Commonwealth Consolidated Acts Commonwealth Consolidated ActsGeneral
(1) In this Act, unless the contrary intention appears:
"Actuary" means the Australian Government Actuary.
"administrative action" has the meaning given by subsection 76A(4).
"AFCA" has the same meaning as in the Corporations Act 2001 .
"affected medical practitioner" has the meaning given by section 34ZQ.
"allied health exceptional claims indemnity" means an allied health exceptional claims indemnity paid or payable under Division 2D of Part 2.
Note: Amounts payable under regulations made for the purposes of section 34ZZZD (allied health exceptional claims payments) are not covered by this definition.
"allied health high cost claim indemnity" means an allied health high cost claim indemnity paid or payable under Division 2C of Part 2.
Note: Amounts payable under regulations made for the purposes of section 34ZZG (allied health high cost claims payments) are not covered by this definition.
"allied health high cost claim threshold" has the meaning given by section 34ZZA.
"allied health profession" means a profession that is:
(a) a health profession within the meaning of the Health Practitioner Regulation National Law, other than the medical profession; or
(b) specified in the rules.
"allied health" termination date means the date, if any, set by rules under section 34ZZM.
"Chapter 5 body corporate" means:
(a) a body corporate that is a Chapter 5 body corporate within the meaning of the Corporations Act 2001 ; or
(b) a body corporate to which a provisional liquidator has been appointed.
"Chief Executive Medicare" has the same meaning as in the Human Services (Medicare) Act 1973 .
"claim" :
(a) means a claim or demand of any kind (whether or not involving legal proceedings); and
(b) includes proceedings of any kind including:
(i) proceedings before an administrative tribunal or of an administrative nature; and
(ii) disciplinary proceedings (including disciplinary proceedings conducted by or on behalf of a professional body); and
(iii) an inquiry or investigation;
and claim against a person includes an inquiry into, or an investigation of, the person's conduct.
Note: Subsection (1A) extends the meaning of claim for the purposes of Division 2B of Part 2 (run - off cover indemnity scheme).
"conducted appropriately" : a defence of a claim against a person is conducted appropriately if, and only if:
(a) to the extent it is conducted on the person's behalf by an insurer, or by a legal practitioner engaged by an insurer--the defence is conducted to a standard that is consistent with the insurer's usual standard for the conduct of the defence of claims; and
(b) to the extent it is conducted by the person, or by a legal practitioner engaged by the person--the defence is conducted prudently.
"contribution year" has the same meaning as in the Medical Indemnity (Run - off Cover Support Payment) Act 2004 .
"defence" , of a claim against a person, includes any settlement negotiations on behalf of the person.
"eligible insurer" has the meaning given in section 34ZZ.
"eligible MDO" has the meaning given in section 34ZZ.
"eligible midwife" has the same meaning as in the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 .
"eligible related claims" : see section 8A.
"eligible run-off claim" has the meaning given by section 34ZB.
"exceptional claims indemnity" means an exceptional claims indemnity paid or payable under Division 2A of Part 2.
Note: Amounts payable under regulations made for the purposes of section 34X (exceptional claims payments) are not covered by this definition.
"exceptional claims termination date" means the date, if any, set by rules under section 34G.
"Federal Register of Legislation" means the Federal Register of Legislation established under the Legislation Act 2003 .
"health care related vocation" means a health care related vocation in relation to which there is at least one State or Territory under the law of which a person must be registered in order to practise.
"Health Practitioner Regulation National Law" means the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).
"health service" means any service, care, treatment, advice or goods provided in respect of the physical or mental health of a person.
"high cost claim indemnity" means a high cost claim indemnity paid or payable under Division 2 of Part 2.
Note: Amounts payable under regulations made for the purposes of section 34AA (high cost claims payments) are not covered by this definition.
"high cost claim threshold" has the meaning given by section 29.
"IBNR exposure" has the meaning given by section 8.
"IBNR indemnity" means an IBNR indemnity paid or payable under Division 1 of Part 2.
Note: Amounts payable under regulations made for the purposes of section 27A (IBNR claims payments) are not covered by this definition.
"incident" means any incident (including any act, omission or circumstance) that occurs, or that is claimed to have occurred, in the course of, or in connection with, the provision of a health service.
"incident-occurring based cover" has the meaning given by section 7.
