Notifiable and not notifiable claims - Medicare Compensation Recovery 011-15020000

For all non-TAC related claims, go to Step 2.

Was a document received naming the TAC as the notifiable person for a:

• common law claim by an injured person who lives in Victoria?, or
• non-Victorian resident injured in an interstate accident involving a motor vehicle that was registered in Victoria (interstate claim)?

If:

• Yes, go to Step 2
• No, this claim is not notifiable under the Act, go to Step 9

Is the compensation:

• a payment for damages
• a payment under an insurance scheme or compensation under law
• a payment (with or without admission of liability) resulting from judgment or settlement of a claim for damages, or a claim under an insurance scheme, or
• any other compensation or damages payment, other than a payment under a scheme where the recipient has contributed. For example, life insurance or superannuation

See the Resources page for examples of notifiable and not notifiable claims.

Do any of the above apply?

• Yes, go to Step 3
• No, this claim is not notifiable, go to Step 8
• Unsure, go to Step 10

Is the notifiable person a company, registered business or medical practitioner?

• Yes, go to Step 4
• No, continue in this step

Is the notifiable person an individual?

• Yes, call the person who submitted the request to get more details, continue in this step
• No, go to Step 4

Are they insured or required by law to be insured?

• Yes, go to Step 4
• No, the claim is not notifiable, go to Step 8
• Unsure, go to Step 10

Was the compensation amount for legal costs only?

• Yes:
• Evidence must be provided to Services Australia to confirm this, such as the Terms of settlement, Deed of release or the legal costs invoice, If clear evidence:
  - is received showing the claim settled for legal costs only, the claim is not notifiable, go to Step 8
  - has not been provided, make 2 reasonable attempts over 48 hours to contact the compensation payer or their solicitor.
  Request evidence of settlement for legal costs only. The evidence provided can be used to determine the amount of damages excluding costs.
  Add clear case notes about each attempt and note any details received
• If contact with the compensation payer or their solicitor was:
  - successful, go to Step 8
  - unsuccessful, (all attempts), escalate to a Program Support Officer (PSO) for advice using a PSO referral
• If the PSO advises:
  - to proceed, go to Step 8
  - they cannot give advice, escalate to a Service Support Officer (SSO5) (service delivery APS5). Recategorise in Workload Manager (WLM), do not send an email
• If the SSO5 advises:
  - to proceed, go to Step 8
  - they cannot give advice, escalate if the PSO and SSO5 cannot give advice to Program Management for a decision. Recategorise in WLM, do not send an email. See Table 1 in Escalations - Medicare Compensation Recovery. Procedure ends here
• No, go to Step 5
• Unsure, if evidence received but still unsure if notifiable or not, go to Step 10

Legal costs are included in the fixed amount for settlements, but not for judgments. Court documents may be needed to determine the amount of damages, excluding costs, for some judgments.

Was a compensation amount fixed by judgment or settlement for more than $5,000, or was a reimbursement arrangement made more than 6 months after the compensation claim was made to the notifiable person?

• Yes, go to Step 6
• No, if the claim is in progress or resolved, go to Step 9
• Unsure, go to Step 10

Was the claim made for an injury/illness to a person?

• Yes, go to Step 7
• No, this claim is not notifiable, go to Step 8
• Unsure, go to Step 10

• Assess the submitted form for required details to register a claim. For process steps, see Process Correspondence - Medicare Compensation Recovery
• Procedure ends here

Check SAP for payments that may relate to this claim banked against an 87 number.

Did the agency receive any payments for the claim?

• Yes, a refund of the payment must be issued to the payer, normally the compensation payer:
• Complete a Referring a case to Compensation Finance email template with the instruction to refund to the payer
• Go to Step 9
• No, go to Step 9

See below actions for a claim previously registered or no claim registered.

If claim has previously been registered:

• Add a case note to advise the claim is not notifiable, include the reason
• Terminate the claim. Note: on the Terminate WIN screen Service Officers must select not notifiable from the Close reason dropdown menu. Go to Close, terminate or reopen a claim - Medicare Compensation Recovery for details on terminating a claim
• Procedure ends here

If no claim is registered, create a provisional record in MCRS. Go to Claim management - Medicare Compensation Recovery for details on registering a provisional claim.

• On the following screens:
• Evaluate - leave the Declaration button turned off
• Capture injured person details - add the injured person's details and injury/illness details. Do not complete the Declaration field, select Continue
• Capture claimant details - if relevant, add claimant details. Select Continue
• Capture notifiable person - add the notifiable person's details. Select Continue
• Review - review the data entered. Select Submit
• A pop up window will show stating Provisional record. Have you entered all information provided? Select Yes

Can the Service Officer confidently identify that the claim is not notifiable?

• Yes:
• terminate the claim. Go to Close, terminate or reopen a claim - Medicare Compensation Recovery for details on terminating a claim
• Procedure ends here
• No, go to Step 10

If unsure whether a claim is notifiable, as a first point of contact, escalate to a PSO for advice using a PSO referral.

Did the PSO help?

• Yes, follow PSO advice to process
• No, request more advice from SSO5 in Service Delivery. PSO to escalate to SSO5

Did the SSO5 help?

• Yes, SS05 to leave a case note advising Service Officers the steps to take to complete actions. Unassign case and recategorise to MCRS_SD_ACTION
• No, escalate to Program Management for a decision if the PSO and SSO5 cannot give advice

See Escalations - Medicare Compensation Recovery.

If the claim is not yet registered create a provisional claim in MCRS and escalate to Program Management.

Add a case note confirming:

• background, all actions taken, details requested and from whom
• reason/s for escalation and recommendations for a decision
• if the injured person has other active claims and if this claim has been escalated before
• review of Operational Blueprint procedures before escalating the claim