Commonwealth Consolidated Acts Commonwealth Consolidated Acts(1) This section tells you what is meant by claims - made based cover and incident - occurring based cover when those terms are used in this Act. There are some kinds of medical indemnity cover that fall outside both those terms.
(2) For the purposes of this Act, the cover provided for by a contract of insurance is claims - made based cover if:
(a) under the contract, the insurer provides medical indemnity cover for a health care professional in relation to a compensation claim against the health care professional in relation to a health care incident only if:
(i) the incident occurs during a period specified in the contract (the incidents period ); and
(ii) the compensation claim is made against the health care professional during a period specified in the contract (the claims period ); and
(b) the incidents period is not a period that has ended before the claims period begins; and
(c) the claims period is fixed.
Note 1: Subparagraph (a)(ii)--subsection 4(9) operates on the reference in this subparagraph to the claim being made during a period.
Note 2: Pure extended reporting benefit cover (which has a defined incidents period that ends before the claims period begins) does not qualify because of paragraph (b). Death, disability and retirement cover (which does not have a fixed claims period) does not qualify because of paragraph (c).
(3) To avoid doubt, the claims period for the contract is taken to be fixed even if the claims period is capable of being extended:
(a) by agreement between the parties to the contract; or
(b) by renewal of the contract.
(4) For the purposes of this Act, the cover provided for by a contract of insurance is incident - occurring based cover if:
(a) under the contract, the insurer provides medical indemnity cover for a health care professional in relation to a compensation claim in relation to a health care incident only if the incident occurs during a period specified in the contract; and
(b) under the contract, the insurer provides that medical indemnity cover:
(i) regardless of when the compensation claim is made against the health care professional; and
(ii) whether or not the health care professional has died, become permanently disabled or retired.
Note: Extended reporting benefit cover (which has a fixed claims period) does not qualify because of subparagraph (b)(i) and death, disability and retirement cover does not qualify because of subparagraph (b)(ii).