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Document Assessment - Medicare Compensation Recovery 011-15010000

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This document outlines information for Service Officers in establishing the mandatory information requirements for Medicare Compensation Recovery forms. External stakeholders use these forms when notifying Services Australia of a compensation claim.

On this page:

MO021 Medicare Compensation Recovery Third party authority form - information requirements

MO022 Medicare Compensation Recovery Notice of judgment or settlement form - information requirements

MO023 Medicare Compensation Recovery Section 23A statement form - information requirements

MO024 Medicare Compensation Recovery Bank account details collection form - information requirements

MO025 Medicare Compensation Recovery Compensation payer's Electronic Funds Transfer details collection form - information requirements

MO026 Medicare Compensation Recovery Notice of past benefits request form - information requirements

MO027 Medicare Compensation Recovery Notice of reimbursement arrangement form - information requirements

Z2801 Declaration - information requirements


MO021 Medicare Compensation Recovery Third party authority form - information requirements

Table 1

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Step

Action

1

Accepted form versions

The authority must be provided in writing using the Medicare Compensation Recovery Third party authority form. The version of the form must start with the number 2. For example, MO021.2XXX.

Note: only accept versions that begin with the number '2'. Reject any version that does not start with '2'.

If an unacceptable version is received, see Process Correspondence.

2

Check mandatory information

Check the form for the following mandatory information:

    • injured person’s name, address, and date of birth
    • authorised third party's details:
    • for an individual, full name (first and last name is sufficient) and address
    • for a business or organisation, the name of the business or organisation and their address
    • full name and signature of the relevant party authorising the release of information, such as the:
    • injured person or claimant information
    • legal representative - a copy of the Power of Attorney, Last Will & Testament, Letters of Administration, Probate or Court order is needed if not attached or already on file
    • parent or guardian of the injured person under 14 years of age if the injured person is enrolled on the parent or guardian’s Medicare card. If the minor is not enrolled on the same card, the parent/guardian must provide evidence, such as the minor’s birth certificate or guardianship documents to confirm the relationship between the two parties
    • Note: signatures can be digital, electronic, or handwritten. All signature types are acceptable, provided the full name of the person signing accompanies the signature. An acceptable full name includes the first and last name
  • if the MO021 form is missing a valid signature from one of the relevant authorising parties above, verbal consent can be accepted in certain circumstances. Go to Step 4
  • the date (DD MM YYYY) the relevant party authorised the release of information to the third party

If the above mandatory information is:

3

Check additional information

Check the date of injury or illness (DOI). The agency must be satisfied the authority received is for the correct compensation claim.

The authority is invalid if:

  • the DOI is missing and there is no other correspondence attached confirming the correct date of injury/illness
    • For example, if the MO021 has the DOI missing but is received with a valid Medicare Compensation Recovery Notice of past benefits request form (MO026) that has the DOI provided, the MO021 can be accepted as valid
  • the DOI provided on the MO021 is before or after the date of injury/illness recorded on an existing compensation claim
  • supporting documentation is not provided when signed on behalf of an injured person who does not have the capacity to sign for themselves or they are deceased

If any of the above additional information is missing, see Table 4 in Authority to access a claim - Medicare Compensation Recovery.

Go to Step 4

4

Missing details for injured person or claimant

At question 18, is the name of the person signing, the signature or the date of signature missing?

5

Missing details for authorised third person

At question 19, is the name of the authorised third party signing, the signature or the date of signature missing?


MO022 Medicare Compensation Recovery Notice of judgment or settlement form - information requirements

Table 2

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Step

Action

1

Accepted form versions

Notification of a judgment or settlement must be in writing. The agency prefers to receive notification on a Medicare Compensation Recovery Notice of judgment or settlement (MO022).

If an MO022 is provided the version of the form used must start with the number 2, for example MO022.2XXX. Only accept versions that begin with the number '2'. Reject any version that does not start with '2'.

If an unacceptable version is received, see Process Correspondence.

