Incurred But Not Reported Indemnity Scheme (IBNR)

Claims may be eligible if:

• the incident occurred on or before 30 June 2002
• the incident occurred in the course of, or in connection with, the practice of a medical profession by a person
• the person had incident occurring based cover on 30 June 2002
• you weren’t notified of the incident or any claim in relation to it before 1 July 2002.

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

• you were notified about them before 1 July 2002
• the insured person didn’t hold incident occurring based cover on 30 June 2002
• they occurred on or after 1 July 2002
• they didn’t occur as part of a person’s practice as a medical professional
• they aren’t normally covered in the person’s ordinary course of business
• you aren’t liable to make a payment in relation to the claim
• it occurred entirely in the provision of treatment to a public patient is in a public hospital.

You can’t claim GST under the IBNR.

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 IBNR.

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 the application.

Before you submit the application, check you have an eligible claim.

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 Medical Defence Organisation’s (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 is not 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.

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