Allied Health High Cost Claim Indemnity Scheme (AH HCCS)

A claim may be eligible if it’s made against a person who is one of the following:

• an allied health professional
• a midwife engaged as an employee to practise as a midwife.

They must be:

• registered with the Australian Health Practitioner Regulation Agency (Ahpra)
• indemnified under an insurance policy with an eligible MII or MDO.

The claim must relate to an incident or series of incidents:

• in connection with the practice by the practitioner of an allied health profession or the midwife engaged as an employee
• that occurred on or after 1 July 2020.

You can’t submit an AH HCCS application for an incident or a series of related incidents if they:

• occurred before 1 July 2020
• all occurred outside of Australia or its external territories
• aren’t normally covered in your ordinary course of business
• aren’t liable to make a payment in relation to the claim
• occurred in the provision of treatment to a public patient in a public hospital.

Incidents that occurred before 1 July 2020 may be eligible under the High Cost Claim Indemnity Scheme.

The eligible claim value must be more than the AH HCCS threshold of $500,000.

You can’t claim GST under the AH HCCS.

You also can’t claim an amount if:

• another party has responsibility to pay it
• the cost wasn’t incurred in relation to the incident
• it’s an insurer-to-insurer payment
• any portion that related to the treatment of a public patient in a public hospital
• the judgment or settlement amounts are still within the appeal period or have been appealed or stayed.

You need to use the Medical Indemnity Online Claims (MIOC) service in Health Professional Online Services (HPOS) to submit an application under the AH HCCS.

You can access HPOS with an individual Provider Digital Access (PRODA) account or organisation account in PRODA. If you don’t have one, register for PRODA online.

To register to use MIOC, email the Medical Indemnity team.

Once you’re registered, we’ll give you a MIOC User Guide. This guide will explain how you submit your application.

Before you submit the application:

• check you have an eligible claim
• decide if you’re going to request to aggregate payments.

We’ll tell you the outcome of the application.

We’ll send all correspondence about the application to the MII’s or MDO’s HPOS mailbox.

You need to let us know if any details of the incident or claim change after you submit your application. This includes, but isn’t limited to if:

• you recover an amount from a third party that relates to the amount we paid you
• any changes effect the amount that was paid under the Medical Indemnity scheme
• a judgment or order becomes subject to an appeal or is stayed
• details of the incident change
• you withdraw support for the insured person
• the amount paid is later found to be not payable under the requirements of the scheme.

If you identify an amount to be refunded you must submit a refund application through the MIOC service in HPOS.

Only an MDO can submit a medical indemnity scheme application for aggregated payments. Applications for aggregated costs can be submitted under the High Cost Claim Indemnity Scheme or the Run Off Cover Indemnity Scheme.

To aggregate payments for the same claim, the MII must fill out and sign the Medical indemnity request to aggregate payments for the same claim form (MO008). The MII must send the form to the MDO who must upload the completed signed form with their application.

These Insurance Statistics Australia (ISA) specialty codes can be used for an AH HCCS payment application.