Note: a notifiable person may give notice with all required information by providing supporting documents or supplementary documents, such as a letter, instead of using an official form. If attempts to get a completed MO022 from the notifiable person are unsuccessful, escalate to Program Management for advice.

See Technical Support and Escalations - Medicare Compensation Recovery.

2

Check for mandatory information

Check the form for the following mandatory information:

  • injured person’s name, address, and date of birth (see Note below)
  • date on which the injured person suffered the injury or illness
  • nature of the injury or illness the injured person suffered (for example, broken arm)
  • names of all parties to the judgment or settlement, including address of the notifiable person.
    Where the notifiable person’s address is missing, but complete details for their acting solicitor are provided, the claim can proceed as an active standard claim. Complete details at a minimum include business name and full address
  • date (if any) by which the amount of compensation is required to be paid
  • total amount of compensation to be paid under the judgment or settlement
  • whether the injured person has been notified of the notifiable person’s intent to make an advance payment. If intent is given in writing on accompanying email or letter, this criterion is satisfied. Note: although notification of the intention to pay the advance payment is required to meet the advance payment criteria, not having the intent recorded on the MO022 or supporting documents is not grounds to reject the Notice of judgment or settlement
  • if the amount of compensation fixed (in whole or in part) redeems liability for periodic payments
  • if the amount of compensation was fixed on the basis that liability for the injury was apportioned between the injured person and the notifiable person because of contributory negligence, the percentage of apportionment (if applicable)
  • name and signature of the notifiable person (signature is unable to be submitted on supporting documents, this must be on the MO022 only). Go to Step 6 for Acceptable variations of the name provided on the MO022 declaration
  • date the declaration was signed
  • date the judgment or settlement was made, and compensation amount was fixed (see Note below)

Note:

  • If the injured person’s details are not completed in claims of historical abuse or psychological injury, to register the claim, see Table 7 in Process correspondence – Medicare Compensation Recovery
  • If the injured person is deceased, see Table 2 > Step 3 Authority to access a claim
  • Some of the above information can be provided on other supporting documents, go to Step 5
  • Signatures can be digital, electronic, or handwritten. All signature types are acceptable, provided the full name of the person signing accompanies the signature. go to Step 6 for declaration variations on the MO022.

If:

3

Date of injury (DOI) is different to existing claim

If the DOI provided on the MO022 form is different to the existing claim, but no other required information is missing make 1 call attempt to the person that submitted the form. If contact is:

Successful

Verbally confirm if the DOI provided on the MO022 is:

  • Correct
  • Incorrect
    • Determine whether verbal confirmation of the missing information is sufficient to proceed rather than defaulting to requesting an amended form

Add a case note recording:

  • the correct date the party contacted
  • the person that confirmed the information
  • all actions taken
  • the reason(s) for the decision

Go to Step 4

Unsuccessful

Note: to check if there is any missing additional information needed in the letter or phone call, go to Step 4.

4

Check for additional (not mandatory) information

While the date of judgment or settlement (DOJS) is not mandatory information under the Health and Other Services (Compensation) Act, it is necessary for processing purposes and is required for a notice to be valid.

If the DOJS is missing from the notice, has a supporting Release document been provided?

  • Yes, go to Step 5
  • No: make attempt to contact the notifiable person or their solicitor by phone
    • if successful, accept verbal confirmation and record the conversation in case notes. To process, see Notice of Judgment or Settlement
    • if unsuccessful, see Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter. Do not proceed to capture Notice of judgment or settlement (NOJS) details
    • add a case note to the claim advising of all actions taken

5

Supporting documents

The notice may be considered valid if some of the information in this table can be obtained from other supporting documents received such as:

  • consent judgment
  • certificate of determination
  • deed of release/discharge
  • terms of settlement
  • complying agreement for workers compensation
  • court order or judgment

If the date of judgment or settlement (DOJS) is not provided on the MO022 form, the date of execution provided on one of the above documents can be used as an alternative. The date of execution is usually provided at the top of the first page of a Release document, using statements such as:

  • This Deed of Release is dated<date>
  • This Deed, handed down on <date>
  • This Deed, executed on <date>

If the Deed does not contain a statement declaring the execution date, the date/s accompanying the signatures of both parties can be used as a reference for the DOJS. The latest signature date must be used.

