Medical Indemnity Act 2002 (Cth)

Medical Indemnity Act 2002

No. 132, 2002

Compilation No. 23

Compilation date: 14 October 2024

Includes amendments: Act No. 38, 2024

About this compilation

This compilation

This is a compilation of the Medical Indemnity Act 2002 that shows the text of the law as amended and in force on 14 October 2024 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents 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 Part 2—Commonwealth payments 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 Part 2A—Universal cover obligation Division 1—Introduction 51 Guide to the universal cover obligation provisions 51A Winding up of medical indemnity insurer 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 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 Part 3—Payments towards the cost of providing indemnities Division 2—Run‑off cover support payment Subdivision A—Introduction 57 Guide to the run‑off cover support payment provisions Subdivision B—Who pays run‑off cover support payment 58 Who is liable to pay the run‑off cover support payment 59 Exemptions Division 3—Administration of the run‑off cover support payments Subdivision A—Introduction 60 Guide to this Division 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 Subdivision C—Refunds 67 Refund of overpaid amounts 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 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. Division 4—Offences 73 Failing to give information 74 Failing to notify 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 Endnotes Endnote 1—About the endnotes Endnote 2—Abbreviation key Endnote 3—Legislation history Endnote 4—Amendment history