Commonwealth Consolidated Acts Commonwealth Consolidated ActsCriteria for certification
(1) The Chief Executive Medicare may issue a certificate stating that a claim is a qualifying claim if the Chief Executive Medicare is satisfied that:
(a) the claim is a claim that is or was made against a person (the practitioner ); and
(b) the claim relates to:
(i) an incident that occurs or occurred; or
(ii) a series of related incidents that occur or occurred;
in the course of, or in connection with, the practitioner's practice as a medical practitioner; and
(c) except in the circumstances specified in rules made for the purposes of this paragraph, either:
(i) the incident occurs or occurred; or
(ii) one or more of the incidents in the series occurs or occurred;
in Australia or an external Territory; and
(d) the incident did not occur, or the incidents did not all occur, in the course of the provision of treatment to a public patient in a public hospital; and
(e) there is a contract of insurance in relation to which the following requirements are satisfied:
(i) the contract provides medical indemnity cover for the practitioner in relation to the claim, or would, but for the practitioner's contract limit, provide such cover for the practitioner in relation to the claim;
(ii) the practitioner's contract limit equals or exceeds the relevant threshold (see section 34F);
(iii) the insurer is a general insurer, within the meaning of the Insurance Act 1973 ;
(iv) the insurer entered into the contract in the ordinary course of the insurer's business; and
(f) the insurer was first notified of the claim, or of facts that might give rise to the claim, on or after 1 January 2003; and
(g) if a termination date for the exceptional claims indemnity scheme is set (see section 34G), the incident, or one or more of the incidents, to which the claim relates occurred before the exceptional claims termination date; and
(h) the claim is not a claim specified in rules made for the purposes of this paragraph; and
(i) the contract of insurance is not a contract specified in rules made for the purposes of this paragraph; and
(j) a person has applied for the certificate in accordance with section 34H.
Note 1: Paragraph (d)--for what happens if some, but not all, of the incidents in a series occur in the course of the provision of treatment to a public patient in a public hospital, see section 34N.
Note 2: Paragraph (g)--for what happens if some, but not all, of the incidents in a series occur after the exceptional claims termination date, see section 34O.
Certain eligible run - off claims may relate to treatment of public patients in public hospitals
(1A) Paragraph (1)(d) does not apply to an eligible run - off claim if:
(a) the claim relates to an incident that occurred, or a series of incidents that occurred, before 1 July 2003; and
(b) at the time the incident, or one or more of the incidents, occurred, there was an arrangement with an MDO under which the MDO would have been able to indemnify the practitioner in relation to the incident or series of incidents if the claim had been made while the arrangement had effect; and
(c) at the time the claim is made, a contract of insurance with a medical indemnity insurer provides medical indemnity cover for the practitioner; and
(d) the medical indemnity cover is provided under an arrangement of a kind referred to in paragraph 26B(1)(f) of the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003 ; and
(e) the medical indemnity cover satisfies all of the requirements of subsection 26A(4) of that Act.
When a certificate is in force
(2) The certificate comes into force when it is issued and remains in force until it is revoked.
Matters to be identified or specified in certificate
(3) The certificate must:
(a) identify:
(i) the practitioner; and
(ii) the claim; and
(iii) the contract of insurance in relation to which paragraph (1)(e) is satisfied; and
(b) specify the relevant threshold.
The certificate may also contain other material.
ART review of decision to refuse
(4) An application may be made to the Administrative Review Tribunal for review of a decision of the Chief Executive Medicare to refuse to issue a qualifying claim certificate.
Note: Section 266 of the Administrative Review Tribunal Act 2024 requires notification of a decision that is reviewable.
Chief Executive Medicare to give applicant copy of certificate
(5) If the Chief Executive Medicare decides to issue a qualifying claim certificate, the Chief Executive Medicare must, within 28 days of making his or her decision, give the applicant a copy of the certificate. However, a failure to comply does not affect the validity of the decision.