Note: the signature of the injured person, or their acting legal practitioner, and a witness (if required) must be provided on a Release document for it to be valid.

While the agency can accept attached documents to provide missing or mismatched information, the preference is notification by a signed MO022 form. The form and any supporting documents must clearly identify the claim, the parties involved and meet compliance under the Act.

If assistance is required with supporting documents, see Technical Support and Escalations - Medicare Compensation Recovery.

6

Acceptable variations of declaration on MO022

When a compensation claim has been finalised the Act requires the notifiable person to notify the agency if a judgment or settlement has been made. They must provide:

  • the names of all parties to the settlement, or the names of all the parties to which the judgment relates, and
  • the notice signed by the notifiable person

Where the declaration on the MO022 form is not clear at question 41, determine whether to accept or reject the MO022 form.

A supplementary document may be used to confirm the identity of the signatory on the form. For example, the email page that accompanies the form has the name and position of the signatory in a signature block. It must be documentation sent and received within the same email, or that can be linked to the same individual.

Service officers are required to apply evidence-based decision-making processes to ensure they can confidently confirm that the person providing supporting and supplementary documents, including email pages, is the person who signed the MO022 form and can be identified as a representative of the notifiable person.

The documents should be used to support their decision and ensure the integrity of the verification process. It must be ensured that the supporting and supplementary documentation provides clear identification and aligns with verification requirements.

Clear case notes must be recorded on the claim, detailing:

  • the decisions made
  • evidence considered
  • actions taken, and
  • justification for each decision

This ensures transparency, accountability and consistency in the decision-making process.

Examples of acceptable variations are provided in Resources.


MO023 Medicare Compensation Recovery Section 23A statement form - information requirements

Table 3

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Step

Action

1

Accepted form versions

The statement must be in writing using Medicare Compensation Recovery Section 23A statement.

The version of the form must start with the number 2. For example, MO023.2XXX.

Note: only accept versions that begin with the number '2'. Reject any version that does not start with '2'.

2

Check for mandatory information

Check the form for the following mandatory information:

  • injured person’s name, address, and date of birth
  • full name and signature of the person making the declaration. The S23A form must be signed by the injured person, claimant or authorised third party only. The notifiable person or their solicitor cannot sign the form
    Note: an authorised third party can sign the MO023 form provided a valid Third party authority form (MO021) has been received naming the law firm or individual as a third party authority on the claim
  • date the declaration was signed
  • be signed either:
    • on the date the amount of compensation was fixed by judgment or settlement, date includes day, month, and year
    • any time after the date of judgment or settlement (DOJS)

The S23A form can be accepted as valid if signed by someone other than the injured person/claimant/authorised third party when:

  • the injured person is over the age of 14 but under the age of 18, and
  • a parent/guardian that is listed on the same Medicare card has signed the declaration, and
  • there is no supporting documentation on the claim, such as a Power of Attorney, Litigation Guardianship, etc

Signatures can be digital, electronic, or handwritten. Each form accepts all types of signatures provided the full name of the person signing accompanies the signature.

Does the S23A form include all mandatory information and meet the above criteria?

  • Yes:
    • Accept the form as valid
    • Supporting documents are not required
  • No, do not accept the form as valid

3

Check for additional (not mandatory) information

Although not required on the S23A form, the below information may be included and assist to confirm the form’s relevance to the claim:

  • the date the injured person suffered the injury or illness
  • the nature of the injury or illness the injured person suffered (for example, broken arm), and
  • the notifiable person's name and address details
  • Note: if any of the additional information provided is different to information on the claim, investigate further to confirm the document relates to the existing claim. If the non-mandatory fields are blank and all mandatory information consistent with the claim is provided, the document can be assessed as valid.

