Document Assessment – Medicare Compensation Recovery 011-15010000

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, MO021.2XX.

Note: only accept versions that begin with the number ‘2’. Any version that does not start with ‘2’ must be rejected.

If an unacceptable version is received, see Process Correspondence.

Check the form for the following mandatory information:

• injured person’s name, address, and date of birth
• authorised third party's full name (first and last name is sufficient) and address if an individual, OR the name of the organisation if the third party is an organisation or business 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
• 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. See Authority to access a claim - Medicare Compensation Recovery
• date, including day, month, and year, the authority is made by the relevant party authorising the release of information

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 above mandatory information is:

• provided:
• process the Third party authority form, see Claim Management
• missing:
• see Table 8 in Process correspondence - Medicare Compensation Recovery to send the required letter
  Note: If an invalid MO021 form is received with a Notice of past benefits request form (MO026) that is signed by the unauthorised third party, go to Table 6 > Step 4

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 is deceased

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

Notice 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.

If an MO22 is provided the version of the form used must start with the number 2, for example MO0022.XX. Only accept versions that begin with the number ‘2’. Any version that does not start with ‘2’ must be rejected.

If an unacceptable version is received ,see Process Correspondence.

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

See Escalations and case notes - Medicare Compensation Recovery.

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 compensation payer
• 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 compensation payer’s intent to make an advance payment. If intent is given in writing on accompanying email or letter, this criterion is satisfied
• 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 compensation payer because of contributory negligence, the percentage of apportionment (if applicable)
• full 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 MO002 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
• 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 MO002.

If:

• the date of injury is different to existing claim, go to Step 3
• other information is missing, go to Step 4

If the DOI 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:

• successful, confirm the correct DOI, proceed through steps
• unsuccessful, see Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter

If the DOI on the notice is:

• verbally confirmed as correct, see Claim Management to decide whether to register a new case, or update an existing case
• 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 proceed to capture NOJS details

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

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 1 attempt to contact the compensation payer or compensation payer’s 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 NOJS details
• add a case note to the claim advising of all actions taken

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
• 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>, or
• 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 both the injured person and the notifiable person, or their acting legal practitioners, must be provided on a Release document for it to be valid.

Information that can be extracted from supporting documents includes:

• date of injury
• nature of the injury or illness
• address of parties to the judgment or settlement
• 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
• notification of the compensation payer’s intent to make an advance payment
• if the amount of compensation fixed (in whole or part) redeems liability for periodic payments
• apportionment of liability due to contributory negligence, the percentage of apportionment (if applicable)date the judgment or settlement was made, and compensation amount was fixed

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

For further assistance with information provided on supporting documents contact a Program Support Officer (PSO).

When a compensation claim has been finalised the Act requires the notifiable person to notify the Agency if a judgement 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, as the case requires; and
• requires the notice to be signed by the notifiable person

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

A supporting 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 supporting 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 documents, including email pages, is the person who signed the MO022 form and can be identified as a representative of the notifiable person.

The supporting documents should be used to support their determination and ensure the integrity of the verification process. It must be ensured that the supporting 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.

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, MO023.2XX.

Note: only accept versions that begin with the number ‘2’. Any version that does not start with ‘2’ must be rejected.

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 or claimant only
• date the declaration was signed
• be signed:
• within 28 days before the amount of compensation was fixed by judgment or settlement, date includes day, month, and year, or
• on, or any time after the date of judgment or settlement (DOJS)

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

• the injured person is over the age of 14 but under the age of 18
• a parent that is listed on the same Medicare card has signed the declaration, and
• there is supporting documentation on the claim, such as a Power of Attorney, Litigation Guardianship, etc

Does the S23A form includes 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

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.

The below information may be included:

• 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 compensation payer’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.

The injured person’s bank account details must be in writing using the Medicare Compensation Recovery Bank account details collection.

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

Note: only accept versions that begin with the number ‘2’. Any version that does not start with ‘2’ must be rejected.

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

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.

• first point of contact for advice is a Program Support Officer (PSO)
• further advice can be requested from APS5 Service Support Officers (SSO5) within Service Delivery
• if PSO and SSO5 are unable to provide advice it must be escalated to Program Management for a decision

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, 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

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.

Versions MO024.2410, MO024.2302 and MO024.2206 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 third party authority 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

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

Note: only accept versions that begin with the number ‘2’. Any version that does not start with ‘2’ must be rejected.

Check the form for the following mandatory information:

• compensation payer's name and address
• branch number (BSB) and account number
• account name
• compensation payer's full name, signature and date completed

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.

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, MO026.2XX.

Note: only accept versions that begin with the number ‘2’. Any version that does not start with ‘2’ must be rejected.

If an unacceptable version is received, see Process Correspondence.

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)
• compensation payer’s name and address details, and
• 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
• compensation payer 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:

• the date of injury is different to the existing claim, go to Step 3
• required information is missing, go to Step 4

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, If the call is not answered, make genuine attempts to contact the customer by phone, using all numbers for the party held on the claim.
• 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

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.

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, MO027.2XX. Note: only accept versions that begin with the number ‘2’. Any version that does not start with ‘2’ must be rejected.

If an unacceptable version is received see Process Correspondence.

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)
• compensation payer’s name and address details
• signature of compensation payer
• date the declaration was signed
• the date the reimbursement arrangement was made, and
• 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, 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.

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.

Check the form for the following mandatory information:

• full name of the person making the declaration
• full name of the person making the declaration
• relationship to the injured person, For example parent or guardian
• 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: signatures can be digital, electronic, or handwritten. All signature types are acceptable, provided the full name of the person signing accompanies the signature.

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