Commonwealth Consolidated Acts

MEDICAL INDEMNITY ACT 2002

TABLE OF PROVISIONS

           Long Title

   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