S23A statement is captured during the NOJS capture process. See Notice of judgment or settlement (NOJS)

If a S23A statement form (MO023) is received without a MO022, see Table 1 in Claim management - Medicare Compensation Recovery.


MO024 Medicare Compensation Recovery Bank account details collection form - information requirements

Table 4

Expand table

Step

Action

1

Accepted form versions

Preference is for the injured person's bank account details to be in writing using the Medicare Compensation Recovery Bank account details collection form. However, in some instances verbal confirmation can be accepted. See Payments, refunds and debts if verbal collection is required

The version of the form must start with the number 2. For example, MO024.2XXX.

Note: only accept versions that begin with the number '2'. Reject any version that does not start with '2'.

2

Check for mandatory information

Check the form for the following mandatory information:

  • injured person’s name, address, and date of birth
  • branch number (BSB) and account number
  • account name
  • full name and signature of the injured person, claimant or a person legally appointed to act on the injured person’s behalf (legal representative)
  • date the declaration was signed

Note: signatures can be digital, electronic, or handwritten. Each form accepts all types of signatures, provided the full name of the person signing accompanies the signature.

Refunds can only be paid into an Australian bank account. If the injured person/claimant is an overseas resident, see Payments, refunds and debts.

If the refund is being paid to the injured person, the bank account details must be for an account they hold, either solely or jointly. An exception to this is if there is trustee involvement in the claim, the trustee account details can be provided. There is no need to make an outbound call to verify details if the injured person has signed the document.

If the refund is to be paid to an individual other than the injured person, the injured person must complete a statutory declaration, providing a satisfactory reason why the refund is to be directed to another person’s bank account. For example, the injured person is incarcerated, and they are providing permission to deposit the refund into their partner’s account.

If unsure, the claim is to be escalated for further consideration, see Technical Support and Escalations - Medicare Compensation Recovery

To be used for refund purposes, the MO024 form on a claim must be no older than 2 years old, from date of receipt.

If the form is older than 2 years, and cross-referencing of other resources shows inconsistent information, contact must be made with the injured person/claimant/authorised third party to confirm details provided on the form are correct.

Make a reasonable effort to contact the injured person/claimant/authorised third party. If unsuccessful, contact attempts are made, a refund via cheque is to be issued.

Issue a cheque refund to the injured person if:

  • any mandatory information is missing, or there is an error with the details
  • unsuccessful contact attempts are made to injured person/claimant/authorised third party to confirm current account details

See Payments, refunds and debts.

3

Payment to solicitor’s trust account

Versions MO024.2410, MO024.2302, MO024.2206 and MO024.2506 only.

Question 10 asks 'Does the injured person or claimant give consent for their solicitor to receive any advance payment refunds into the solicitor’s trust account?'

Service officers can accept this form version and process a refund without an escalation to Program Management, if:

  • it is for an advance payment refund
  • Question 10 is answered yes
  • the injured person has correctly signed and dated the MO024
  • there is a valid MO021 Medicare Compensation Recovery third party authority form on file naming the solicitor or law firm that the refund is being directed to, and
  • the solicitor’s trust account details are provided on the MO024 form


MO025 Medicare Compensation Recovery Compensation payer's Electronic Funds Transfer details collection form - information requirements

Table 5

Expand table

Step

Action

1

Accepted form versions

The version of the form must start with the number 2. For example, MO025.2XXX.

Note: only accept versions that begin with the number '2'. Reject any version that does not start with '2'.

2

Check for mandatory information

Check the form for the following mandatory information:

  • compensation payer's name and address
  • branch number (BSB) and account number
  • account name
  • representative of the compensation payer's full name, signature and date completed. Examples of acceptable signature variations are provided in Resources

If any mandatory information is missing, a refund will be made by cheque to the notifiable person.

Note: signatures can be digital, electronic, or handwritten. All signature types are acceptable, provided the full name of the person signing accompanies the signature.


