doctor needs to:
- advise the specific harm you suffered was most likely caused by the COVID-19 vaccine and that other circumstances are less likely
- complete a COVID-19 vaccine claims scheme medical report, which you must include with your claim.
If you had AstraZeneca Vaxzeria, the following clinical conditions are accepted under the scheme:
- Anaphylactic reaction
- Thrombosis with Thrombocytopenia Syndrome
- Capillary leak syndrome
- Demyelinating disorders including Guillain Barre Syndrome (GBS)
- Thrombocytopenia, including immune Thrombocytopenia.
If you’ve had Pfizer/Biontech Comirnaty or Moderna Spikevax, the following clinical conditions are accepted under the scheme:
- Anaphylactic reaction
If you had Novavax Nuvaxovid, the clinical condition of anaphylactic reaction is accepted under the scheme.
Which injuries are eligible
The following clinically diagnosed injuries are also accepted under the scheme, regardless of which TGA approved vaccine you’ve had:
- a shoulder injury you got when you received a COVID-19 vaccine
- other moderate to significant physical injuries that caused permanent impairment, or the need for an extended period of medical treatment.
In both cases, the injuries must have been sustained during the physical act of being given the vaccine.
The following harm isn’t covered under the scheme:
- contracting COVID-19
- psychological and psychiatric conditions
- secondary injuries, like an injury suffered when fainting, or a haematoma where you were injected that becomes infected.
These other side effects aren’t accepted under the scheme:
- injection site reaction
- muscle or joint pain
- pain in extremity
- nausea or vomiting
- decreased appetite
- abdominal pain
- urticaria or rash
- influenza-like illness
- anxiety-related reactions.
Read more about the conditions and injuries accepted under the COVID-19 vaccine claims scheme policy on the Department of Health and Aged Care website.
You must have been admitted to hospital as an inpatient due to COVID-19 vaccine-related harm.
Presenting to a hospital emergency department doesn’t meet this requirement. If you weren’t admitted to hospital as an inpatient to treat the harm, but should have been, you need to seek a waiver. This only applies to the 7 accepted clinical conditions.
Read more about requesting a waiver in the COVID-19 vaccine claims scheme policy on the Department of Health and Aged Care website.
Your doctor will also need to complete the COVID-19 vaccine claims scheme medical report. Your doctor must answer the questions about why you weren’t admitted as an inpatient to hospital.