Document Assessment – Medicare Compensation Recovery 011-15010000

The authority must be in writing using one of the below versions of the Medicare Compensation Recovery Third party authority form:

• MO021.2302 (current and latest version)
• MO021.2206, MO021.2010, MO021.2103

Do not accept other versions.

Check the form for the following mandatory information:

• injured person’s name, address, and date of birth
• authorised third party's name and address, or the name of the organisation if the third party is an organisation
• full name and signature of the relevant party authorising the release of information, such as the:
• injured person, 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 guardianship documents to confirm the link between the two parties
• Call a Program Support Officer (PSO) for more help
• full name and signature of the authorised third party
• date, including day, month, and year, the authority is made by the:
• relevant party authorising the release of information, and
• authorised third party

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 Resources page has a link to the Signature fact sheet.

If the above mandatory information is:

• provided:
• process the Third party authority form, go to Claim Management: Search, update or register
• missing:
• go to Table 8 in Process correspondence – Medicare Compensation Recovery to send the required letter

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

The authority is invalid if:

• the date is missing and there is no other correspondence attached confirming the correct date of injury/illness
• the date 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, send either of the following letters:

• ‘We are unable to process’ (Z2798)
• ‘More information is needed to process the third party authority form’ (Z2802)

The notice of judgment or settlement must be in writing. The agency prefers to receive it on one of the below versions of the Medicare Compensation Recovery Notice of judgment or settlement:

• MO022.2302 (current and latest version)
• MO022.2206, MO022.2110, MO022.2104 or MO022.2010

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 compensation payer (is unable to be submitted on supporting documents, this must be on the MO022 only)
• date the declaration was signed
• date the judgment or settlement was made, and compensation amount was fixed (see Note below)

Note:

• If injured person details are not completed in claims of historical abuse or psychological injury, to register the claim, go to 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. Each form accepts all types of signatures, provided the full name of the person signing accompanies the signature. The Resources page has a link to the Signature fact sheet

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:

• contact the person who submitted the form to check if the date is correct
• make 1 call attempt. If unsuccessful, go to Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter

If the DOI on the notice is:

• verbally confirmed as correct, go to Claim Management: Search, update or register 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. Go to 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.

The date of judgment or settlement (DOJS) is needed for the notice to be valid.

If the (DOJS) is missing from the notice:

• 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, go to Notice of Judgment or Settlement
• if unsuccessful, go to 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 in MCRS

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

While the agency can accept attached documents to provide missing 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 Health and Other Services (Compensation) Act.

The statement must be in writing using one of the below versions of the Medicare Compensation Recovery Section 23A statement:

• MO023.2302 (current and latest version)
• MO023.2206, MO023.2010 or MO023.2103

Do not accept other versions.

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
• 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
• after the date of judgment or settlement (DOJS)

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 Resources page has a link to the Signature fact sheet.

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.

The injured person’s bank account details must be in writing using one of the below versions of the Medicare Compensation Recovery Bank account details collection:

• MO024.2302 (current and latest version)
• MO024.2206, MO024.2010 or MO024.2013
• MO024.1911 can be accepted if the form was issued with the Medicare history statement

Do not accept other versions.

Check the form for the following mandatory information:

• injured person’s name, address, and date of birth
• name of bank, building society or credit union
• 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

If the injured person is being paid the refund, 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.

If the refund is to be paid to a third party, the injured person must complete a statutory declaration detailing the reasons why.

If any mandatory information is missing or there is an error with the details, the refund will be sent as a cheque to the injured person.

There is no need to make an outbound call to verify details if the injured person has signed the document.

Go to Referring a case to compensation finance to issue a cheque refund

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 Resources page has a link to the Signature fact sheet.

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, and
• the solicitor’s trust account details are provided on the MO024 form

Check the form for the following mandatory information:

• compensation payer’s name and address
• name of bank, building society or credit union
• 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. Each form accepts all types of signatures, provided the full name of the person signing accompanies the signature.

The Resources page has a link to the Signature fact sheet.

The request must be in writing using one of the below versions of Medicare Compensation Recovery Notice of past benefits request:

• MO026.2302 (current and latest version)
• MO026.2206, MO026.2101, MO026.2103 or MO026.2010

Do not accept other versions.

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. Each form accepts all types of signatures provided the full name of the person signing accompanies the signature.

The Resources page has a link to the Signature fact sheet.

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
• make 1 call attempt. If unsuccessful, go to Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter

If the DOI on the notice is:

• verbally confirmed as correct, go to Claim Management: Search, update or register 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. Go to Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter. Do not process the request until the valid document is received

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

• Any other information as determined by the Chief Executive Medicare
• Medicare card number, if unable to identify the correct injured person’s enrolment record based on the mandatory information supplied

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

• MO027.2302 (current)
• MO027.2206, MO027.2010 or MO027.2103

Do not accept any other versions.

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 compensation payer, compensation payer’s agent or compensation payer’s solicitor by phone
• make 1 call attempt
• if successful, accept verbal confirmation and record the conversation in case notes. To process, go to Notice of reimbursement arrangement
• if unsuccessful, go to 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 in MCRS

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

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 Resources page has a link to the Signature fact sheet.

As the Commonwealth of Australia Declaration Criminal Code Act 1995 form (MO028) is not published externally, accept the form version returned.

Only accept this form with a returned Statement by claimant (SBC). The declaration and care services statement form a part of the Notice to claimant (NTC).

Check the form for the following mandatory information:

• full name of the injured person or claimant
• full name of the person making the declaration
• address of the person making the declaration
• a tick against one box in relation to nursing home, residential or home care (if both boxes are ticked the declaration is invalid)
• 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, go to Table 8 in Process correspondence - Medicare Compensation Recovery to issue the required letter.

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 Resources page has a link to the Signature fact sheet.

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