MO026 Medicare Compensation Recovery Notice of past benefits request form - information requirements

Table 6

Expand table

Step

Action

1

Accepted form versions

The request must be in writing using Medicare Compensation Recovery Notice of past benefits request.

The version of the form must start with the number 2. For example, MO026.2XXX.

Note: only accept versions that begin with the number '2'. Reject any version that does not start with '2'.

If an unacceptable version is received, see Process Correspondence.

2

Check for mandatory information

Check the form for the following mandatory information:

  • injured person’s name, address, and date of birth
  • date on which the injured person suffered the injury or illness
  • nature of the injury or illness the injured person suffered (for example, broken arm)
  • notifiable person's name and address details. Where the notifiable person’s address is missing, but complete details for their acting solicitor are provided, the claim can proceed as an active standard claim. Complete details at a minimum include business name and full address
  • full name and signature of one of the below:
    • injured person or claimant
    • authorised third party if a valid MO021 form is provided for the related claim
    • notifiable person or their solicitor
  • date the declaration was signed
    Note:     signatures can be digital, electronic, or handwritten. All signature types are acceptable, provided the full name of the person signing accompanies the signature

If:

3

Date of injury (DOI) is different to existing claim

If the DOI is different to the existing claim, but no other required information is missing:

  • contact the person who submitted the form to check if the date is correct
  • if first call attempt is unsuccessful, or the call is not answered, make genuine attempts to contact the customer by phone, using all numbers for the party held on the claim. Case note each attempt made
  • Record the following details on the claim:
    • what numbers were called (for example, 'mobile number called')
    • the date and time of each call
    • the result of each call (for example, no answer and no voicemail facility, message left and details of the message)
    • sufficient detail to allow a subsequent officer to complete any required work

If the DOI on the notice is:

  • verbally confirmed as correct, see Claim Management to decide whether to register a new claim, or update an existing claim
  • verbally confirmed as incorrect:
    • add a case note with the correct date
    • ask for a resubmitted notice with the correct DOI while on the call. See Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter. Do not process the request until the valid document is received

4

Mandatory information is missing

If any of the above required information noted in Steps 2 and 3 is missing, send one of the following letters:

  • For provisionally registered claims, see Table 3 > Step 10 in Claim management - Medicare Compensation Recovery to issue a ‘We need more information to register a compensation claim (Z2798) letter, or
  • For an existing claim, see Table 8 > Step 2 in Process Correspondence - Medicare Compensation Recovery to issue a ‘More information is needed to process the third party authority form’ (Z2802) letter
    Note:     When a MO026 is received with an invalid MO021, and the MO026 is signed by the unauthorised third party, upon receipt of a valid MO021 the work item can be processed using the original MO026. A new re-signed copy of the MO026 is not required in this instance.

The original MO026 form must only be used when the sole reason for it being invalid was that it was signed by an unauthorised third party. If it was invalid for any other reason a new or amended MO026 must be requested as per normal processes.

See Table 3 in Claim management - Medicare Compensation Recovery to provisionally register a claim.


MO027 Medicare Compensation Recovery Notice of reimbursement arrangement form - information requirements

Table 7

Expand table

Step

Action

1

Accepted form versions

The request must be in writing using one of the below versions of Medicare Compensation Recovery Notice of reimbursement arrangement.

The version of the form must start with the number 2. For example, MO027.2XXX. Note: only accept versions that begin with the number '2'. Reject any version that does not start with '2'.

If an unacceptable version is received see Process Correspondence.

2

Check for mandatory information

Check the form for the following mandatory information:

  • injured person's name, address, and date of birth
  • date on which the injured person suffered the injury or illness
  • nature of the injury or illness the injured person suffered (for example, broken arm)
  • notifiable person's name and address details
  • signature of notifiable person or their acting solicitor
  • date the declaration was signed
  • the date the reimbursement arrangement was made
  • the date the claim for compensation was lodged

If date of lodgement of the claim and/or date the reimbursement arrangement is missing from the notice:

  • contact the notifiable person, notifiable person's agent solicitor by phone
  • make genuine attempts to the customer by phone over a 24 hour period, using all numbers for the party held on the claim
    • if successful, accept verbal confirmation and record the conversation in case notes. To process, see Notice of reimbursement arrangement
    • if unsuccessful, see Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter. Do not proceed to Capture NORA details
  • add a case note to the claim detailing any actions taken

If any other mandatory information is missing or provided on an old form version, see Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter.