"indemnify" has a meaning affected by subsection (2).
"indemnity scheme payment" means:
(a) an IBNR indemnity; or
(b) a high cost claim indemnity; or
(c) an exceptional claims indemnity; or
(d) a run - off cover indemnity; or
(e) an allied health high cost claim indemnity; or
(f) an allied health exceptional claims indemnity.
"insurance business" has the same meaning as in the Insurance Act 1973 .
"insurer" means a person who carries on insurance business.
"insurer-to-insurer payment" means a payment that:
(a) is made by an MDO or insurer to an MDO or an insurer; and
(b) is not made by the MDO or insurer on behalf of another person.
"invoice" includes:
(a) any document issued by an MDO to a person (whether or not the person is already a member of the MDO) that contains a quote for the amount of subscription that is or would be payable by that person for membership of the MDO; and
(b) any document issued by a medical indemnity insurer to a person (whether or not the medical indemnity insurer already provides medical indemnity cover to the person) that contains a quote for the amount of premium that is or would be payable by that person for provision of such cover.
"late payment penalty" :
(a) in relation to an amount repayable under section 24--means a penalty payable under section 27; and
(aa) in relation to a debt owed under section 34T--means a penalty payable under section 34W; and
(ab) in relation to a debt owed under section 34ZJ--means a penalty payable under section 34ZM; and
(ac) in relation to a debt owed under section 34ZZZ--means a penalty payable under section 34ZZZC; and
(b) in relation to a run - off cover support payment--means a penalty payable under section 65.
"legal practitioner" means a person who is enrolled as a barrister, a solicitor, a barrister and solicitor, or a legal practitioner, of:
(a) a federal court; or
(b) a court of a State or Territory.
"MDO" has the meaning given by section 5.
"medical indemnity cover" : a contract of insurance provides medical indemnity cover for a person if:
(a) the person is specified or referred to in the contract, whether by name or otherwise, as a person to whom the insurance cover provided by the contract extends; and
(b) the insurance cover indemnifies the person (subject to the terms and conditions of the contract) in relation to claims that may be made against the person in relation to incidents that occur or occurred in the course of, or in connection with, the practice by the person of a medical profession.
Note: A single contract of insurance may provide medical indemnity cover for more than one person.
"medical indemnity insurer" means:
(a) a body corporate authorised under section 12 of the Insurance Act 1973 that; or
(b) a Lloyd's underwriter within the meaning of that Act who;
in carrying on insurance business in Australia, enters into contracts of insurance providing medical indemnity cover for other persons.
"medical indemnity payment legislation" means the Medical Indemnity (Run - off Cover Support Payment) Act 2004 .
"medical practitioner" means a person registered or licensed as a medical practitioner under a State or Territory law that provides for the registration or licensing of medical practitioners.
Note: Subsection (6) gives this definition an extended meaning in Division 2B or 4 of Part 2.
"medical profession" includes a health care related vocation.
"medicare program" has the same meaning as in the Human Services (Medicare) Act 1973 .
"member" of an MDO has the meaning given by section 6.
"midwife insurer" means an insurer that is an eligible insurer within the meaning of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 .
"midwife professional indemnity cover" has the same meaning as in the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 .
"participating MDO" means UMP.
"payment" made in relation to a claim has (other than in Divisions 2A and 2D of Part 2) the meaning given by subsections (3) and (4).
"practitioner's contract limit" , in relation to a person for whom a contract of insurance provides medical indemnity cover, means the maximum amount payable, in aggregate, by the insurer under the contract in relation to claims against the person.
Note 1: If the contract provides medical indemnity cover for more than one person, there must be a separate contract limit for each of those persons.
Note 2: For how this definition applies if the contract provides for deductibles, see section 8B.
Note 3: For how this definition interacts with the high cost claim indemnity scheme and the allied health high cost claim indemnity scheme, see sections 34D and 34ZZJ.
"private medical practice" means practice as a medical practitioner, other than:
(a) practice consisting of treatment of public patients in a public hospital; or
(b) practice for which:
(i) the Commonwealth, a State or a Territory; or
(ii) a local governing body; or
(iii) an authority established under a law of the Commonwealth, a State or a Territory;
indemnifies medical practitioners from liability relating to compensation claims (within the meaning of the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003 ); or
(c) practice conducted wholly outside both Australia and the external Territories; or
(d) practice of a kind specified in the rules.
