High Cost Claim Indemnity Scheme (HCCS)

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

• a medical practitioner
• an allied health professional, if the incident occurred before 1 July 2020
• a midwife engaged as an employee to practise as a midwife, if the incident occurred on or after 1 July 2010 and before 1 July 2020.

They must be 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 a medical profession
• practice by the midwife engaged as an employee.

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

• you were notified about them before 1 January 2003
• they all occurred outside of Australia or its external territories
• they aren’t normally covered in your ordinary course of business
• you aren’t liable to make a payment in relation to the claim
• they occurred in the provision of treatment to a public patient in a public hospital.

The eligible claim value must be more than the relevant HCCS threshold. The HCCS threshold is based on the date the MII or MDO was first notified of the incident or claim.

The table below lists the HCCS thresholds.

You can’t claim GST under the 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 must use the Medical Indemnity Online Claims (MIOC) service in Health Professionals Online Services (HPOS) to apply under the 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, you’ll need to email the Medical Indemnity team.

Once you’re registered, we’ll give you a MIOC User Guide. The guide will explain how you submit the 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 by the end of the next month.

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 a HCCS payment application for incidents that happened on or after 1 July 2020.

For incidents that happened before 1 July 2020