Note: signatures can be digital, electronic, or handwritten. All signature types are acceptable, provided the full name of the person signing accompanies the signature.

3

Supporting documents

The notice may be considered valid if some of the information in this table can be obtained from other supporting documents received such as:

  • a certificate of determination
  • an Administrative Review Tribunal (ART) Decision
  • an ART Order

While the agency can accept attached documents to provide missing or mismatched information, the preference is notification by a signed MO027 form. The form and any supporting documents must clearly identify the claim, the parties involved and be compliant under the Act.

If assistance is required with supporting documents, see Technical Support and Escalations - Medicare Compensation Recovery.

4

Acceptable variations of declaration on MO027

When a claim has been finalised the Act requires the notifiable person to notify the agency if a reimbursement arrangement has been made. They must provide:

  • the names of all parties to the arrangement, or the names of all the parties to which the arrangement relates; and
  • requires the notice to be signed by the notifiable person

Where the declaration on the MO027 form is not clear at question 17, the service officer must determine whether to accept or reject the MO027 form.

A supplementary document may be used to confirm the identity of the signatory on the form. For example, the email page that accompanies the form has the name and position of the signatory in a signature block. It must be documentation sent and received within the same email, or that can be linked to the same individual.

Service officers are required to apply evidence-based decision-making processes to ensure they can confidently confirm that the person providing supporting or supplementary documents, including email pages, is the person who signed the MO027 form and can be identified as a representative of the notifiable person.

The supplementary documents should be used to support their determination and ensure the integrity of the verification process. It must be ensured that the documentation provides clear identification and aligns with verification requirements.

Clear case notes must be recorded on the claim, detailing:

  • the decisions made
  • evidence considered
  • actions taken, and
  • justification for each decision

This ensures transparency, accountability and consistency in the decision-making process.

Examples of acceptable variations are provided in Resources.


Z2801 Declaration - information requirements

Table 8

Expand table

Step

Action

1

Accepted form versions

As the Z2801 Declaration form is not published externally, accept the form version returned.

Only accept this form with a returned Statement by claimant (SBC), unless there was not a service statement generated as part to the Notice to claimant (NTC) The declaration and care services statement form a part of the NTC.

2

Check for mandatory information

Check the form for the following mandatory information:

  • full name of the person making the declaration
  • relationship to the injured person, For example parent or guardian. See Authority to access a claim for more information
  • business name (if applicable)
  • address of the person making the declaration
  • signature of the person making the declaration
  • the date the declaration is signed, including day, month, and year
  • supporting documentation where a party is signing on behalf of an injured person who does not have capacity to sign for themselves, or is deceased

If any of the above mandatory information is missing or illegible, see Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter.

Note: the Z2801 Declaration can be accepted as valid if signed by someone other than the injured person/claimant when either:

  • the injured person is over the age of 14 but under the age of 18, and
    • a parent that is listed on the same Medicare card has signed the declaration, and
    • there is no supporting documentation on the claim naming a specific claimant, such as a Power of Attorney, Litigation Guardianship, etc,
  • the injured person/claimant's solicitor has signed the declaration and there is a valid Third Party Authority (MO021) form naming the law firm as third party authority on the claim

Signatures can be digital, electronic, or handwritten. All signature types are acceptable, provided the full name of the person signing accompanies the signature.

3

Check for additional (not mandatory) information

The additional (not mandatory) information requirements are:

  • date of birth of the injured person
  • date of injury and/or illness
  • reference number. The agency must be satisfied that the declaration signed is for the correct injured person and compensation claim