"professional indemnity cover" : a contract of insurance with a medical practitioner provides professional indemnity cover if it provides medical indemnity cover for the practitioner in relation to the practitioner's private medical practice.
"provable" : an amount that an MDO or insurer is liable to pay is provable if:
(a) it is provable in the winding up of the MDO or insurer if the winding up of the MDO or insurer has commenced; or
(b) it would be provable in the winding up of the MDO or insurer if the MDO or insurer were to be wound up.
"public hospital" means a recognised hospital within the meaning of the Health Insurance Act 1973 .
"public patient" has the same meaning as in the Health Insurance Act 1973 .
"qualifying allied health claim certificate" means a certificate issued by the Chief Executive Medicare under section 34ZZK.
"qualifying allied health" liability , in relation to a claim, has the meaning given by section 34ZZS.
"qualifying allied health payment" : see subsection 34ZZB(4).
"qualifying claim certificate" means a certificate issued by the Chief Executive Medicare under section 34E.
"qualifying liability" , in relation to a claim, has the meaning given by section 34M.
"qualifying payment" : see subsection 30(2).
"related body corporate" has the same meaning as in the Corporations Act 2001 .
"relevant allied health threshold" : see subsection 34ZZL(1).
"relevant threshold" : see subsection 34F(1).
"risk surcharge" has the meaning given by subsection 52C(1).
"rules" means the rules made under section 80.
"run-off cover credit" has the meaning given by subsection 34ZS(2).
"run-off cover indemnity" means a run - off cover indemnity paid or payable under Division 2B of Part 2.
Note: Amounts payable under regulations made for the purposes of section 34ZN (run - off claims payments) are not covered by this definition.
"run-off cover support payment" means a payment payable under Division 2 of Part 3.
"Secretary" means the Secretary of the Department.
"subject to appeal" : a judgment or order is subject to appeal until:
(a) any applicable time limits for lodging an appeal (however described) against the judgment or order have expired; and
(b) if there is such an appeal against the judgment or order--the appeal (and any subsequent appeals) have been finally disposed of.
"total run-off cover credit" has the meaning given by section 34ZS.
"UMP" means United Medical Protection Limited.
Notifications by practitioners may constitute claims
(1A) A reference in Division 2B of Part 2 to a claim includes a reference to a notification by or on behalf of a person of an incident, or a series of related incidents, if:
(a) at the time of the incident, or one or more of the incidents, the person was a medical practitioner; and
(b) the notification is to a medical indemnity insurer or an MDO; and
(c) at the time of the notification:
(i) a contract of insurance with the insurer provided the person with medical indemnity cover; or
(ii) an arrangement with the MDO provided medical indemnity cover (within the meaning of the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003 ) for the person;
and the cover would have indemnified the person in relation to any claim relating to the incident, or series of incidents, if the claim had been made at the time of the notification.
The notification is taken, for the purposes of Division 2B of Part 2, to be a claim against the person.
(2) To avoid doubt, a person may, for the purposes of this Act, indemnify someone else by either:
(a) making a payment; or
(b) agreeing to make a payment.
Note: A person may indemnify someone else by making a payment even if the payment was not preceded by an agreement to pay.
Payments in relation to claims
(3) For the purposes of this Act (other than Divisions 2A and 2D of Part 2):
(a) a payment is made in relation to a claim against a person if and only if the payment is made to:
(i) satisfy or settle the claim; or
(ii) meet legal and other expenses that are directly attributable to any negotiations, arbitration or proceedings in relation to the claim; and
(b) a payment is made in relation to a claim by a person if and only if the payment is made to meet legal and other expenses that are directly attributable to any negotiations, arbitration or proceedings in relation to the claim.
(4) A reference in this Act (other than Divisions 2A and 2D of Part 2) to a payment being made to satisfy or settle a claim against a person includes a reference to a payment that:
(a) is made to reimburse the person for a payment the person has made to satisfy or settle the claim; or
(b) is made to the person so that the person can make a payment to satisfy or settle the claim.
Changes in body corporate names
(5) A reference in this Act to a body corporate by a particular name is a reference to the body corporate that had that name on 30 June 2002.
(6) A reference in Division 2B or 4 of Part 2 to a medical practitioner includes a reference to a person who has been a medical practitioner.