Notice of past benefits request and Notice to claimant (NTC) - Medicare Compensation Recovery 011-15030050

A Notice of past benefits request (MO026) is a form submitted to Medicare Compensation Recovery. Once received, it results in the creation of a Notice of past benefits (NOPB). This NOPB outlines the amount of Medicare benefits and care costs that must be repaid to the Australian Government in relation to a notifiable compensation claim.

Submitting the MO026 leads to the issue of a Notice to claimant (NTC) by MCRS. When the injured person/claimant completes and returns the NTC as a Statement by claimant (SBC). This results in a/an:

• Notice of past benefits (NOPB), or
• Notice of past benefits - advance payment (NOPB-AP), provided a valid Medicare Compensation Recovery Notice of Judgment or Settlement (MO022) form and payment of the advance payment is received after the NTC is issued, and prior to the SBC being returned, or
• Notice of charge (NOC), provided a valid MO022 form is received after the NTC is issued, and prior to the SBC being returned

When and how to make a request

An NOPB can be requested before or after:

• a judgment/settlement, or
• entering into a reimbursement arrangement

If an NOPB is requested before judgment/settlement, the request must be made on a current Medicare Compensation Recovery Notice of past benefits request (MO026) form.

The following conditions prompt the system to issue an NTC, pending confirmation by a Service Officer, is automatically sent if a/an:

• valid Medicare Compensation Recovery Notice of Judgment or Settlement (MO022) form or Medicare Compensation Recovery Notice of reimbursement arrangement (MO027) form is received by the agency, and
• NOPB does not exist, or has expired, or a received Medicare Compensation Recovery Section 23A statement (MO023) form is not accepted when an MO022 is received
  Note: an MO026 is not required in these situations.

The Resources page contains links to forms.

Who can make a request

The request can be made by a/an:

• injured person
• authorised third party
• claimant or legal representative, for example:
• power of attorney
• legal guardian
• executor, or
• administrator of a deceased estate
• notifiable person (compensation payer or insurer), or their delegate or agent

Note: an agent or delegate is another business, such as another insurer or solicitor, who has been contracted to manage the claim. For example, a state Worker's Compensation authority may contract work to a third party insurer.

See Table 6 on the Process page in Document Assessment - Medicare Compensation Recovery for the MO026 information requirements.

Processing the request

When the valid MO026 form is processed in MCRS, an NTC is issued.

An NTC is issued to the injured person/claimant or the authorised third party if a valid Medicare Compensation Recovery Third party authority (MO021) is held on the claim:

• in response to a valid Medicare Compensation Recovery Notice of past benefits request (MO026) form, or
• if a valid Medicare Compensation Recovery Notice of Judgment or Settlement (MO022) form is received without a valid Medicare Compensation Recovery Section 23A statement (MO023) form, and:
• there is not a valid NOPB at date of judgment or settlement
• an NTC has not already been issued, or
• a statement by claimant (SBC) is not awaiting processing
• if a reimbursement arrangement was entered into before an NOPB was issued

When an NTC is issued it will include a/an:

• Identify related Medicare history and care services (Z2800) letter
• Medicare history statement, care services statement and declaration (Z2801) letter

An NTC:

• will not include a Medicare history statement if:
• no Medicare services were received between date of injury and date of statement issue, or
• the date of injury and the date of judgment/settlement if a NTC is being issued in response to an MO022 form, or
• the claim is for an injured person not entitled to Medicare. In this situation Services Australia will request confirmation of care services received in relation to the compensable injury/illness by issuing a care services statement and declaration
• will become an SBC (Z2801) when returned
• will result in the issue of a:
• Notice of past benefits (NOPB), or
• Notice of past benefits - advance payment (NOPB-AP), or
• Notice of charge (NOC)
• may be issued more than once for the same compensation claim. Each subsequent notice will include services (selected items) that were identified on the last statement (known as verified services)
• may be a re-issued copy of a previous NTC, (if a copy was requested). See Medicare Compensation Recovery

Return statement by the due date on the notice

The completed SBC must be returned on or before the due date provided on the Identify related Medicare history and care services (Z2800) letter, sent with the statements and declaration.

The due date is 37 days from the date the statement is printed. This is the legislated 28 days plus up to 9 days allowance for receipt by regular mail (post).

See Statement by claimant (SBC) - Medicare Compensation Recovery for the contents of a valid SBC.

If the completed SBC is not returned, all items on the Medicare history statement:

• will be taken as related to the compensated injury/illness,
• will be included in the total recoverable amount, and
• must be paid to the Australian Government if the NOPB is valid when the claim is finalised by:
• judgment
• settlement, or
• reimbursement arrangement

Note: any related care cost amount that appears on the expired NOPB will be carried forward and added to the notice with all services included.

An extension of time to return the completed Medicare history and care services statement/s and declaration (Z2801) may be requested on or before the due date. For more details see Extensions, decisions and reviews - Medicare Compensation Recovery.

When the agency will not issue an NTC

There may be circumstances where the agency may elect not to issue an NTC. For example, if a verified NOPB is currently valid and the injured person/claimant is seeking another NTC, or the notifiable person is seeking another NOPB. See Extensions, decisions and reviews - Medicare Compensation Recovery. Where a new document advises a change to the date of injury, a new NTC may be required. See Table 4 in Claim management - Medicare Compensation Recovery.

If the time period in which an NOPB or NOC must be issued has passed. For example, if it is 3 months or more after the agency received a notice of judgment or settlement or valid advance payment (whichever is later):

• MCRS will not give the option to send an NTC, and
• The agency will not be eligible to recover benefits and subsidies for the claim, unless an extension was granted for the return of the SBC

See:

• Extensions, decisions and reviews – Medicare Compensation Recovery
• Notice of judgment or settlement (NOJS)
• Claim management - Medicare Compensation Recovery